Perspective: Why Comparing Painkiller Addiction to Crack Worsens the Problem

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As the Obama administration and the media increasingly promote the idea that prescription drug misuse is this generation’s crack epidemic, I want to take a few minutes to note how irresponsible and off-base this idea is. 

First, there is a widespread misunderstanding about how the crack epidemic affected society. People tend to see crack as the destroyer of inner cities, yet it was actually the government’s crack-related policies that did the most harm.

Consider that although whites use and sell cocaine at exactly the same rates as blacks, the U.S. puts 1 in 3 young African American men in their 20s under criminal justice supervision, largely as a result of the drug war—a number many times that for young white men. At any given time, 7% of all young African American men are incarcerated. Despite equal rates of drug use and sales among whites and ethnic minorities, 90% of state prisoners who are sentenced for drug crimes are black or Hispanic.

Crack itself didn’t harm the black family the way locking up black parents did. It was the federal policies that were supposedly aimed at fighting the drug that did the most damage.  One in 15 African American children now have an imprisoned parent, and 70% of black mothers are single. Mainly because of the drug war, 13% of black men now have felony convictions, which can significantly hamper employment opportunities.

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I should point out as well that incarceration either exacerbates or has no effect on addiction — so drug-war policy cannot be credited with the decline in crack use that has occurred in recent years. Rather, that was largely due to what some have called the “older sibling” effect, which steered youth, having witnessed the effects of crack on the older generation, away from the drug. The older sibling effect is also why drug “epidemics” never escalate infinitely the way fear-mongerers predict in order to justify harsh policies.

I wrote last week about the New York Timescoverage of “Oxycontin babies,” which failed to note that that stereotype itself holds potential for great harm: the damage from stereotyping children as “crack babies” in the late 1980s and early ’90s was found to be worse than that caused by drug, causing caregivers to treat these babies more harshly and allowing the youngsters’ behavioral problems to be attributed to drug exposure instead of child abuse.

In one of the angriest letters to the editor that I’ve ever seen from an academic, Yale professor and addiction expert David Fiellin expressed further outrage in response to the story. He noted that the “jarring ethical quandary” that doctors navigate, according to the Times, when deciding how to treat opioid-addicted pregnant women actually doesn’t exist.

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In the Apr. 19 letter, Fiellin wrote:

Scientific evidence and expert consensus support the provision of methadone or buprenorphine over alternative treatments, including withdrawal, during pregnancy.

This is the recommendation of a National Institutes of Health consensus panel, three federal guidelines and a World Health Organization guideline.

In other words, the Times omitted key facts showing that the relevant experts are not conflicted on this question, exaggerating fears about the future of opioid-affected babies — in the same way the media did during the crack years. The Times went on to run another similarly panic-filled article this week, headlined “Ohio County Losing Its Young to Painkillers’ Grip.”

If we want to do better this time — and not scapegoat minorities or worsen the suffering of pain patients — hysterical coverage like this doesn’t help. To promote compassionate and realistic solutions, we need to recognize that addiction is not primarily a cause, but a result, of community problems — and one that can exacerbate them. We need to treat the emotional and economic pain that drives addiction, rather than demonizing painkillers or the people who take them. As the White Stripes sang, “You can’t take the effect and make it the cause.”