Legislation to Address Illicit Drug Use

In 1971, President Nixon declared a formal war on drugs, deeming them a threat to national security and productivity. Ten years later, President Reagan augmented Nixon’s efforts by passing a series of legislation to address illicit drug use. The Crack Epidemic of the 1980s was plagued with sensational journalism and mass incarceration of minorities. Decades later, in wake of the Opioid Crisis, policymakers must reevaluate their approach to drug addiction. In assessing several different tactics to combatting overdose fatality, it is imperative that policymakers implement radical policy change that prioritizes prevention and rehabilitation, rather than criminalization.

According to the Drug Enforcement Administration, the price of crystallized cocaine dropped by 80% in the late 1970s, which resulted in a large increase in quantity demanded. By the late 1980s, nearly every major U.S. city had access to cheap crack cocaine. Reagan’s Anti-Drug Abuse Act of 1986 created a mandatory five-year minimum sentence for crack cocaine possession, and a disparate 100:1 ratio regarding penalties for crack vs. powder cocaine usage. The War on Drugs increased the American prison population by almost tenfold, clearly prioritizing criminalization over rehabilitation.

The media played a large role in enflaming public hysteria over crack use. The myth of ‘crack babies’, or dysfunctional babies born from crack-using mothers, stigmatized the African-American community. Widespread crack cocaine use was regarded by the public as a moral problem, rather than a health problem.

Beyond its creation of enduring racial division within American Society, the war on drugs failed to accomplish its goal of eliminating illicit drugs. Crop eradication has proven ineffective and unrealistic. President George Bush’s 1989 message to drug cartels that ‘the rules have changed,’ did little to combat production in coca fields. John McWilliams explains, ‘Politicians, the media, and much of the American Public who lack an understanding of history fail to realize that ours never has been a drug-free society, and there is no reason why we should expect to become one anytime soon.’ Instead of trying to eliminate illicit drugs, policymakers should minimize the harm caused by them.

Thirty years after the start of the Crack Epidemic, America faces a similar drug addiction problem. Last year, 49,000 Americans died from opioid overdoses, according to the Centers for Disease Control. Predominantly white and affluent, opioid abusers face a more sympathetic policy response than their black counterparts did. According to the nonprofit Henry J. Kaiser Family Foundation, 84% of crack users in the 1980s were black, and 80% of opioid users today are white.

The Opioid Crisis was primarily caused by excessive prescription of pain-killers. Doctors prided themselves in prescribing opioids for treating patients with overlooked pain. Patients were largely unaware of opioids’ addictive nature, and many fell victim to severe addiction. When they could no longer get pills from their doctors, or could no longer afford them, opioid addicts turned to Heroin. A cheaper alternative to prescription opioids, Heroin caused 16,000 over-dose related deaths in 2017. The recent surge in heroin use is a product of two factors: reduced access to prescription opioids, and plummeting heroin prices. Fentanyl, a synthetic opioid often sourced from China and Mexico, is the largest contributor to over-dose related deaths, according to the NIDA. In 2017, Fentanyl use resulted in nearly 30,000 overdose-related deaths.

Media outlets have played a very different role in shaping opinion of the Opioid Epidemic when compared to the Crack Epidemic. Race still plays a critical role, accounting for large disparities in solution suggestions. In suburban and rural areas, predominantly populated by whites, journalists mention prevention, education, treatment, and cracking down on doctors’ prescriptions. In urban, predominantly black areas, journalists mention arrest and criminal justice involvement. This undoubtedly has shaped public opinion and policy response to opioid addiction.

While the Crack Epidemic was fueled by racial and political division, the Opioid Epidemic has received a bipartisan effort. The Senate passed the Opioid Crisis Response Act in September, which reduced controlled substance quotas, promoted telemedicine treatment efforts, and increased mail security to combat the importation of drugs. In October, President Trump signed the Support for Patients and Communities Act, a bipartisan bill aimed at addressing opioid abuse. The bill will reduce access to opioids and expand access to prevention, treatment, and recovery services.

