The opioid epidemic has metastasized into one of the largest and most highly publicized public health crises in American history. Starting in the late 1990s, pharmaceutical companies marketed opioid painkillers such as oxycontin and oxycodone as effective, non-addictive pain relievers, resulting in the massive overprescribing of opioids across the US. The crisis has expanded from exclusively prescription abuse to widespread proliferation of illicit synthetic opioids, and even heroin use in some cases. Hundreds of thousands of Americans have died as a result of this ongoing public health emergency; of the 70,000 drug overdose deaths in 2017 alone, nearly 70% were due to opioids.
Despite these staggering figures, new statistics have shown a decrease in opioid-related deaths over the past two years, potentially indicating that recent drug policies are finally working. State and federal policymakers have had to adjust their approaches to the opioid crisis, focusing on treatment and preventive efforts rather than the highly punitive measures employed during the War on Drugs. The opioid epidemic may therefore prove to be a pivotal turning point for drug policy in the US, as authorities continue to approach the crisis not as a law enforcement issue but as a public health issue.
Most states and the federal government have made treatment programs their top policy priority in addressing the opioid crisis. Over the last 20 years, the proportion of federal funding dedicated to treatment programs has increased dramatically: federal funding for treatment programs jumped from nearly $600 million in fiscal year 2017 to $2.1 billion in 2018. Medical officials can expect the crisis to worsen significantly if addicts are left untreated, especially since opioid addicts are 40 times more likely to become heroin users than those who do not abuse prescription painkillers. Since opioid addiction functions as a “gateway” into more dangerous illicit drugs, well-funded treatment options can save lives. The more the federal government has allocated resources to treatment programs, the better states have been able to sustain programs in the long-term, as consistent funding is often cited as a barrier to this type of policy solution.
Even more unconventional treatments, such as medication-assisted therapy (MAT), have been gaining government support. MAT programs ease users into full independence by first substituting opioids for drugs that reduce cravings and withdrawal symptoms without creating a “high.” Such programs are stigmatized in the addiction community, which often focuses on full drug independence rather than substitution leading to independence, but there is promising research to back the effectiveness of MAT programs. Over the past two decades, state and federal governments have shifted from hardly acknowledging treatment as a policy solution, to actively increasing and exploring such program options. This marks a shift in attitude from treating addicts like criminals to treating them like people with diseases that deserve funded, researched, publicly-available treatment options.
Preventive policies have also been adopted to address the hard-to-pin-down sources of opioids. The biggest source for abusers are friends and family who either have their own prescription opioids stolen, or they willingly sell them to users in their life. To combat this, legislators emphasize educating the public and providing dropboxes at police stations for leftover drugs to be left anonymously and disposed of properly. But this only solves part of the problem.
Perhaps the most well-known source of opioids comes from overprescribing. New efforts have been made to reverse the idea that drugs like oxycontin are “minimally addictive,” and a new focus has been placed on educating doctors on the dangers of opioids. Among the most effective of these new policies have been Prescription Drug Monitoring Programs (PDMPs), which allow medical officials to track prescription records to see if patients have been “doctor shopping” (visiting multiple doctors in efforts to get more prescription opioids) and if doctors have been prescribing inappropriately. Focusing on the main sources of opioid abuse has helped medical boards, policymakers, and law enforcement work to collaboratively and successfully stem the flow of drugs to consumers.
Compared to the efforts of policymakers today, the War on Drugs was an abject failure. Particularly during the 1980s when cocaine use was epidemic, state and federal laws focused almost exclusively on law enforcement as a means of containing the crisis. By locking up sellers and users, they hoped to “rid the streets” of illicit behaviour, essentially leaving the problem to solve itself. In practice, this led to the systemic and disproportionate incarceration of people of color, specifically Black men, on a staggering scale. In 2007, over 30 years after Nixon declared the War on Drugs, “one in eight African–American men aged 25–29 years was incarcerated on any given day in the USA.” Notably, the opioid epidemic is overwhelmingly white. Minority patients are prescribed opioid pain relievers at half the rate white patients are, and the vast majority of people who die from opioid deaths are white individuals (i.e. in 2016, 79% were white and 10% were non-white). Race cannot account entirely for the difference in policy approaches, but the disparity cannot be overlooked as a contributing factor for the shift. Overall, the exclusively-punitive policies of the War on Drugs hardly resemble the more compassionate, public-health approach that drive policymaking today.
A number of factors in the opioid crisis has led policymakers to explore different solutions at the state and federal levels. From prioritizing treatment programs to formulating effective prevention methods, drug policy in 2020 has become substantially more effective than the War on Drugs-era punitive approach. It is crucial to note that race is a defining factor of these epidemics: where people of color were locked up at astonishing levels (despite nearly identical rates of drug use as whites) during the War on Drugs, white individuals have been offered medical treatment for addiction. Race, in addition to differences such as drug source and more advanced treatment options today, have perhaps created a shift in policy regarding drug crises. While the end of the opioid crisis is not yet in sight, recent trends are promising, and will hopefully lead to a long term change in the way America approaches drugs and public health. The human toll of drug crises cannot be overstated, but at the very least previous failures may give way to a new, life-saving policy framework.