The Opioid Crisis: The War on Drugs Is Over. Long Live the War on Drugs

Abstract

A closer examination of media coverage, the response of law enforcement and policy makers, the legislative record, and the availability of proven, high-quality treatments for substance abuse casts doubt on claims that the country pivoted toward public health and harm-reduction strategies to address the opioid crisis because its victims were disproportionately white people. Law enforcement solutions directed at people who use and sell street drugs continue to far outpace public health and harm-reduction strategies. Government support for expanding access to proven treatments for opioid use disorder that save and rebuild lives remains paltry given the scale of this public health catastrophe. And although the rhetoric has been somewhat more sympathetic, at times it rivals the excesses of the crack era. The article examines the various phases of the opioid crisis as they have unfolded over the past 25 years; related geographic and racial shifts in overdose fatalities with each new phase; media coverage of the crisis; the federal government's response, including by the US Congress and presidents from George H.W. Bush to Joe Biden; punitive developments at the state and local levels; and the country's poor record on prevention and making effective treatment widely available for people with substance use disorder.