The United States is facing two catastrophic challenges simultaneously, a pandemic, and a forgotten but long-present epidemic, the US opioid crisis. While talk of opioids and overdoses is not new to many Americans, the death rate and the recent dramatic uptick of this crisis are staggering. On November 17th, 2021 the US government announced that more than 100,000 people have died of overdoses between April 2020 and April 2021. This equates to roughly 275 people every day and represents a 28.5% increase in overdose deaths from the same time period a year earlier. With crisis comes motivation for change and it is the responsibility of the US federal and state governments to address this issue head-on, as this crisis is a symptom of a bigger issue, a weakening of American democracy.
Freedom House has identified three fundamental issues with American democracy: unequal treatment for people of color, the improper influence of money in politics, and an increase of polarization and extremism. It is through the examination of these three variables that it becomes clear, the US opioid epidemic is both a symptom and a driver of democratic backsliding in the United States.
Characterizing the Problem
Opioids are a class of drugs that include the illegal drug heroin, synthetic opioids such as fentanyl, and pain relievers available legally by prescription. Fatal overdoses involving synthetic opioids are the primary driver of the increased mortality rate, according to the DEA and CDC. In 2020, Fentanyl factored into 93.1% of opioid-related deaths in Maryland. Since 2015, spikes in fentanyl usage, both intentional and unintentional, have drastically increased the death rate due to its potency.
The problem with the US opioid crisis is a lack of understanding, compounded with a lack of urgency. To put things in perspective, gun violence is still a major danger to American lives with nearly 20,000 people being killed during the pandemic. This crisis is viewed as an urgent matter by the public. In comparison, an issue that has killed more people in the same time span, 100,000 overdose deaths is often overlooked by policymakers.
Unequal Treatment For People of Color
The unequal treatment of people of color pervades most aspects of American life, and the opioid crisis is no exception. America’s longest war, the “War on Drugs,” has harmed this community by institutionalizing racial bias in law enforcement. June 2021 marked the 50th anniversary of the war on drugs, and yet, after spending over a trillion dollars enforcing drug policy, the US continuously faces record overdose rates.
In 2019, white Americans accounted for roughly 80 percent of opioid overdose victims, but the incarceration statistics do not reflect this. In 2019 nearly 80% of the people in federal prison and almost 60% of people in state prison for drug offenses were Black or Latino. Additionally, despite making up just 13.4% of the US population, the FBI reported that in 2019 more than a quarter of drug-related arrests were of Black American adults.
Misconceptions and bias should not inform drug policy, but the fundamental lack of understanding about who is getting addicted, and how, has meant that many communities are falling through the cracks. The failure to address this inequality has led to a very low score on Freedom House for the U.S. ensures that laws, practices, and policies are applied equally across the population. In a true democracy, every citizen must be of equal value. Therefore, the US must do more to address how drug policies harm communities of color.
Improper Influence of Money in Politics
The influence of money in US politics is directly tied to the ongoing opioid crisis. This is supported by lobbying and information campaigns such as issue-centric lobbying firms, as well as pharmaceutical companies themselves. The industry spends an average of $233 million a year lobbying the US Federal Government. Historically, there have been massive campaigns to market opioids as “non-addictive,” when this is scientifically inaccurate. These strategies are effective; a new study has shown that physician target marketing is directly associated with opioid overdose deaths. It was found that for every three additional payments made to physicians by pharmaceutical companies, overdose rates were roughly 18% higher.
Money that could be used to help fight addiction is constantly being cycled through the industry, and in the process, also being used to subvert government regulations. Recently, a major producer of a fentanyl drug was able to exert influence over the development of the drug’s risk evaluation strategy. The development of safety strategies is required by the Food and Drug Administration to keep medications from being improperly prescribed, but there is an obvious conflict of interest when the companies who aim to make a profit from these drugs are also influencing their safety standards.
A key characteristic of democracy is the continuing responsiveness of the government to the preferences of its citizens. While the opioid crisis affects communities in both red and blue states, the nature of the conversation around implementing decisive opioid policy is very polarizing in Congress and the federal government. This leads to band-aid policy proposals that do very little to address the real drivers of this crisis. As President Biden’s Social Policy Bill is making its way through Congress, one of the main recognitions of any type of drug policy only limits the amount that pharmaceutical companies can increase drug prices. This does little to address addiction and drug abuse, but it has still led to intense lobbying from the pharmaceutical industry. There has been no debate about addressing this crisis because partisanship often gets in the way of real progress.
This crisis clearly can not be solved by increasing the amount of available funding, it requires addressing inefficiency at the core of our governing bodies, and reevaluating the way we think about opioids. Many experts suggest that the strategy going forward should be three-pronged, and focus on reducing unnecessary prescriptions, funding specific treatment options, and improving social services while reducing stigma. This is the plan, but it will take recognizing and addressing the harm that this crisis continues to create in communities of color, ensuring that big pharmaceutical companies take responsibility, and ultimately bridging the partisan divide in the US that has stopped critical bills in their tracks. As the United States continues to grapple with a multitude of pressing issues, it is important to shift our mindsets and realize that many of these problems stem from the same failings in the system, which ultimately connect to the erosion of democracy. It may take a long time to address these overarching issues in governance, but in the meantime, let’s treat the US opioid crisis for what it truly is, an emergency.
Photo Credit: Joe Piette
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