Why the U.S. Responded Differently to the Opioid and Crack Cocaine Epidemics

Professor Ekow Yankah and I were interviewed on Detroit Today by Stephen Henderson. The subject was why the country took a different approach to the current opioid epidemic than it did to the crack cocaine epidemic.

You can listen to the show here. This is a brief summary of my own analysis of why we have had a more public health-oriented response this time around.

1. The opioid epidemic is afflicting white people and middle class people more heavily than did the crack cocaine epidemic. Historically, the country has tended to attribute addiction among oppressed groups as an indicator of moral failing worthy of punishment. That was certainly the dominant perspective on the crack cocaine epidemic in Black communities in the 1980s, which was met with a ferocious law enforcement response. But when a drug epidemic happens among white people (especially white people with economic resources, as Adam Gelb pointed out to me on Twitter, we were not particularly kind to dirt poor white meth-addicted people in the 1990s) the framing of the problem is more sympathetic and the response is much more oriented towards help than discipline.

Ekow made this point beautifully on PBS News Hour recently, and I find particularly powerful his description of how bittersweet the policy change is for Black Americans.

2. The crack cocaine epidemic had enormous associated violence. I was at ground zero on Detroit’s Cass Corridor during the epidemic and it was a frightening place. The violence came about in part from dealers shooting it out, but a lot of it was pharmacologically driven (e.g., people high on cocaine losing their temper and hurting or killing someone). Terrified by all that violence, both blacks and whites demanded tough enforcement and punishment.

The opioid epidemic has been far less violent. Much of the supply came from people who carry stethoscopes rather than guns, and pharmacologically, opioids usually have a sedating effect rather than making people aggressive. Less violence translates into less fear, increasing the likelihood of a more compassionate response.

3. An increasingly successful treatment/recovery movement has achieved major political victories supportive of public health responses to addiction (e.g., the 2008 parity law that expanded access to treatment). You can’t accuse those activists of doing their good work just with whites in mind because they’ve been at it since long before the current epidemic started. They have made a significant difference culturally and politically, and they have benefited addicted people of all races in the process. Good on them, they’ve earned their place in heaven.

[Cross-posted at The Reality-Based Community]

Keith Humphreys

Keith Humphreys is a professor of psychiatry at Stanford University. He served as a senior policy advisor at the White House Office of National Drug Control Policy from 2009 to 2010.