The Great American Opioid & Heroin Epidemic: When the Victims are Mostly White

It’s time to Break It Down!

In the 1980’s and 90’s, the scourge of powder and crack cocaine plagued the American psyche. It’s fair to say the collective and typical response to the epidemic was in a word, visceral; an instinctive, deep-seated, gut-wrenching sense of despair about all involved, sellers, buyers, users, the broken, the mangled, the dead, and the imprisoned. This is especially true of the imprisoned.

The drug epidemic of that era prompted the advent of the now infamous Clinton Crime Bill, including provisions such as the 3-Strike Law, and disparate sentencing for cocaine and crack, even though the latter is a derivative of the former; in essence, the same drug. Not coincidentally, more whites used cocaine, while more blacks used the cheaper crack.

Needless to say it was a different time. Add to President Clinton’s Violent Crime Control and Law Enforcement Act, a.k.a. The Clinton Crime Bill, the comments of First Lady Hillary Clinton, whom at one point made the following reference:

“But we also have to have an organized effort against gangs. Keene Just as in a previous generation we had an organized effort against the mob. We need to take these people on. They are often connected to big drug cartels; they are not just gangs of kids anymore. They are often the kinds of kids that are called super predators — no conscience, no empathy. We can talk about why they ended up that way, but first, we have to bring them to heel.”

Mrs. Clinton made those remarks in a 1996 speech at Keene State College in Keene, New Hampshire. The comments haunted Clinton during her recent Presidential run, as first Bernie Sanders, and then Donald Trump used them to attack her during the campaign. Interestingly, the full context of the speech does link children and super predators. It does not, however, directly label African-American youth that way. But this is not a post to litigate that question. It was simply a point worth making.

The essential point revolves around the contemporary issue of today’s opioid and heroin epidemic. The preamble was necessary to provide a measure of context when contrasting the harsh and disparate public policy prescriptions then, versus the consistently far more empathetic reaction and approach to today’s problem.

The relationship of Americans with drugs and alcohol has a long and winding history. Though alcohol is currently a staple in many social settings, there was actually a period, known as the Prohibition Era, when from 1920 to 1933; the country maintained a constitutional ban on the production, importation, transportation, and sale of alcoholic beverages. High incidences of alcoholism, family violence, and saloon-based political corruption led activists to lobby for ending the alcoholic beverage trade. It was thought the cessation would cure a sick society. The effort started in the late 19th century and culminated with the Eighteenth Amendment to the United States Constitution in 1920. Legislation known as the Volstead Act established the rules for enforcing the ban and defining the parameters for the alcoholic beverages that would be prohibited.

The reality was the law was widely disregarded, tax revenues were lost, and organized crime took over the alcohol market. Prohibition ended with the ratification of the Twenty-first Amendment, which repealed the Eighteenth Amendment on December 5, 1933. Prohibition failed politically. However, though seldom acknowledged, it succeeded in cutting overall alcohol consumption in half. From a public policy standpoint, that in and of itself is a significant accomplishment. In the end though, the loss of needed tax revenue during the Great Depression, and the increased influence of criminal organizations rendered the law unsustainable.

Fast forward to the 21st century and the discourse around marijuana is not so dissimilar as the one around alcohol a century ago, One major difference that is frequently not highlighted is the posture that the alcohol lobby takes on legalizing, or even de-criminalizing cannabis. Suffice it to say, they do not tend to invite or encourage the competition. There is a spirited public health debate on the subject though. Slowly, and perhaps inexorably, there is a nationwide movement afoot to make weed accessible, either medicinally, recreationally, or both. Who knows; perhaps it’s coming to your state, or one near you, soon.

Check almost any evening newscast, and you can see a story discussing the challenges that certain Americans face due to opioids, heroin, and/or prescription meds. You know we are in a different place with this epidemic than we were with the cocaine, crack epidemic, when the liberal Democratic (though the irony then was Bill Clinton was not a liberal) President led the drive to enact an onerous crime bill, while today the conservative Republican (though the irony now is Donald Trump is neither a conservative, nor a Republican) President named a commission studying the opioid epidemicoften brings up the alcohol addiction that consumed and killed his brother.

