Drug-overdose deaths have been climbing steadily since the late 1990s—to the point that they now easily outnumber deaths by car or gun—and lawmakers have finally taken notice. Last week saw two significant events in the effort to fight the epidemic.
The Obama administration offered a handful of actions. It finalized a rule to expand the use of buprenorphine, a drug that, like methadone, satisfies addicts’ cravings without getting them very high. Doctors were previously limited to prescribing it to 100 patients; the ceiling is now 275. (Apparently the cap was put in place out of a concern that the drug could itself be abused or sold on the black market.) It also proposed ending a system that pays Medicare doctors in part based on whether patients say their pain was adequately managed, which many say leads doctors to overprescribe opioids.
For its part, Congress struggled to hammer out a compromise on the Comprehensive Addiction and Recovery Act. Right and left agreed on the basic outlines of the bill—indeed, they met in a conference committee because both the House and the Senate had already passed a version of it. The legislation is aptly named, as it covers not only treatment, but also drugs that reverse overdoses and prescription monitoring.
The argument was over how to fund the new initiatives. Democrats wanted to include almost $1 billion in the bill itself; Republicans wanted to leave the money debate to the normal appropriations process later in the year, and the current GOP appropriations bills spend less. On Friday, the House passed the bill without the funding provisions, and the Senate is expected to begrudgingly follow suit this week. It’s not clear whether the president plans to sign it.
In discussing these efforts, pundits often celebrate their focus on treatment—a “public health” approach, rather than the criminal-justice approach of the past. Expanding treatment is indeed promising, given the long waiting lists at many rehab clinics and studies showing that buprenorphine and similar drugs help significantly (though relapse rates are still high, likely somewhere around 40 percent). Many suggest that the race of the addicts plays a role in the public’s reaction to drug epidemics: unlike many of its predecessors, the opioid crisis is seen—correctly as it happens—as a white phenomenon.
But we aren’t really witnessing a sea change in how we react to drug addiction. It’s more like a modest rebalancing of priorities.
In fact, the War on Drugs has never been waged all that enthusiastically against users, as opposed to dealers. While the vast majority of drug arrests are for possession, most drug prisoners are at least low-level dealers. Even the rightly infamous five-year mandatory minimum for crack possession (since repealed) kicked in at 5 grams, while crack is normally sold in fractions of a gram. The law referred to it as “Serious Crack Possession.”
Americans, as punitive as they may be, have long supported keeping addicts out of prison. In 1989, at the height of both the crack epidemic and tough-on-crime fever, the public favored treatment over punishment 57-33 percent, as Barry Latzer notes in The Rise and Fall of Violent Crime in America. And in 2001, when the current epidemic was in its infancy (drug-overdose deaths were below half their current level), Americans’ favorite anti-drug strategy by far was to stop importation, followed by arresting domestic drug dealers and improving education; arresting users ranked last.
In the years since, drug deaths have skyrocketed, especially among whites, but whites have become no more likely to say we’re not spending enough to fight addiction. A majority of whites have thought we spend too little since at least the 1970s. If anything is changing, it’s that policymakers may finally take heed, now that our drug-overdose rate is about triple our murder rate.
Empathy for addicts, however, has not precluded a criminal-justice response to dealers in the past, and this is unlikely to change too much. For example, Congress’s much-hyped but now moribund sentencing-reform compromise would actually increase penalties for those who make, distribute, or traffic Fentanyl, an opioid that is often mixed with heroin to lethal effect. States have debated similar proposals.
Speaking of heroin, many painkiller addicts have switched to it as policymakers have worked to cut down on opioid prescribing, and Mexican cartels have come north to meet the demand. Late last month, Sean Kennedy and Parker Abt of the American Enterprise Institute suggested that heroin may play a role in the widely reported rise of homicide in big cities over the past two years. The increases seem to be concentrated in cities where more than one gang is vying for heroin turf. This theory is far from proven, but no one disputes that foreign criminal enterprises are putting down roots in the U.S. to distribute the narcotic, or that drug-gang activity is, to put it mildly, undesirable.
For better or worse, it seems almost inevitable that American law-enforcement agencies will put up a serious fight if these trends continue. The people wouldn’t stand for it otherwise, even as they strongly support doing everything we can to help the addicted.
Robert VerBruggen is managing editor of The American Conservative.Follow @RAVerBruggen