Web Roundup: Opioids as a National Emergency

After several years in the headlines, the U.S. opioid crisis has been in the news this summer as the federal government debates its status as a national emergency. On July 31st, the President’s Commission on Combating Drug Addiction and the Opioid Crisis, led by New Jersey Governor Chris Christie, released its interim report on the state of the U.S. opioid crisis. As their “first and most urgent recommendation” for President Trump, the members of the Commission urged him to “[d]eclare a national emergency under either the Public Health Service Act or the Stafford Act.”

The report emerged just as federal officials published a widely cited study showing that 91.8 million (37.8%) U.S. adults had used prescription opioids in 2015, 11.5 million (4.7%) had misused them, and 1.9 million (0.8%) had an opioid use disorder. Nearly half (40.8%) of the individuals who had misused opioids had obtained them for free from family or friends. News reports on the study also declared that “[o]pioid abuse started as a rural epidemic” of “hillbilly heroin” but has now become a “national one.”

President Trump did not initially declare a national opioid emergency, vowing instead in a briefing on August 8^th to focus on prevention, increased law enforcement and drug-related prosecutions, and more aggressive policing of U.S. borders. By August 10th, after significant criticism, Trump told reporters, “We’re going to draw it up and we’re going to make it a national emergency.” As of September 1st, the Trump administration had yet to take the legal steps to formally declare a national emergency around the opioid crisis.

While the federal administration has debated the appropriate response, there have been more alarming statistics and headlines related to the opioid crisis this August. The National Center for Health Statistics found overdose deaths rose sharply in the first three-quarters of 2016 compared to the same nine months in 2015. Hospitals saw a 64% increase in opioid-related inpatient stays and a doubling of emergency room visits between 2005 and 2014, while other research suggests hospitals’ interventions after non-fatal overdoses were inadequate and increasingly expensive. One study found a seven-fold increase in the number of fatally injured drivers who tested positive for prescription opioids since 1995, while another found that more than two-thirds of surgery patients end up with unused prescription opioids.

These stories of the “opioid epidemic” make headlines daily. Addiction—and opioids in particular—even played an unusually public role in the 2016 presidential election when Politico described the U.S. Republican presidential candidates as “hooked on addiction stories.” Governor Chris Christie spoke tearfully of a nicotine-addicted mother and a classmate’s prescription drug overdose. Jeb Bush was candid about daughter Noelle’s addiction and drug-related arrest during his time as Florida’s governor. Senator Ted Cruz lost a half-sister to “the demons of addiction and anger,” while Carly Fiorina lost her step-daughter to overdose in 2009. Donald Trump’s brother, Freddy Trump, died of alcohol-related causes at age 43.

Epidemics have played a potent symbolic function in U.S. history. From opium to crack cocaine, the moral panics that ensue in drug-related epidemics suggest that a certain social threat could infringe upon a society’s fundamental values. While the term, “epidemic,” commands great authority, it is a state often born more of sentiment than of science. The declaration of a national emergency, however, can move U.S. resources in greater numbers and with greater expediency. A national emergency could allow for special regulatory powers, including the removal of restrictions on methadone and buprenorphine prescribing as well as the widespread dispensing of the overdose reversal drug, naloxone, without a prescription.

These conversations beg the question of what and when a crisis becomes both “national” and “emergent.” In the public imagination, the current opioid crisis began as a “rural epidemic,” one often implicitly or explicitly coded as white. Reminiscent of the differential approaches to cocaine and its crack cocaine equivalent, the current panic over opioids has patterned our public health and policing responses in ways that substantiate or naturalize addiction across racial and geographic lines. This has not gone unnoticed. Dahleen Glanton wrote about the lack of compassion in the crack cocaine crisis of the 1980s and its impact on the “opioid epidemic” today. Last year, Professor Ekow Yankah penned a New York Times op-ed on the about-face of American drug policy “when addiction has a white face.” As Yankah writes, “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.’”

Compassion and awareness are critical pieces of addressing the growing opioid crisis in the U.S. today. This race-based double standard, however, allows for public compassion for white opioid users while Attorney General Jeff Sessions continues to escalate the war on drugs in many communities of color. As the national response to curb opioid addiction and overdose mounts, it is worth considering how race and class shape our epidemic declarations and emergency responses and which drugs and drug users are deemed eligible for such compassion and intervention.

 

More links of interest:

• “Is the opioid crisis a national emergency?” New York Times. Summary of existing national and public health emergencies and the distinctions between the two.
• “Race, the crack epidemic and the effect on today’s opioid crisis.” Chicago Tribune. Column comparing the responses to the crack cocaine epidemic of the 1980s to those toward the opioid crisis today.
• “How states have used emergency declarations to fight the opioid epidemic.” STAT News. Review of state-based emergency declarations around opioid addiction and overdose.