“Cocaine is an epidemic now. White people are doing it.” – Richard Pryor
Heroin has a new face. The new face of heroin elicits more sympathy, compassion, and understanding. The new face of heroin is, were told, less threatening. Ninety percent of new heroin users are white. From punishment to public health, local and national responses to heroin have been remarkably fluid over time. In each case, our approach is animated by the esteem—or lack thereof—with which we hold using demographics. As new heroin and opioid users are disproportionately white and often middle class, how we view the problem and options to address said problem have changed dramatically. An ahistorical optimist might view our new vibrant discussion and consideration of public health approaches and harm reduction at the local and state level as clear markers of progress. A drug historian might ask: how will approaches change when users change or new drugs with new using demographics emerge? Those that prescribe to David Musto’s dictum of periods of tolerance and intolerance in United States drug control might rightly hold their breath for our next period of intolerance.
Perhaps not surprisingly, the reason nonwhite populations have been less adversely effected by heroin’s rise is also steeped in racial prejudice. The history of medicine has long revealed the ways in which various nonwhite ailments have been ignored or minimized by the medical profession. In our present context, Dr. Andrew Kolodny, a drug abuse expert argues that doctors are much more reluctant to prescribe painkillers to minority patients, worrying that they might sell them or become addicted. Had practitioners viewed all of their patients with similar suspicion and caution the iatrogenic addiction of opioids leading to heroin may have been avoided. In 2012, twelve states processed a volume of opioid prescriptions that outstripped their population. In Alabama, the staggering ratio rested at 142.9 opioid prescriptions for every 100 citizens.
I first wrote about this trend in 2014, after the Governor of Vermont dedicated his State of the State Address to the heroin problem. As I argued then: Sound policy steeped in punishment—it turns out—makes much more sense when applied to 1970s Harlem rather than the land of maple syrup, autumn foliage, and good neighbors. When addressing the same drug with different users in decades past, punishment reigned. The addict and the peddler–often doubling as the same shadowy figure–became cemented as cultural boogeymen. Addicts, not society or disease, caused the problem and bore the threat to public safety. In Vermont however, Governor Peter Shumlin transformed addicts as victims. De-centering traditional narratives of crime and deviance, Shumlin painted a picture of heroin users as everyday people, victims caught in a downward spiral. Schulman cited the conclusions of a local Pediatrician Dr. Fred Holmes: “These kids don’t look different, walk different, talk different. It’s just the nature of the disease that’s different. A relentless relapsing illness that is potentially fatal.” A far cry from the “super-predators” of the Crack Era.
More recently in 2015, alarmist pieces citing increasing mortality rates among poorly educated whites ages 45 to 54 made their rounds. The rising death rates were chalked up to premature deaths due to suicide, drug abuse, and alcohol. Reports did not blame a lack of skills, personal responsibility, or the culture of Appalachia. The “Culture of Poverty” thesis and personal failings best apply to urban districts and their residents. Instead reports cited high levels of unemployment, low work force participation rates, and a creeping sense of hopelessness. One could make the same argument about young, nonwhite urbanites detached from the labor market in the years of heroin and crack. In fact, they did. In a 1988 New York Times op-ed, drug warrior Charles Rangel argued: “For too long we have ignored the root cause, failing to see the connection between drugs and hopelessness, helplessness and despair.”
When economist Angus Deaton explained the phenomena of increasing white mortality, he cited structures of the economy to explain the turn to drugs, alcohol, and suicide: “Those are the people who have really been hammered by the long-term economic malaise.” John Skinner, a professor of economics and medicine argued that having the “financial floor fall from underneath them” was disheartening and traumatic for whites ill-equipped to compete in an economy that had largely left industry and manufacturing behind. The same report also listed the increasing accessibility of opioids, and later, heroin as an explanatory factor. Might we apply the same argument to cities hobbled by deindustrialization and the rise of illegitimate labor via the drug trade in decades past? Instead policy makers and pundits blamed place, culture, family, community, and by extension, race.