Trump named New Jersey Governor, and 2016 Presidential candidate Chris Christie to lead that commission. The Governor discusses his own compassionate approach to people suffering from opioid addiction; he frequently refers to a personal friend with a successful law practice a brilliant wife, and wonderful kids. Carly Fiorina, who also vied for the 2016 GOP Presidential nomination, mentioned her daughter’s death, due to drugs. Former Florida Governor, and 2016 GOP Presidential candidate Jeb Bush wrote an article on his daughter’s drug struggles. And that doesn’t even begin to count the many, many state lawmakers who have shared similar stories about husbands, wives, sons, daughters, friends, and coworkers who struggled with addiction. This amazing up close and personal insight, according to their individual stories, has led them to believe in the need for better, comprehensive drug treatment.

What these anecdotes reveal is how shared experiences and personal relationships influence public policy deliberations and decisions. These pols introduce and discuss people in their lives who suffered and sometimes died due to their involvement with drugs. They made this nexus with a specific purpose in mind: to call attention to addiction in a way that focuses on public health rather than criminal justice. In other words, when policymakers have skin in the game, it’s amazing how much more empathetic their remedies are, to issues that would otherwise have drawn draconian prescriptions.

There is another issue that these stories bring to the fore that may not be evident upon first blush: race. Even after decades of progress on racial issues, America remains a very segregated country. On a day-to-day basis, most Americans closely interact only with people of the same race. And that impacts our policies.

For example, the opioid epidemic contributed to the record 52,000 drug overdose deaths reported in 2015. Because the crisis has disproportionately affected white Americans, white lawmakers — who make up a disproportionate amount of all levels of government — are more likely to come into contact with people afflicted by the opioid epidemic than, say, the disproportionately black drug users who suffered during the crack cocaine epidemic of the 1980s and ’90s. Not surprisingly, that means a lawmaker is more likely to have the kind of interaction that Christie, Trump, Bush, and Fiorina described — one that might lead them to support more compassionate drug policies — in the current crisis than the ones of old.

Given those dynamics, is it any surprise then, that the crack epidemic led to a “tough on crime” crackdown focused on harsher prison sentences and police tactics, while the current opioid crisis has led more to calls for legislation, including a measure Congress passed last year, that boosted spending on drug treatment to get people with substance use disorders help? In a word, no!

Social stratification and racial segregation are huge factors in the how and why we deal differently with the matter of addiction in different communities. The data shows that the opioid crisis has hit white communities harder, which in turn has led to more overdoses and deaths among whites than among blacks, and Latinos. That alone makes this drug epidemic unique in the history of American drug epidemics.

In addition to stratification and segregation, virulent racism is also a factor in creating disproportionate white victims of opioids. First off, the leading edge of the epidemic sprang from doctors oversubscribing opioids…to white patients. This oversubscription led, indirectly to children, family members, and neighbors acquiring the drugs, by accident, or by the white patients directly sharing them. Alternately, studies show that doctors have generally been more reluctant to prescribe painkillers to minorities, because doctors mistakenly believe that minority patients feel less pain or are more likely to misuse and sell the drugs. In a perverse and ironic way, this discriminatory practice prevented minority patients from drowning in the tsunami of opioid painkiller prescriptions that got white Americans hooked on opioids, including heroin, and led to a wave of deadly overdoses.

While I won’t dwell on the stereotyping, I will observe that sooner or later, one way or another, karma will hunt you down, and what happens next…well, just try harder to do the right thing, and stay on the right side of karma. The cocaine and crack epidemic of the 80’s and 90’s deserved a more empathetic response. It didn’t happen. The current crisis is not exactly a do-over, but it is, nevertheless, still an opportunity to do the right thing. Let’s not lose the lesson, or the opportunity. We are here now. Let’s handle this. The Great American Opioid and Heroin Epidemic: When the Victims are Mostly White!”

I’m done; holla back!

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