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Substance Use Disorder

Approximately 15-20% of individuals over the age of 18 in the United States suffer from substance use disorder (SUD), and every year a large percentage die from overdose or addiction-related issues. While alcohol use disorder has long been the number one cause of substance-related deaths in the United States, in recent years, deaths from opioid overdoses have skyrocketed, constituting a national public health epidemic.

 

Substance Use Disorder

According to the Center for Disease Control, nearly 50,000 deaths resulted from prescription and illicit opioids in 2016. As of 2018, the National Institute on Drug Abuse reported a daily death rate of approximately 130 people from an opioid overdose; the opioid epidemic is now on par with the number of lives claimed by firearms in the United States every year.

Addiction to any substance is dangerous and often difficult to treat due to

  • high relapse rates
  • the need for continuous, long term or multiple rounds of treatment
  • co-occurring mental and physical health problems
  • adverse impact on social and financial resources
  • pervasive stigmatization of addicted people

Opioid Use Disorder (OUD) poses additional and unique challenges

  • due to their highly addictive nature
  • an arduous detox process
  • the extensive prescription of opioids within the healthcare system

Conceptualization and Criminalization of Addiction

The concept of addiction first appeared in the early 1800s through the writings of Thomas De Quincy in what has been characterized as the world’s first addiction memoir. De Quincy struggled with opioid use, and he wrote equally of the euphoric highs and harrowing lows of addiction. These contradicting descriptions of opium perpetuated the belief that addiction was a voluntary choice. 

The vilification of addicts in the eighteenth and nineteenth centuries has left a lasting mark on society’s beliefs about addiction and how to treat it. Overwhelmingly, US drug policy and treatment have prioritized law and order rather than focused on understanding and helping those who are afflicted by addiction.

Race and Addiction

During the 1850s, addiction was likened to “a form of chemical slavery,” and ties between race and addiction began to circulate in the American consciousness. Historically, the term “addiction” refers to a relationship of bondage, the Latin root meaning “enslaved by” or “bound to,” which conjured associations between Black people and addiction, interlocking and overlapping the stereotypes of the two. 

Social threats of addiction and drug use became a convenient new way to oppress and control Black, Indigenous, People of Color (BIPOC) under the guise of law and order. Today, Black people are ten times more likely than white people to be arrested for drugs and sentenced to prison time. The Association for Multidisciplinary Education and Research in Substance Use and Addiction proposes an initial set of strategies to promote diversity, equity, and inclusion, to dismantle racism against Black, Indigenous, and people of color across the substance use continuum.

Epidemics

History has demonstrated that drug epidemics have hit the hardest in large cities’ poor communities, primarily Black, Indigenous, and People of Color (BIPOC). Notably, the crack cocaine epidemic beginning in the mid-1980s and continuing through the 1990s, ravaged Black communities, particularly Black youth, in major cities like New York to an extent previously unseen. 

The opioid epidemic, however, has broken this mold to some extent, primarily impacting white Americans in rural areas. Sources and methods of access to opiates have impacted who is most likely to use them and who is most at risk for abuse, addiction, and overdose-related injury and death. 

Prescription opioid overdose deaths alone were twice as high for white people than for Black and Hispanic Americans between 1993 and 2009. Below is the breakdown of individuals who overdosed on opioids in 2019:

  • 79% Non-Hispanic White
  • 10% Black
  • 8% Hispanic

This racial disparity may be because many individuals with opioid addiction first began using after receiving a legal prescription, and medical racism infiltrates prescription writing. Researchers have found that providers’ conscious or unconscious prejudiced belief that BIPOC are more likely to abuse drugs has caused white patients to be prescribed opioids disproportionately more than any other racial group.

America’s Response to Addiction

  • 1960s represented a period of dramatic increases in-laws and regulations related to drugs that dramatically increased incarceration rates and essentially halted all medical and life sciences research on drug safety and medical efficacy.
  • 1971 - President Nixon declared a “war on drugs,” introducing harsh mandatory minimum sentencing for drug offenses and funneling money into federal drug control agencies like the Drug Enforcement Agency.
  • 1980 - President Reagan took office just before the crack-cocaine epidemic hit the United States, he expanded America’s war on drug policies.
  • From 1980, the number of citizens behind bars for non-violent drug offenses increased from 50,000 to 400,000.
Over time, harsher, zero-tolerance drug policies and anti-drug campaigns like “DARE” expanded (now widely discredited and infamous for its inefficiency) and funneled funding away from treatment and research.
  • 1980-1990s, the New York Rockefeller laws, passed by Governor Rockefeller in 1973, tripled arrests for drug-related crimes. This legislation was an effort to look “tough on crime” and mandated minimum sentences of 15 years to life in prison for possession of narcotics, even for first-time offenders.
  • 2016, the American Surgeon General officially declared addiction a disease and, for the first time, explicitly condemned the narrative of addiction as a moral failure, nearly 250 years after it was first suggested

The legacy created by the “war on drugs” and “tough on crime” era can still be seen today in incarceration rates, drug arrests, and addiction-related deaths and overdoses.

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