We Need a Fundamental Shift in the Way We Frame Drug Issues

Janine Jackson: Donald Trump called on the Department of Health and Human Services to declare a “public health emergency,” stating, in what the New York Times called “an elaborate and emotional ceremony,” that opioids represent “the worst drug crisis in American history and even, if you really think about it, world history.”

As is often the case, it wasn’t exactly clear what he was talking about, but media aren’t always much clearer. Is the crisis overdose deaths? Opiates themselves? Their overprescription? Their use? Addiction? The issues that lead to addiction? You don’t need to be in denial about a problem to recognize that the definition of the problem will affect the response. And when it comes to the “war on drugs” in this country, it’s not as though there is no record to check.

So what does Trump’s recent declaration mean, and what possible responses to problems associated with opioids are existing, but maybe not mentioned? We’re joined now by Maria McFarland Sánchez-Moreno, executive director of Drug Policy Alliance. Welcome to CounterSpin, Maria McFarland Sánchez-Moreno.

Maria McFarland Sánchez-Moreno: Thanks so much for having me.

JJ: I’ve heard Trump’s declaration of a public health emergency around opioids described as “good but not enough,” “good but it needs money attached.” We can be grateful for official attention, which we know is meaningful, but if a policy is wrongheaded or misdirected, it’s hard to wish that it had more fuel behind it. I wonder if you can just walk us through some of the things that you found problematic or that concerned you about Trump’s declaration.

MMSM: Yeah, so, I wouldn’t call his declaration “good.” I would say that there were a couple of good proposals buried in there that might mitigate some of the harm of the overdose crisis. But overwhelmingly, his speech just betrayed ignorance, and perhaps deliberate indifference to the realities underlying drugs and drug use in the United States. And if the US really pursues the path that he has charted in his rhetoric, it’s a recipe for more overdose deaths, continued harsh war on drugs, and no real meaningful progress.

JJ: You have said that the war on drugs is a factor in the overdose crisis. What do you mean by that?

MMSM: A big part of the problem here is the war on drugs itself, the fact that for over 50 years, the US has been focusing on strictly prohibiting access to certain types of drugs, and using criminal justice responses to deal with them. As a result, people who use drugs are often doing so underground, in ways that make it much more likely that they will overdose; much more likely that they will encounter substances that have been adulterated, for example with fentanyl, and have no way to check them; much more likely that they will not have basic information about how to mitigate risk.

For example, a huge number of the overdoses that we’re seeing right now have to do with mixing substances, with mixing opioids and alcohol or mixing opioids and benzodiazepine. Those deaths perhaps could be prevented if people knew that mixing was a major factor in overdose. But right now, public education on drugs doesn’t really get into those issues.

And what Trump was proposing in his speech was a return to “just say no”–style ad campaigns and education campaigns from the 1980s, which are what the Reagans pushed, and were proven to be utterly ineffective, because young people tend to dismiss them as patronizing and not based on reality.

Yeah. I mean, “just say no,” I think many people thought that that was kind of a punchline at this point. But now it’s being reintroduced as actual policy, and Donald Trump has said of opioids, and of drugs in general, “It’s really, really easy not to take them.” And it seems sort of emblematic of a bifurcation, of a difference, where some people think if you talk about drugs — the same as sex — if you talk about it, that’s going to make people do it. And so what we really need to say is, no, that’s not acceptable, you won’t do that, that’s not going to happen. And then you don’t get any clarity about what happens if it happens.

Yeah. I think we need to talk about a fundamental shift in the way we frame drug issues. I think we need to as a society, and certainly the government needs to, recognize that drug use is a fact, that there are always going to be some people in society who use drugs, whether they’re legal or not. Then you have to look at, OK, some people are going to use drugs, some people will misuse drugs. How can you reduce the likelihood that people will misuse drugs, and that they will have the whole host of problems that are associated with misuse? And how can you mitigate the risks that the worst things will happen, like overdose?

If you approach it from that perspective, then you’re talking about, for example, supervised consumption sites, which San Francisco is now considering and Seattle is considering, which would allow people to inject drugs under the supervision of trained professionals, who can make sure that they don’t overdose; make sure that they’re using clean needles, which reduce the likelihood of infection; and refer them to treatment or other services as needed to help them if they want help.

But instead you have this just harsh, black-and-white, “just say no” mentality, that is still reflected in the criminal justice system, where if you use drugs, the sole response is punishment. And that hasn’t worked. The US has done that for 50 years, and it’s landed us here. It’s time to think about new, more compassionate and, frankly, more evidence-based, scientific approaches.

