We still don’t know if this is the beginning of a sustained trend (deaths due to prescription opioid overdoses are plummeting, but overdoses involving fentanyl continue to surge). But even if death counts continue to fall, we still need major policy changes rooted in a quality that’s been in short supply: compassion for those with substance abuse disorder.
Americans often express concerns about drugs and crime, but the health and well-being of those suffering from drug addiction has never ranked among our top national priorities. It’s easy for politicians to make the case for helping hard-working middle-class Americans who struggle to get by, or to rally urgent policy responses when the people at risk are perceived to be innocent.
But whenever voters believe that a group of people has any level of culpability in their own woes, the political will to address their needs vanishes.
The same apathy played a role in making the AIDS crisis so deadly: At the height of that epidemic in 1995, the disease claimed the lives of more than 50,000 people aged 13 or older. The early victims of that crisis included both gay men and intravenous drug users, people who were considered unsympathetic or even expendable by the public. Only after a number of high-profile cases where patients contracted HIV through blood transfusions made people understand that the disease could affect anyone, and only through the diligent activism of the LGBTQ community did public opinion change.
Ultimately, the government invested hundreds of billions of dollars over the past few decades to reduce deaths from HIV. Today, the death toll has fallen to a fraction of its peak — a little more than 6,000 in 2016 — and yet the public consensus still views it as a cause worth heightened attention.
Public awareness of the opioid crisis is certainly at an all-time high, but we have yet to see that necessary shift in public opinion needed to ground policy in compassion.
No one has made this more evident than President Trump, who talks about the opioid crisis as a scourge created by malevolent drug dealers at our southern border and insists that must be stopped primarily with a wall. (This is, of course, very silly.)
Meanwhile, the Trump administration has offered little more than lip service to address addiction itself. Since 2017, the administration and Congress provided only $3.3 billion for treatment, prevention and recovery services — money that is set to run out next year. At the same time, doctors continue to provide proper treatment to those with substance abuse disorder. More than half of U.S. counties lack even one prescriber of buprenorphine, one of the most common medications used to treat addiction.
That hasn’t kept Trump from using the recent drop in overdose deaths to proclaim that his drug policies have had a “tremendous effect,” as he did last month. How tragic would it be if this small tick down in the overdose death rate gives Republicans license to declare “Mission Accomplished” and move on?
The solution we need is not to let the crisis play itself out over the course of decades. We should, as some activists have proposed, mount a campaign against overdose deaths with a scale comparable to our campaign against HIV/AIDS. That would include dramatically expanding access to Medicaid as well as our medical system’s capacity to deliver medication-assisted addiction treatment. We should also continue to flood the country with the anti-overdose drug naloxone, just as pharmaceutical companies flooded our country with prescription painkillers.
And if, for a moment, you wonder whether those addicted to opioids deserve so much effort, remember that they are victims. They are victims of a predatory pharmaceutical drug supply system that hooked them on their products and profited off their misery. They are victims of a federal government that chose to prioritize those companies’ business interests over investigating suspicious sales of painkillers. And they are victims of a health-care system that shows little interest in helping them help themselves.
And, most of all, they are victims of a society that too often sees them with contempt or sees them not at all. As with HIV, our commitment to ending the opioid epidemic must be more than just a public health campaign. Until we restore justice and dignity to the people we allowed to suffer, we’re simply setting ourselves up for the next crisis.