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.
Partisan Polarization
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.
Moving Forward
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
References
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Gilens, Martin. 2005. “Inequality and Democratic Responsiveness.” The Public Opinion Quarterly 69(5): pp. 778-796.
Hassan, Maggie. 2019. “To Hold Big Pharma Accountable, First We Need Transparency.” Modern Healthcare. https://www.modernhealthcare.com/opinion-editorial/hold-big-pharma-accountable-first-we-need-transparency (November 18, 2021).
Keating, Dan, and Lenny Bernstein. “100,000 Americans Died of Drug Overdoses in 12 Months during the Pandemic.” Washington Post. https://www.washingtonpost.com/health/2021/11/17/overdose-deaths-pandemic-fentanyl/ (November 18, 2021).
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This is an amazing topic! Is it an uncomfortable topic to talk about or bring to the table? Definitely! But one thing you said that I agree with and want to add to, was when you said, “the problem with the US opioid crisis is a lack of understanding, compounded with a lack of urgency.” This is true because this is something that we need to rethink because there’s a lot of stigmas where people often say “oh, he or she is addicted to Opioid, they’re weak and are failures.” But in reality, this addiction is more of a disease that hijacks and physically changes the brain, it drives people to put Opioids above everything else. Opioid is not a moral weakness, but rather it’s a chronic disease. It changes people brain, which makes it harder for them to quit, even when addiction is destroying their lives. Even when they try again and again. This is a bigger topic that needs to be stressed upon in this country. I liked how you mentioned the unequal treatment against people of color because that’s one of the big stigmas in this country against people of color when it comes to drug addiction. I liked how you included the statistics:
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.
Like you also said, “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.” This is true because people of color are often characterized and stigmatized, the misconception and biases that’s perceived, is unbelievable. Not many would agree with this, but the overall truth about Opioids is that it needs a lot of attention and people need to be educated on it more. The U.S. needs to do a better job reporting on it and emphasizing that this is a problem, and it needs to be talked about.
Marley,
I think you highlighted this important topic so well. Given the pandemic, so many people have fallen to mental health issues due to the absence of human contact and isolation that we’ve faced for the past 20 something months. It does not shock me that the number of overdose deaths has increased by over a quarter in the past year. The number is staggering and devastating. But it is a result of lack of government action and assistance. As you stated, the opioid crisis is due to “a lack of understanding, compounded with a lack of urgency.” If the US had tackled this issue as it first arose with the same level of urgency that they tackled COVID-19, we could’ve avoided the death of 275 Americans each day. It shocks me that the death of so many can be so overlooked and brushed under the carpet by policymakers. How many more lives is it going to take to make a difference? For the country to take action? I believe 1 death is enough to call for action. I’m disappointed that the people we elect to office don’t agree. Noting the racial inequality and bias that is paired with this crisis is important, because racial minorities are constantly taking the fall for social issues. I think socioeconomic backgrounds and communities with lower incomes should be observed and considered to be assisted first. I’m not sure how long it will be before every citizen is considered to be of equal value in the US but I don’t see it happening soon, unfortunately. The influence of money is also staggering, and this corporate and monetary corruption is just another factor of the eroding democracy in the US. This corruption is being overlooked by the US, as they continue to profit from the decisions of big pharma, and as long as that occurs, the deaths tied to the opioid crisis will also be ignored. Corruption is just another factor of a failing democracy, as corruption ties into populism, which drives democracies to become autocracies, as Andrea Kendall-Taylor and Erica Frantz note. Do you think the three-pronged strategy that you outlined will be feasible in the foreseeable future? Will Biden be the one to take action on this or will we have to wait for another administration to take action and address this emergency issue? I hope this can be solved sooner rather than later.
Marley,
Great post! You do a good job at explaining your argument that the opioid crisis is a result of democratic erosion in the United States. Purdue Pharma has come under fire recently for single-handedly starting the issue. You touch on this in your “Improper Influence of Money in Politics” section. A whole post can be dedicated to their role and influences in making opioids accessible. But, you take this blog post to a different level of analysis. You say this was only possible because of how the system is broken. From lobbying to how the crisis unfairly impacts those already disadvantaged by the system to the ineffectiveness of polarization.
My question for you is, how are local and state politics fighting this issue? Do we see the same kind of system on the state level that we do on the federal level? For example, in Massachusetts, midwestern counties have been hard hit by not only opioids but also heroin. So much so that the most affected towns, Holyoke and Springfield have been referred to as the “Heroin Highway” as Interstate-95 connects these gateway cities to New York City. Are the opioid crisis and the destruction of communities/livelihood due to heroin addiction comparable issues, in your opinion with your knowledge on the topic?
Overall, insightful post!
Hi Marley! I applaud you for tackling such a big issue in your blog post. The opioid epidemic is an important and dense topic and you did a great job of covering all of the details in a succinct blog post. This is an issue that should have been at the forefront of conversations for the past decade but, unfortunately, it gets ignored and outshined by issues that are, in my opinion, less important. I wrote in my first blog post that politics has become less about the actual issues and I feel as if this is a perfect example. Our legislators should be fighting for the issues that are impacting the country the most. As you stated, the opioid epidemic has taken over the country and is getting increasingly worse every year. Why are our legislators not working harder to help fix this? I would love to know more about your thoughts on this.
I loved your section about “improper influence of money in politics” and wanted to dive into it a little deeper! The amount of money and lobbying efforts that contribute to the opioid epidemic is outrageous. The fact that this information and these statistics are easily available to the public makes it even worse. The elected officials contributing to this should not be reelected and it is so frustrating that their constituents continue to vote for them despite of this. Personally, I would love to see more government regulation of the money and information that is involved in these misleading campaigns. Do you think that would make a difference? In class, we have had plenty of discussions about crossing the line and restricting/regulating the freedom of others. There hasn’t been a solid agreement about what is crossing the line or even where the line is, and I feel that the public may be struggling with the same issue regarding the opioid crisis. At what point do we tell lobbyists that enough is enough and fight for more regulations?
Overall, I really love the research you did on this issue. I think that the three solutions you found from freedom house are great because they are concrete solutions that people can look at and work towards. These solutions helped me identify the root cause of this issue and inspired me to learn more about it in the future. Solving the opioid epidemic has always seemed like a “pie in the sky” type policy but reading all of your research made me realize that it just needs to be broken down into smaller, doable steps.