As discussed in “Emergency! Public Health Edition,” the opioid crisis is a long-running public health emergency that affects the US. What are the contributing factors to this massive public health risk, how did it arise, and what other factors influence a public health response?
Opioids: The Basics
As usual, any discussion of public health begins with the basics.
Opioids are a type of pain-relieving drug that are named after their interaction with the body’s opioid receptors. Examples include heroin, fentanyl, OxyContin, morphine, and many other drugs.
Specifically, ingestion of an opioid allows the substance to attach to the brain’s opioid receptors, which are key to the body’s ability to perceive pain and feel pleasure.
These medications can become deadly as heightened amounts may lower your heart rate or slow your breathing, as well as lead to risky behaviors. And of course, they’re highly addictive.
But how does one lethal drug lead to a crisis?
Over the past fifteen years in the US, opioid-related deaths (often by overdose) and addiction rates have skyrocketed, accounting for an estimated 1 in 6 drug-related deaths each year. While there is no singular cause for such widespread usage of the drug, many suspect that the wide availability of these drugs--whether through prescription or illicit sale--greatly contribute to their dissemination. Such a massive effect naturally constitutes a major public health risk.
Yet that isn’t the end of the story...
The War on Drugs
An analysis of the opioid crisis and identifying potential solutions to the public health emergency is impossible without consideration of the history of drug policing.
Think back to the War on Drugs, an arguably ongoing effort by the federal government since the 1970s to eliminate illegal drug use. While such a simple concept is seemingly in line with public health and community safety, the War on Drugs in fact justified many other harms through racial discrimination and mass incarceration by heavily criminalizing people of color. To delve into the War on Drugs is an entirely different article in itself, but its impacts--aside from the vestigial structures it leaves in court--are still felt.
Whereas the War on Drugs led to Black Americans being six to ten times more likely to be imprisoned for drugs than White Americans and the highest incarceration rate of a nation (See “Prison: Where Public Health Goes to Die” to learn more), the modern war on opioids has been starkly different.
In fact, many studies have shown that, likely due to the association of opioid abuse with White Americans, the response to the opioid crisis has been much less punitive and more clinical than the similar War on Drugs. Many responses to the proliferation of opioids have primarily treated these drugs as medical or even decriminalized them, whereas many of the archaic harsh punishments that primarily affected people of color remain intact.
Of course, there are far too many confounding factors to conclude that the response to the opioid crisis is intentionally opposed to the racialized and punitive nature of the War on Drugs. For instance, there have been recent surges in opioid use by people of color, and also a modern movement away from the carceral systems of past through rehabilitation rather than punishment rhetoric. However, the notably similar situations between the two suggest that race certainly plays a role in the approach to this public health crisis, whether it is discriminatory or not.
In essence, public health is difficult work that involves many nuances, but it is because of those complexities that it is so vital. This line of work requires reconciling the truths of scientific findings with their social implications and analyzing the past. There are no immediate right answers, but addressing these crises--discrimination in public health and drug overdose--is critical.
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