Discussing the Opioid Epidemic

I was discussing yesterday with an American friend about the forthcoming vote in the U.S. Senate on the opioid response package and how it is just another example of racialized policymaking. Even a form of social construction of policy target groups. When you think about the policies the US government tends to adopt regarding substance abuse, it’s obvious that these policies are, without exception, resulting from the way you frame de discourse and the terminology you use in the public space. Words have consequences, language is performative because it frames reality and consummates an action.

When it comes to drug consumption and abuse, U.S. policymakers usually discuss the topic through two disparate and racialized discourse lenses. On the one hand, when the press or politicians talk about the opioid crisis in the midwestern US, which affects mostly blue collar and poor white demographics, the terminology used is medical in nature: “opioid epidemic”, “health crisis”, “substance-abuse”, “overdose crisis,” and so on. On the other hand, when they are discussing the same issue affecting the black communities, the same actors usually make use of a different terminology, such as: “war on drugs”, “trafficking”, “illicit drug”, “addict”, “criminals” and so on. One cannot escape the obvious racial dichotomy that exists in the public use of these words.

When it affects a certain demographic, the issue is medicalized and resources are allocated to alleviate and help the victims, which are seen as injured, as in need of help. When the same issue affects another demographic, the approach is entirely the opposite: they are seen as criminals unwilling to stop consuming illicit substances. Thugs that intentionally break the law for their own pleasure. The discrimination is obvious to any reasonable individual.

From these distinct discursive approaches towards the same issue emerge two different policy approaches. In the first case, substance abuse among whites is medicalized and resources are allocated toward treatment, prevention, and preemption. In the second case, substance abuse is criminalized and resources are allocated for the imprisonment of „criminal” addicts. The terminology matters! The words we use, the narratives we build, define the playing field and subsequently constrain and direct policy action.

But even before we get to discuss policy, we should ask ourselves why is drug consumption a problem? Why should we, as a society, care that some people have become addicted to certain psychotropic substances? Why should it be of public concern and not simply a private problem of the affected person and maybe his or her family? We definitely don’t care, as a society, about most of the individual problems affecting all of us separately.

We may find many humanitarian reasons to consider an individual problem as a public concern, but society as a whole cynically cares only about those issues that produce negative externalities. We care only when it affects us or the community as a whole. When this happens, the state intervenes to alleviate, control, or eliminate the unwanted externalities. In this case, by resolving the cause of the problem. The issue needs not to be objectively real, but only to be perceived as such in order for the government to act.

So, why is opioid consumption a public concern? Because it produces negative externalities. Drug consumption increases health care expenditures, decreases economic productivity, produces unwanted social behavior that derives from the addiction (e.g. stealing to buy drugs), and in some cases reduces the relative size of the labor force. This list is obviously not exhaustive. If we focus on these negative externalities, which have a significant impact on local communities, the general welfare, and the public good (in any way we define it), then it becomes quite obvious to any reasonable person that criminalizing the issue will not improve the general welfare. It will not alleviate the negative externalities caused by the phenomenon in question. If we care about the general welfare and individual autonomy, then we cannot treat drug consumption as a criminal phenomenon that requires punitive measures, except if the intent is different. Considering that the criminalization of substance abuse decreases the general welfare of the communities affected and attacks individual autonomy, then you will want to pursue such a line of action only if you are malicious in your intent towards those communities and people. Framing substance abuse in criminal terms can only show hostility towards the victim.

Therefore, substance abuse should be medicalized, not criminalized. From heroin consumption down to weed smoking, all of them should be treated as medical problems and be decriminalized. The same way we treat tobacco use or alcoholism. A racial inclusive and non-discriminatory policy towards substance abuse mandates that the state provide not only equal treatment to all but also equal opportunities. And equal opportunities means equal access to professional treatment for those in need and a focus on the needs of the communities affected. 

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