I wrote in real time about corporate media’s near-gleeful promotion of the idea of “crack babies” — children whose mothers used crack while pregnant — as “a race of subhuman drones,” a “bio-underclass,” a group of people whose “inferiority was stamped at birth.” It was vile and racist and wrong, and had an impact. And I just wonder, is it possible to go forward without reckoning with that? Lots of folks have talked about the difference, the more public health–based and compassion-based approach to opioid addiction, which is affecting primarily white people, and comparing it with crack. But it’s not, though, that race is somehow absent in this current conversation, is it?

Well, I think that people who are being impacted by the opioid overdose crisis, they’re people of all backgrounds and colors, but the focus has been on the impact on white people, and that’s because the highest increases in overdose rates have been seen among white middle-aged men. And so there’s this perception that the overdose crisis is about white people, when, in fact, many people of color are also affected.

I think what we need to consider is, one, that, yes, society as a whole is treating this crisis differently from past crises. But it’s also not talking about all of the horrible ways in which the criminalization approach has impacted people of color, by incarcerating and arresting enormous numbers of black and brown people in grossly disproportionate manners. A black person in Manhattan is 11 times more likely than a white person to be arrested for simple drug use, even though they use drugs at the same rates. And that tells you something about how the war on drugs has been waged.

There are generations worth of harm there that have been done, that need to be accounted for, that aren’t just going to be wiped away because states might start looking at opioids. And I think we also need to watch out for responses that may look more compassionately at people who use drugs, or may offer more treatment or more access to Naloxone, which is the overdose reversal medication, for people who use drugs, but still come down harshly on people who are perceived as supplying or distributing those drugs.

And that was in Trump’s speech. Trump spoke about immigrants who are supposedly bringing all these drugs across the border, and how we need to solve the problem by building a border wall — which, again, is an old, old solution. The US has poured billions of dollars into trying to stop drugs from coming into the United States, and it has completely failed, not for lack of trying, but simply because when you talk about an illicit market of this size, the amount of money that organized crime can get through it is so huge that they can always find new ways around the barriers that the US puts up. And every time the US or Mexico or another country arrests a senior leader of one of these groups, somebody else comes in and fills their shoes, because it’s that profitable.

So, again, this is a never-ending war. It will not stop. Because the more money the US puts into it, the more profitable it becomes, and it’s just this vicious cycle.

We need to find other ways to deal with these problems, that aren’t just criminalize, demonize certain communities, and the other piece of it is, of course, he’s focusing on immigrants or, as in the past and to this day, demonizing certain communities as being responsible for drug problems, when in fact that’s a gross exaggeration, and it involves stigmatizing people and it’s going to do terrible harm.

Let me just ask you, finally, sometimes I think, in part because of media, it becomes difficult to see other ways out. We’re offered what look like a range of choices, but some things are off the page. And I just wonder if you could talk a little bit about what an actual public health approach to, in this case, the opioid crisis would look like.

It would have different pieces. One would be simply focusing on direct overdose prevention. Trump talked a little bit about this, but really putting resources into funding Naloxone, the overdose reversal medication, at the community level, and removing bars on access to it and focusing on reducing its price, which is a major barrier to access. So it’s not just putting it in the hands of first responders, but so that also family members and friends, people close to those who use drugs, can also have access to Naloxone, and use it in a timely way at the time of an overdose.

Another piece of it has to do with treatment. I feel very strongly, and I would argue that it’s very important that treatment be available to people who want it voluntarily, but the US should not be focused on coercing people into treatment, because that tends to be ineffective. Now, for people who want it, often they can’t access it. So there’s a lot to be done in increasing access to treatment, including the treatment that has been proven to be most effective for opiates, which is medically assisted treatment with methadone and other medications. That’s another piece of that.

There’s also putting resources into research and evaluating other forms of pain management, looking at medical marijuana as an option, and there are studies that suggest that in states that have legalized medical marijuana, opioids are less of a problem.

I would also say that we need to look at reducing harms from drug misuse, not just overdose but infection, spread of hep C and so on. And that means looking at supervised consumption sites, which I mentioned before, and providing free drug-checking, so that people who are using heroin or other drugs can get them checked to make sure that they’re not contaminated with fentanyl, and they won’t be at as high a risk of overdose.

And then the final piece of this is around education and prevention, and that means offering meaningful, evidence-based education around drugs, and the risks of drug misuse, that go far beyond “just say no.”

We’ve been speaking with Maria McFarland Sánchez-Moreno. She’s executive director of Drug Policy Alliance. They’re on line at DrugPolicy.org. Thank you very much, Maria McFarland Sánchez-Moreno, for joining us this week on CounterSpin.

Thank you so much, Janine. It’s been lovely to talk to you.