Huntington, West Virginia has been especially hard hit, we’re told. Rather than declare war on citizens and demand more vigorous law enforcement, the Mayor of Huntington, Steven Williams has taken a different tact. Appealing for public sympathy, Williams explained the tragedy unfolding in his community to NPR: “What I’ve determined is that overdoses are more a symptom. The actual disease is hopelessness.” While his explanation mirrors that of Charles Rangel’s decades earlier, the conclusions and broader policy prescriptions that followed are virtually antithetical. Instead of calling for more police and harsher sentencing or boiling down addiction by urging addicts to “Just Say No,” Williams admitted: “Well, there had been such an aggressive effort focused on law enforcement, and we can’t arrest our way out of these problems. They
would just break your heart.” Instead of a muscular criminal justice response, Williams implemented a needle exchange program. When asked to explain the decision, he responded: “We have to be able to reach out to someone who is in addiction and take them by the hand and give them an assurance that we are not going to let go.” Frequent calls to bring back the death penalty, even in New York State, throughout the Crack Era suggest that we were more than willing to let go and discard a different set of users.
In Upstate New York, where I currently reside, heroin has also become an increasingly salient concern. Here too it is difficult not to notice the new, more humane, compassionate approach. The Mayor of Ithaca, Svante Myrick, the son of an addict, has proposed the nation’s first safe injection site. HOPENY, a New York State government organization has undertaken a massive public awareness campaign putting a human face–and context–to addiction. The website banner reads: “Addiction can happen to anyone, any family, at any time.” Below are a slew of videos entitled “faces of addiction/faces of hope.” In each, predominately white, often middle class addicts tell their stories firsthand. More recently, CVS struck a deal to sell narcan over-the counter in New York State along with eleven others. Parents of means are tired of watching their children overdose when drugs like narcan can be made available and prevent such tragedies. When we decide citizens that are dying or hurting matter, harm reduction and public health solutions appear to win more support.
Tuesday night PBS aired a Frontline special entitled Chasing Heroin. Advertisements for the two hour special previewed the “new face of heroin” and the subsequent “new war on drugs.” The profile of four white users did similar cultural work to the HOPENY testimonials. It humanized drugs users and drug addiction. Mayor of Bremerton, Washington Patty Lent was stunned when she started receiving phone calls about municipal bathrooms clogged with used syringes. In response, Lent proposed a methadone maintenance clinic. A local business owner, and former opponent of the clinic changed his tune midstream when he discovered his son too had fallen to heroin addiction. Unfortunately, many human beings fail to view addicts as human beings deserving of compassion until those human beings are their own.
Most interestingly, the special also highlighted a Seattle law enforcement initiative called LEAD, Law Enforcement Assisted Diversion. Summarily different from drug courts that are all too coercive, LEAD effectively affords officers the discretion to decriminalize heroin on a case by case basis. The overarching goal of LEAD is to push towards treating addiction as something other than a crime. LEAD is not preoccupied with forcing addicts to get clean before they are ready, but rather, more interested in reducing harm, limiting addicts contact with police and ancillary crime, and advocating for public health. Think of LEAD as Bunny’s “Hamsterdam” in The Wire, but with more infrastructure, resources, and the official approval of authorities. It should also be noted that viewers might be less stunned or horrified at LEAD versus “Hamsterdam”because of the different sets of users. To be clear, LEAD was not implemented until white addiction became prominent. Before that, Seattle PD spent plenty of time punishing drug users of a different ilk. While LEAD is undoubtedly a marker of progress, it reminds us that progress is not color-blind. To that effect, will the discretion of officers to decriminalize play out the same bias already implicit in the criminal justice system?
In a powerful op-ed, Law Professor Ekoh Yankah reminded readers of an important message that warrants refrain: “We do not have to wait until a problem has a white face to answer with humanity.”