This post is a part of our Bioethics in the News series
By Karen Kelly-Blake, PhD
The U.S. is in the grips of an opioid addiction crisis. According to the CDC, the rate of opioid (prescription and heroin) overdose deaths has quadrupled since 1999.
Consider the following:
Economic Impact of the Opioid Epidemic:
- 55 billion in health and social costs related to prescription opioid abuse each year
- 20 billion in emergency department and inpatient care for opioid poisonings
On an average day in the U.S.:
- More than 650,000 opioid prescriptions dispensed
- 3,900 people initiate nonmedical use of prescription opioids
- 580 people initiate heroin use
- 78 people die from an opioid-related overdose
There is a strident call for prevention, treatment, research, and effective responses to quell this modern day public health scourge. The Obama administration is calling on Congress to 1) expand access to medication assisted treatment (MAT); 2) improve prescription drug monitoring programs; 3) advance prescriber education; 4) encourage safe pain management; 5) accelerate research on pain and opioid misuse and overdose; 6) expand telemedicine in rural America; 7) safe disposal of unneeded prescription opioids; and 8) improve housing support for those in recovery.
Along with these initiatives, expanded use of naloxone is deemed critical as a lifesaving measure for first responders and others to reverse drug overdose. Injection clinics, where users can inject heroin (illegal drugs) in a safe environment is regarded as a reasonable and appropriate response to the problem.
Undoubtedly, there is a striking difference in tone about this “new” heroin epidemic compared to the old epidemic of crack cocaine, which affected predominately black, poor, and urban communities. The difference is that young white people are addicted and dying, reflecting a shift over the last 50 years in the demographic composition of heroin users. A New York Times analysis found that young white adults are dying at rates not seen since the AIDS epidemic. This new epidemic is predicated on addiction to prescription painkillers and people turning to heroin and fentanyl as cheaper alternatives with no administrative barriers (contracts, doctor visits, prescriptions).
The current narrative goes something like this: “…[B]ut these are people and they have a purpose in life and we can’t as law enforcement look at them any other way. They are committing crimes to feed their addiction, plain and simple. They need help.” So, when young white people become heroin addicts they are “people with a chronic health problem” and thus are deserving of patience, tolerance, and help. Coming from middle-class and suburban environs, they are portrayed as high achievers from exceptional families, and so the addiction is not their fault—it is not a personality flaw or character deficit.
In contrast, at the height of the crack cocaine epidemic in the mid-80s, black people were branded as pathological, unsympathetic “superpredators” and therefore deserved disdain and incarceration. Black crack addicts had several personality flaws—lazy, stupid, it was their fault that they became addicted—their addiction was the result of a moral failure.
Racism is in full effect in this new public health scourge. Of course, addiction requires medical intervention and all the social resources needed to help those afflicted. BUT, let’s not have a conversation about the new heroin epidemic in a vacuum with scant if any attention to the racist underbelly of the discourse. Minority and poor people were junkies and criminals deserving nothing more than a jail cell. Today’s addicts are not even called addicts. The goal is to avoid stigmatizing language and so language conveying a chronic illness is preferred such as substance abuse disorder. Addiction is a serious public health issue and it is encouraging to see the change in strategy to treat those afflicted. We know that mass incarceration is not an effective public health response.
It is problematic that we are having a white washed conversation about opioid addiction. This new conversation is occurring in an ahistorical vacuum. The goal is not to incarcerate young white heroin users, but to help them. However, this new enlightenment is a sting for black and Latino families who suffered the same problems, but they were not deemed “people with futures” or “people who deserved help.” They were junkies and criminals. Ironically, black people are suffering less from this new epidemic because of pervasive racial stereotypes whereby doctors are reluctant to prescribe painkillers to minority patients believing they will sell them or become addicted.
It is disingenuous to frame the conversation ahistorically. The current responses and narratives surrounding the heroin epidemic shows that it indeed matters who is in the grip of addiction: “White heroin addicts get overdose treatment, rehabilitation and reincorporation, a system that will be there for them again and again and again. Black drug users got jail cells and “Just Say No.”
The new white face of heroin addiction has changed the discourse of addiction from criminalization to public health, and the change is welcomed. However, it does give me pause that the white face was necessary to enact humane responses for a health problem that affects us all.
Karen Kelly-Blake, PhD, is an Assistant Professor in the Center for Ethics and Humanities in the Life Sciences and the Department of Medicine at Michigan State University.
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References
- Katharine Q. Seelye. In Heroin Crisis, White Families Seek Gentler War on Drugs. October 30, 2015. http://nyti.ms/1KKw5zt
- The Opioid Epidemic: By the Numbers. http://www.hhs.gov/sites/default/files/Factsheet-opioids-061516.pdf
- Fact Sheet: Obama Administration Takes More Actions to Address the Prescription and Heroin Epidemic. https://www.whitehouse.gov/the-press-office/2016/07/06/fact-sheet-obama-administration-takes-more-actions-address-prescription
- Potier C, Laprévote V, Dubois-Arber F, Cottencin O, Rolland B. Supervised injection services: what has been demonstrated? A systematic literature review. Drug and Alcohol Dependence. 2014 Dec 1;145:48-68. doi: 10.1016/j.drugalcdep.2014.10.012. Epub 2014 Oct 23. PMID: 25456324. http://www.sciencedirect.com/science/article/pii/S0376871614018754
- Cicero TJ, Ellis MS, Surratt HL, Kurtz SP. The Changing Face of Heroin Use in the United States: A Retrospective Analysis of the Past 50 Years. JAMA Psychiatry.2014;71(7):821-826. http://dx.doi.org/10.1001/jamapsychiatry.2014.366
- Gina Kolata and Sarah Cohen. Drug Overdoses Propel Rise in Mortality Rates of Young Whites. January 16, 2016. http://nyti.ms/1OWwo0R
- Ekow N. Yanka. When Addiction Has a White Face. February 9, 2016. http://nyti.ms/1LdiwdH
MSU Bioethics 
What is country or countries of origin of the heroin, and what are the major transportation routes into the U.S? Who is profiting, and how does the money flow?
Dr. Anderson, thank you for taking the time to reply to this post. Please feel free to copy and paste the link below. It should provide a good starting point to answer your questions.
http://www.whitehouse.gov/ondcp/global-heroin-market
Black lives matter. Bigotry here is manifested as the inability/unwillingness to empathize with the suffering of another simply because they are perceived as “Other”. Our culture is bleeding us of our humanity, leaving us afraid, alone and apathetic.
Dr. Meerschaert, Thank you very much for your eloquent and passionate response!