Moving Beyond Opioids: 5 Lessons for the Next Drug Crisis

By Tessie Castillo 01/05/18

Once certain groups are labeled as criminal or undeserving, or “not like us,” it is easy to enforce supposedly fair and colorblind laws in a discriminatory manner, whether deliberately or subconsciously.

A multi-ethnic group of people.

It’s an exciting time to be an advocate for drug policy reform and harm reduction. For the first time in decades, people trumpeting the failures of the War on Drugs are being heard, while victories on overdose prevention, syringe exchange, medication assisted treatment, and more are passing in state after state. The reason for harm reduction’s sudden shift in status from outcast to mainstream public health ally can be summed up in one word: opioids. The opioid epidemic has caused a wave of drug-related death on a scale never before seen in the United States. More importantly, the problem has infiltrated the white, affluent class in charge of policy and decision-making, leading to compassionate attempts at reform that were scorned as “soft on crime” during previous drug crises, when the user population was perceived as primarily poor or brown. While the momentum to address the opioid crisis is encouraging, a major concern still lingers: What will happen to all these reforms once opioid addiction declines? Will current levels of sympathy still hold if the majority of drug users are once again perceived as poor and brown? To answer this question, I recently caught up with several national harm reductionists and drug policy advocates for advice on how to take the current momentum on drug policy reform beyond opioids. Here are the top five ways we can make reforms permanent and more equitable towards all people regardless of race or class:

  1. Make the Minority Interest the Majority Interest

The age-old challenge for anyone who has ever had to fundraise or promote a cause is this: how do we convince a critical mass of people to care about a problem that doesn’t directly affect them? Most people in the United States are not addicted to drugs, so whether our nation’s drug policies are overly punitive, ineffective or racially biased is simply not a concern for Average Joe. One way to change this is to link drug policy concerns to a larger issue that does impact a critical mass of Americans. There are several issues that could serve this purpose. One of these is health care.

“We need to continue to talk about the linkages between health care and substance use,” says Grant Smith, Acting Director of the National Affairs Office for the Drug Policy Alliance. “This linkage reinforces the understanding that substance use is first and foremost a health issue, regardless of the drugs being used. Improved health care access and coverage is critical to improving the odds that someone will be able to seek substance use treatment if they want it. Framing substance use as a health issue also challenges our current policy of treating drug use as solely a criminal justice issue.”

With all the uncertainty and concern over the future of our health insurance system, the time is ripe for action on health care access, which will lead to better and more permanent outcomes for people with substance use issues as well.

  1. Create Strong Collaborative Partnerships with New Stakeholders

The opioid crisis has already accomplished this on a scale never seen before. Harm reductionists and drug users now work side by side with law enforcement, paramedics, prosecutors, behavioral health specialists, medical providers, the faith community, parent groups, and other organizations that once operated in separate spheres. New collaborative partnerships are also part of building a critical mass of supporters.

Jeremy Saunders, Co-Director of VOCAL New York, a harm reduction organization, says he has never seen so many social justice organizations interested in drug policy until the opioid epidemic. “To recruit more people into this work, we need to meet them where they are at, which may mean talking about opioids initially. But eventually we need to expand the conversation to include problems with drug policy as a whole, and even larger issues such as health care and affordable housing,” he says.

Saunders brings up a good point, which is to first find common ground with new collaborators. Once trust and rapport is established, that common ground will start to expand into other issues. New partnerships forged between harm reductionists and non-traditional allies will not disappear overnight once the opioid crisis declines, though they may weaken. By actively keeping these partnerships alive and seeking new ones, advocates can continue the work inspired by common interest in opioids even after the drug of choice changes.

  1. Fight Tendencies to Classify Certain People as “Other”

In addition to building relationships with new collaborative partners, advocates need to ensure that they don’t also lose critical mass by allowing themselves to be divided and pitted against one another. For example, this division is currently happening in conversations about people who use drugs versus people who sell them. Public opinion is turning a compassionate eye towards people who struggle with drug addiction, while at the same time many policymakers are calling for harsher penalties for people who sell drugs – in some cases even charging them with murder if someone overdoses on their product. Kingpins and cartels aside, the notion that there is always a clear, consistent difference between users and sellers is nonsense. Many users also sell drugs to support their habit. But by claiming that there is a big difference, proponents of a criminal justice approach to substance use can continue the punitive and ineffective policies of the current War on Drugs with only a slight narrowing of the target population.

