Like drug warriors before them, Trump and Sessions depict drugs as a foreign scourge inflicted by outside powers. But the latest public health figures indicate that nearly 92 million Americans — more than 1 in 3 adults — used a prescription opioid in 2015, with 11.5 million reporting misuse and nearly 2 million a disorder. Fatal overdoses are also skyrocketing. In 2015, overdoses claimed more lives than car accidents, and heroin killed more people than gun violence. The Trump White House now estimates that 142 Americans are killed by narcotics daily, the equivalent of a 9/11 attack every three weeks.
In short, the opioid epidemic is among the greatest threats facing the nation and the worst drug crisis in living memory.
America’s drug problem has a long history, and the causes of the present crisis are legion. But one stands out: the stubborn survival of the drug war. Serving as both a system of control and a style of political discourse, the drug war has turned the nation’s response to addiction into a zero-sum game between treatment and enforcement and consistently fixed the national gaze on criminal evildoers instead of the legal drug industry.
For nearly a century, policymakers have insisted on seeing drugs as a police problem to be remedied through an aggressive attack on illicit supply and criminal traffickers at home and abroad. Harry J. Anslinger, the nation’s first drug czar from 1930 to 1962, epitomized that get-tough mentality. He saw drugs and addiction as moral evils to be confronted, not accommodated, and he ensured the rest of government shared his view. Over the course of the 20th century, this rhetorical war became a literal war, spawning an oppressive police apparatus and furthering reactionary political goals, but doing little to alleviate American addiction.
The drug war rests upon a crucial assumption: that the lure of drugs will always prevail over public health strategies to reduce demand. As Anslinger explained in 1946, “Opium, wherever produced, will always seek a consumer.” Treatment was futile because there would always be new users. The only path to victory was to reduce supply, prevent new exposure and contain the spread of addiction.
Over time, that premise led U.S. drug warriors on quixotic ventures around the globe to disrupt the illicit trade before it could reach U.S. shores. But neither global enforcement programs nor heightened border inspections have stemmed the flow of drugs. To Anslinger and his successors, this failure simply demanded greater levels of intervention abroad and greater punishments for drug users at home.
Although the drug war failed to contain the drug problem, it remained a useful political device by distilling all of the complexities of American addiction into a simple morality tale of good vs. evil and the United States against its enemies. As Reagan put it in 1986, “Drug abuse is a repudiation of everything America is.” When the culture wars ran white hot over everything from race to music to sex, combating drugs was a way to assert a particular brand of American values and identity.
During the 1970s, ’80s and ’90s, these ideas accelerated the nation’s confrontational approach to crime and drove the war on drugs to new heights. As politicians of both parties joined the war on crime, they left little room for treatment and rehabilitation — hence the moral absolutism of Reagan’s “Just Say No” campaign and Clinton’s “Three Strikes” laws.
Each new cycle of drug war, however, merely created new problems without ever addressing the underlying structural inequalities and cultural proclivities that create demand and sustain patterns of abuse.
Perhaps most importantly, fixating on crime obscured the risk posed by legal industry. So by the turn of the 21st century, the United States was busy jailing an alarming proportion of its own citizenry just as the opioid crisis arrived on the horizon — thanks in part to government actions.
While politicians at the local and national level were cracking down on crime, they were also easing restrictions on Big Pharma and turning a blind eye to the explosive growth of a multibillion-dollar legal opioid industry that quadrupled the volume of narcotics available for consumption over the past 20 years. This flood of addictive drugs and over-prescription hastened the demise of economically depressed regions like the Rust Belt and reinvigorated the heroin market.
Where previous cycles of the drug war focused on urban minorities and foreign villains, the opioid crisis is indisputably white, rural and suburban and born of legal practices. Now, the drug problem can no longer be shrugged off as a symptom of crime.
Trump, however, is doing just that. Drugs have been a pronounced feature of his political bombast and anti-immigration rhetoric, and his instincts are leading him toward a new cycle of escalation. Actual policy has so far been left to two rival factions: a White House commission led by New Jersey Gov. Chris Christie and a DOJ task force led by Sessions.
An old-fashioned drug warrior, Sessions has been tight-lipped about his task force but clearly favors a draconian approach. Virtually all the tactical and policy shifts he has announced come directly from drug war orthodoxy, including a return to mandatory minimums, civil forfeitures and the war on pot — all despite the more relaxed views of his fellow task force members.
While Session’s plans will surely repeat, rather than reverse, past failures, acting DEA chief Chuck Rosenberg — an Obama holdover and James B. Comey’s former chief of staff — has argued for the need to “change the culture” rather than spin up the police state. Likewise, the emergence of treatment funding as a pawn in the congressional health-care negotiations demonstrates that legislators are sensitive to the problem, even if they haven’t lost their zeal for using drugs as a wedge issue.
The reality, of course, is that the drug problem is not a zero-sum game and requires both treatment and enforcement. But these are not days of nuance, and Trump appears to be playing a Christie-led public health approach against a Sessions-led drug war, leaving the fate of both uncertain.
If Trump renews the drug war, it will have disastrous consequences. Continuing to focus on illicit supply without reevaluating the root causes of addiction, the possibilities of treatment or the regulation of pharma will simply exacerbate the injustices of the drug war as the opioid crisis spins further out of control. We must flip Anslinger’s construction on its head: Wherever there is demand, drugs will flow. After a century of failure, it’s time to try something new.