Health officials, law enforcement, and educators must work in tandem to address opioid addiction and overdose. From a health perspective, several different strategies have proven successful in preventing opioid overdose. Targeted distribution of Nazolone, a drug that quickly reverses the potentially fatal effects of an overdose, would dramatically shorten the time gap between an overdose onset and care. When trained to use Nazolone, first responders could save lives with no negligent risk if misused. Additionally, elimination of prior-authorization requirements for medication-assisted treatment (MAT) would help patients receive help without delays. In this case, MAT would become a standard benefit covered by all health-insurance providers. Policymakers would need to work with health insurance companies and Medicaid programs to implement this change. Routine screening for Fentanyl in clinical toxicology testing would also tremendously help prevent overdose, as Fentanyl is typically unidentifiable and taken accidentally.

Law enforcement also plays a critical role in preventing overdose-related deaths. The implementation of 911 Good Samaritan Laws provides bystanders with limited immunity from drug-related criminal charges as an incentive to call first responders, who are usually accompanied by police. Often opioid users themselves, bystanders may be reluctant to call for help for fear of facing criminal charges. 911 Good Samaritan Laws circumvent this conflict of interest and ensure that overdose symptoms are treated as quickly as possible. It is imperative that with implementation of such laws, the public be made aware of their meaning. A study determining the effectiveness of a New York 911 Good Samaritan Law found that a lack of information about the law still prevented many witnesses from calling first responders.

Educators have the potential to prevent initial opioid abuse by creating an informed youth. Past methods of education have proven unsuccessful, likely due to their Zero-Tolerance, non-nuanced approach to drug use. First lady Nancy Reagan’s ‘Just Say No’ campaign aimed at discouraging youth from illicit drug use failed for this reason. A key part of preventing abuse is giving students accurate information about drugs, rather than using scare tactics. Schools often teach children that marijuana is highly addictive and poses risk for dangerous dependence. They later find out from peers that this is simply not true, which makes them distrust drug education. Thus, when educators give children accurate information about more dangerous drugs, like heroin and cocaine, children are reluctant to believe them.

In crafting federal policy to confront the opioid crisis, U.S. policymakers ought to look to foreign models of success. In the early 1990s, Zurich, Switzerland dealt with a similarly devastating heroin crisis. Platzspitz park, often called ‘needle park’, was filled with heroin use, gang violence, HIV spread, and prostitution. Zurich responded by emphasizing therapy and treatment. The city made anti-addiction drugs available to heroin users, and even offered non-synthetic heroin prescriptions to long-term users. In 1997, the Swiss public voted against adoption of stricter drug policies in favor of more lenient ones. By the end of the 1990s, heroin overdoses were reduced by nearly 50%. Clearly, a treatment focused approach to drug crises proves to be more effective than criminalization.

Supervised injection facilities, a controversial method of overdose prevention, have proven effective in Vancouver. There, drug users are offered clean needles, a private space, and treatment available in case of overdose. Vancouver’s safe-injection site opened in 2003 and its services have been associated with reduced overdose-related deaths and HIV infections. Many U.S. cities, such as Philadelphia, San Francisco, and Washington D.C. have taken interest in creating supervised injection facilities to prevent overdose-related deaths. Critics argue that supervised sites encourage drug use and attract crime to cities. Supervised injection facilities undoubtedly take a ‘harm-reduction’ approach to opioid abuse, which may be necessary in light of this epidemic’s severity.

In assessing incremental steps towards change, policymakers must also consider the negative externalities created by the battle against opioid abuse. In attempting to confront opioid addiction, many health professionals have started to withhold pain-killers from chronic pain patients. These patients suffer greatly without medical treatment. Doctors face a dilemma when deciding to prescribe or withhold opioids from chronic pain patients, who often become dependent and addicted to their prescribed medication. Research found by Dr. Howard Fields explains that in many cases, opioids are only effective in treating pain for about two months before their potency declines.

Thus, doctors should exercise caution in prescribing opioid medication. However, Fields also found that the presence of pain acts as a protective agent against the rewarding effects of opioid use. When treated appropriately for pain, most patients face little risk of addiction. Health professionals must take a nuanced, individual approach to prescribing opioids, rather than simply decreasing the amount of prescriptions given.