In a keynote speech at the 2017 Drug Policy Alliance conference, Michelle Alexander, acclaimed civil rights lawyer and author of The New Jim Crow, spoke of the need to “recognize and challenge our tendency to be less compassionate to those perceived as ‘other.’” This human tendency to judge others harshly while forgiving our own mistakes is at the heart of the racial and class bias within current drug policy. Once certain groups are labeled as criminal, undeserving, or “not like us,” it is all too easy to discard them and to enforce supposedly fair and colorblind laws in a discriminatory manner, whether deliberately or subconsciously. We need to fight this tendency if we can ever hope for equitable drug policy.

  1. Create Popular Investment in Reform

Making the minority interest the majority interest, creating collaborative partnerships and fighting efforts at division are all well and good, but these reforms can change swiftly if public opinion towards drug users changes. The best way to ensure that positive drug policy reforms stick around for good is to invest in it by giving people things they won’t want taken away. For example, for all the criticism and resentment towards the Affordable Care Act, recent political drama has showed us that once millions of people have access to health care for the first time, it’s really hard to take it away. The same is true for programs like Medicare and Social Security or even drug policy. If we invest in access to health care, behavioral health services, mental health services, substance use treatment, etc., even people who don’t give a hoot about drug users will not want to lose services they are accustomed to receiving. Those same people will be a powerful force to hold politicians accountable if they try to take away these essential benefits.

“The opioid epidemic has started a cultural shift towards seeing drug use as a behavioral health issue,” says Daryl Atkinson, Co-Director of Forward Justice, a social justice nonprofit in Durham, North Carolina. “If we build local power to advocate for keeping those changes and hold politicians accountable, the new policies will become more durable.”

  1. Ensure that Directly Impacted People Lead the Movement 

Last but perhaps most important is that any lasting drug policy reform must be led by people directly affected by drugs and drug policy. Directly impacted people bring experience and passion to the cause that can effect lasting change. One of the biggest problems with current solutions to the opioid crisis is that many of the movers and shakers behind efforts to increase access to medication assisted treatment, modify prescribing habits, train first responders on overdose response, etc., are middle or upper class white people in positions of power in government and on nonprofit boards. These leaders may be impacted by the current opioid epidemic, but if they are not impacted by future drug crises, the reforms of today may be only temporary. It is critical that non-opioid users, people in low-income communities and people of color hold leadership positions so that reforms reflect their community interests as well.

Terri Hurst, Policy Coordinator for the Colorado Criminal Justice Reform Coalition, explains, “Drug policy reform has to be crafted from communities of color and people directly impacted by existing policies. We also need to create feedback loops and ways to evaluate whether policy is working the way it should, so it can be monitored and changed if it is not having a positive impact on the communities it is meant to help.”

It will take concerted effort to maintain course towards compassionate, evidence-based drug policy reform even after the opioid crisis lessons and the user demographic changes, but there is evidence that may happen.

As Robert Suares, Organizational Leader of VOCAL New York, pointed out, “Many of our lighter skinned brothers and sisters affected by opioids are starting to understand what people of color have known for a long time. We are starting to come together to say that the policies of the past will no longer be tolerated. We are building a movement.”

With directly impacted people guiding drug policy reform as experts and leaders, engaging new collaborators, fighting against divisive rhetoric, and framing the message so that a critical mass of the public is invested in permanent reform, we may yet build a movement that is here to stay.

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Tessie Castillo is a writer and drug policy advocate in Raleigh, North Carolina. Her articles explore topics such as criminal justice reform, drug policy, and harm reduction. Castillo previously served as the Advocacy and Communications Coordinator for the North Carolina Harm Reduction Coalition (NCHRC), a statewide nonprofit that advances drug policy and criminal justice reform. During that time, she played a pivotal role in helping to legalize syringe exchange programs and expand access to naloxone, a medicine that reverses opioid overdose. Find Tessie at her website or on Facebook, TwitterInstagram, and LinkedIn.