Recently, driven largely by opioid-related deaths—predominantly of our white sisters and brothers—President Donald Trump proclaimed that the opioid problem was now a national emergency. He vowed to “spend a lot of time, a lot of effort and a lot of money on the opioid crisis” because “it is a serious problem the likes of which we have never had.”
This is false. Beginning in the late 1960s, the heroin crisis played out in a similar fashion, except that the face of the heroin addict then in the media was black, destitute and engaged in repetitive petty crimes to feed his or her habit. One solution was to lock up users, especially after passage of New York State's infamous Rockefeller drug laws in 1973. By the early 2000s more than 90 percent of those convicted under those laws were black or Latino, far out of proportion to the fraction of users they represented.
I am concerned that declaring the opioid crisis a national emergency will serve primarily to increase law-enforcement budgets, precipitating an escalation of this same sort of routine racial discrimination. Recent federal data show that more than 80 percent of those who are convicted for heroin trafficking are either black or Latino, even though whites use opioids at higher rates than other groups and tend to buy drugs from individuals within their racial group.
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The president also claimed that the opioid crisis “is a worldwide problem.” It isn't. Throughout Europe and other regions where opioids are readily available, people are not dying at comparable rates as those in the U.S., largely because addiction is treated not as a crime but as a public health problem.
It is certainly possible to die from an overdose of an opioid alone, but this accounts for a minority of the thousands of opioid-related deaths. Many are caused when people combine an opioid with another sedative (such as alcohol), an antihistamine (such as promethazine) or a benzodiazepine (such as Xanax or Klonopin). People are not dying because of opioids; they are dying because of ignorance.
There is now one more opioid in the mix—fentanyl, which produces a heroinlike high but is considerably more potent. To make matters worse, according to some media reports, illicit heroin is sometimes adulterated with fentanyl. This, of course, can be problematic—even fatal—for unsuspecting heroin users who ingest too much of the substance thinking that it is heroin alone.
One simple solution is to offer free, anonymous drug-purity testing services. If a sample contains adulterants, users would be informed. These services already exist in places such as Belgium, Portugal, Spain and Switzerland, where the first goal is to keep users safe. Law-enforcement officers should also do such testing whenever they confiscate street drugs, and they should notify the community whenever potentially dangerous adulterants are found. In addition, the opioid overdose antidote naloxone should be made more affordable and readily available not just to first responders but also to opioid users and to their family and friends.
The vast majority of opioid users do not become addicts. Users’ chances of becoming addicted increase if they are white, male, young and unemployed and if they have co-occurring psychiatric disorders. That is why it is critical to conduct a thorough assessment of patients entering treatment, paying particular attention to these factors rather than simply focusing on the unrealistic goal of eliminating opioids.
In many countries, including Switzerland, the Netherlands, Germany and Denmark, opioid treatment may include daily injections of heroin, just as a diabetic may receive daily insulin injections, along with treating the patient's medical and psychosocial issues. These patients hold jobs, pay taxes and live long, healthy, productive lives. Yet in the U.S., such programs are not even discussed.
For about 20 years, the number of Americans who have tried heroin for the first time has been relatively stable. Heroin use specifically and opioid use in general are not going anywhere, whether we like it or not. This is not an endorsement of drug use but rather a realistic appraisal of the empirical evidence. Addressing the opioid crisis with ignorant comments from political figures and the inappropriate use of public funds do little to ensure users’ safety. Perhaps, for once, we should try interventions that are informed by science and proven to work.