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American drug epidemics and their responses: perceptions of drug users vary along racial lines

The United States has been struggling with the ever-worsening opioid epidemic since the 1990s when increased opioid prescriptions led to widespread opioid addiction. Driven by greed, private companies fraudulently marketed highly-addictive narcotics as safe for moderate pain — as seen in the case of Purdue Pharma and their drug Oxycontin. Growing up in New Hampshire I always knew that there was a drug problem in my community. Many people I know have family members who have struggled with drug abuse, and there aren’t many good resources for mental health and addiction treatment in the area. Recently though I have had my eyes opened even further through discussions in a class on the war on drugs and how companies — and the government — almost always put profit and politics over people. 

The opioid epidemic has killed an estimated five hundred thousand individuals in the United States since 1999. Each year the number of opioid related deaths increases fairly steadily, and in the year 2020 nearly 92 thousand people died from drug overdoses including opioid overdoses. These deaths are not confined to illicit opioid use but prescription opioids as well — in 2020 over 16 thousand individuals died from opioid overdoses involving prescription opioids. Ever since the market for prescription opioids being used for moderate pain was created in the 1990s, the pharmaceutical industry, healthcare providers and illicit drug dealers have been profiting from over-prescription and later, addiction. This fact is not even hidden as “pill mills”, clinics that prescribe opioids at extremely high levels, have persisted despite attempts by the government to curb opioid addiction in the United States. Still, 81 percent of oxycodone prescriptions in the world are written in the United States, and hundreds of millions of prescription painkillers are distributed yearly. Some of these “pain clinics” don’t just stop there, but have figured out ways to make even more money off of the addictions they create. One chain of pain care clinics in New Hampshire, Granite State Pain Associates, is “affiliated” with an addiction recovery center called ROAD To A Better Life. These medical resources are not only located in the exact same five towns in the state, but have an overlap of four medical staff members. These clinics are able to get patients hooked on prescription painkillers and profit more off of the addictions that follow suit. 

Lack of adequate regulations surrounding these drugs and how they are prescribed — even now — has pushed the epidemic further. With the incentive of money in such a money-driven society, many prescribers are pushed to look past their morals as medical providers. Even those who are unaware of the harm they are causing are over-prescribing opioids for things as minor as ankle sprains. But even with this prescription-happy world that we live in, non-white pain patients experience significant discrimination within the medical community in how their pain is treated. Black patients are 22 percent less likely than white patients to receive pain medication in numerous settings. 47 percent of physicians underestimate the pain of Black patients as compared to 33.5 percent of physicians underestimating the pain of non-Black patients. Disparities in pain treatment and a lack of addressing implicit biases and ignorance within the medical community has been reflected in the overprescription of pain medications for white patients and the underprescription of pain medications for Black patients. This has made the opioid epidemic a largely white epidemic, which explains the more enthusiastic response given to those who have suffered from opioid addiction as compared to largely non-white drug epidemics. 

The crack cocaine epidemic of the 1980s and ’90s, a significant portion of sufferers Black, lower class Americans, was responded to with the 1986 Anti-Drug Abuse Act. This legislation, as promoted by the Reagan administration, consisted of imposing harsher sentences for crack cocaine users than powder cocaine users and demonized an entire community of drug users. Reagan’s “War on Drugs” targeted Black inner city drug users and significantly increased the rate of incarceration of Black Americans. By 1989 one in four Black male Americans was either incarcerated or on probation or parole. It’s clear this criminalization of those with drug addictions and those who resort to selling drugs for income is mostly focused on Black individuals as the opioid epidemic presents an entirely different story than the crack epidemic. 

Instead of instantly putting in place mandatory minimum sentences for opioid users, the government and media perspective on drug abuse shifted to that of sympathy. $7.4 billion was allotted in 2018 to fight the epidemic through furthering research and treatment as opposed to the billion-or-so dollars dedicated to incarcerating crack users in the 1980s and ’90s. Even during the opioid epidemic with this change to a sympathetic view of drug users, the general perspective of non-white drug addicts has remained the same. When reading through stories of Black and Latino opioid cases, their crimes are highlighted, their personal lives and struggles are not highlighted as well or as often as what is done for white opioid users.

Earlier this year the Biden administration announced it was planning on distributing $30 million of grants within a nation-wide harm reduction program. The program, as a part of the Substance Abuse and Mental Health Services Administration would disperse funding that could be used to purchase equipment for safe drug use including needles, overdose reversal medications and safe smoking kits. This funding and subsequent harm reduction effort could significantly reduce the risk of individuals’ getting blood borne diseases, reduce likelihood of overdose deaths, reduce stigma around the disease of addiction and hopefully lead people to feel more comfortable getting help within their communities. But, with the announcement of this grant, the administration gained significant backlash from Republican lawmakers who utilized racist rhetoric within their tactics. 

Republicans claimed this money would be used to fund “crack pipes” which is incorrect and very clearly plays to the racist narrative of crack and crack users being significantly more dangerous than other drugs and drug users. Simply using the term “crack pipe” instills fear in many ignorant Americans who associate drugs they don’t use or understand with violence, but opioid addicts with mental illness. Republicans didn’t create an uproar over free needles being a part of the kit because their constituents are likely much closer to the opioid epidemic than the crack epidemic. They utilized the Reagan-era racist demonization of Black Americans and drugs commonly associated with Black communities to their political benefit. 

This type of harm reduction efforts is a step in the right direction for the United States, but it took hundreds of thousands of white Americans to die before action was taken. If the demographics of the opioid epidemic were anything like those of the crack epidemic, it is safe to say that even fewer efforts would be taken to prevent overdose deaths. Conversely, good-samaritan laws likely wouldn’t be common and there would be significantly less advancement in the field of addiction rehabilitation. 

Harm reduction is seen as vital in modern American drug policy, unless it has anything to do with reducing harm to Black communities and individuals. This, like everything else in American public policy, stems back to the racist roots of our system and people.


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