by Susan Kim, Americorps VISTA at RxSafe Marin

The US is experiencing an Opioid Epidemic that is more harmful is a public health crisis. Drug overdose is the #1 cause of
accidental death in America, surpassing car crashes and gunshots. Over 70,000 died from opioid ODs in 2018. Most U.S.
drug epidemics over the past two centuries were sparked by pharmaceutical companies and physicians pushing
products that gradually proved to be addictive and dangerous.
Beginning in the 1800s, opiate-based medications like opium was sold in liquid form like laudanum and used for pain or
trouble sleeping. It was also used to get high by “opium fiends” who smoked it in opium dens in San Francisco’s
Chinatown.

The drug problem shifted from opium after the Civil War when soldiers became addicted to a new pharmaceutical called
morphine, one of the first of many man-made opioids. The morphine epidemic was made worse when pharmaceutical
companies Merck & Bayer developed cocaine and heroin, in part to treat morphine addiction. Cocaine became an
ingredient in over-the-counter tonics for sinus problems and other ailments. Because of its energizing effects, beverage
makers put it in their wines and sodas and laborers in the South sniffed it to get through grueling work shifts.
In the early 1900s cocaine became a reviled epidemic and physicians began documenting use disorders and police linked
cocaine use to prostitution and violent crime. Cocaine abuse led to the first national effort to contain a drug epidemic
and in 1914, Congress passed the Harrison Act, making it illegal to sell cocaine and heroin in over-the-counter remedies
or in consumer products. Cocaine use remained rampant in 1920s Hollywood, but the Depression and the growing
stigma of cocaine use restrained the epidemic.

Amphetamines were developed in the 1930s and took off in the 1950s because they were marketed by drug companies
and promoted by doctors for weight loss, anxiety and depression. Drug company, Burroughs Wellcome developed
methamphetamine and marketed it to American housewives as a diet pill and energizer. Among other drug abusers,
meth users were called speed freaks and were outcast in a society of drug-user outcasts. Greater regulation of the drugs
in the 1970s, along with the stigma attached to speed freaks, caused meth use to decline.

In the 1960s & 1970s, heroin-use surged again partly because soldiers returning from war who began using heroin in
Vietnam but unlike previous drug epidemics fueled by doctors and pharmaceutical companies, the heroin crisis
victimized poor inner-city neighborhoods most. In 1970-1971, more black and Puerto Rican youth died of heroin OD
than any other cause but there was little compassion for heroin addicts. In 1971, President Nixon declared a “war on
drugs”, kicking off a long period of fierce law enforcement and tougher sentences for drug crimes. Heroin use faded in
the late ’70s but cocaine use came back stronger in the form of rock cocaine which sold on the streets for $5 or $10
fueling an epidemic of crack in the 1980s. At this time, youth were wary of heroin and needles, thought crack was less
dangerous because it was smoked like marijuana. Like the heroin surge before it, crack was tied to urban blight and
violent crime and died out in the 1990s.

The US history of drug epidemics have experts examining solutions from a historical perspective. Evidence had
determined that it was not the strict police action towards drug users and dealers that curbed the crack crisis. Instead,
the decline of crack use is attributed to families and communities who were shattered by crack-related murders and
arrests, causing a growing repulsion to crack and “crackheads” in the community.

LET’S COMPARE THE NUMBERS
In 1900, when cocaine and heroin were legal and popular, there were 250,000 Americans with a drug addiction,
according to one historical estimate. That was about 1 in 300 Americans. Today, the estimate is 1 in 133, and drugs are
deadlier than ever. There were fewer than 3,000 overdose deaths in 1970, when a heroin epidemic was raging in U.S.
cities. There were fewer than 5,000 recorded in 1988, around the height of the crack epidemic. More than 70,000
Americans died from an opioid drug overdose in 2018. OxyContin and aggressive marketing and distribution pushed
hundreds of millions of pills into communities. Then more and more addicts turned to cheaper alternatives, bought
illegally, like heroin and fentanyl.

SOLUTIONS – What to do now?
The first step in understanding substance use disorder is to ask what is stigma? Stigma, by definition, is a mark of
disgrace associated with a circumstance, quality, or person. Essentially, a stigma is a bad reputation across a specific
group of people. The stigma of addiction comes as no surprise considering so few people understand the disease of
addiction at all. Science has proven that substance use disorder is a chronic relapsing brain disease that can be managed
with medical treatment. It is NOT a moral failing or a character flaw. Addiction is highly stigmatized, and that stigma is
fueling an American public health crisis.
The World Health Organization (WHO) defines stigma as a major cause of discrimination and exclusion and it contributes
to the abuse of human rights. Stigma is rarely based on facts but rather on assumptions, preconceptions, and
generalizations. Its negative impact can be prevented or lessened through education and awareness. This is the time for
change.

Many other diseases like Cancer and HIV, have been harmfully affected by stigma. Years ago, people whispered about
“The Big C”. It was taboo, and people who had cancer were often isolated but as people began talking about cancer
openly, sharing their personal stories and uniting their communities, the stigma subsided. Today, cancer awareness
events and organizations commonplace making people unaware that the disease was considered a shameful secret
For centuries, those who indulged in excess were judged, and excessive use was moral failing of the individual. In the
1970’s, drug policies centered on punishment and those who used drugs were criminals who made a personal choice to
break the law. It was the moral theory of addiction.
Then In the 1980’s, the disease model was popularized, viewing addiction as a biological disease that could be treated
like other medical diagnoses. In this model, people began to understand that addiction is something that happens in the
brain, and overcoming it requires medical treatment.
At the same time addiction was being defined as a brain disease, another movement called Co Addiction or “tough love”
became popular.

The co-dependency movement pushed addicts to hit “rock bottom.” “Tough love” makes sense if one considers
addiction as a choice. Setting limits hoping to force an individual to choose to stop being an addict. This approach causes
pain to those families involved, and for some “tough love” has worked.
It is understandable why a family feels that have no more options because SUD affects not only the user, but everyone
close to them. Feeling that frustration, fear and pain repeatedly takes a toll, leaving all feeling lost and not knowing what
to do. “Tough love” feels like the last stop of a complicated journey. “Tough love” also removes love and support people
with SUD desperately need. They already feel stigmatized and isolated, alone and unworthy. Negative feelings, for which
drug use acts as a coping mechanism. Depriving loved ones of support and love often amplifying those negative feelings
of loneliness, fear or anger resulting in the opposite of what was intended: increasing drug use, not deterring.

Providing empathy and social support have been shown to have a greater positive impact on recovery than “tough love.” And
second, allowing someone to hit” rock bottom” can result in worse outcomes, possibly even death, as “rock bottom”
may mean an overdose from which one cannot recover.
Stigma is preventing harm reduction practices. Narcan and fentanyl test strips save lives. The rates for new HEP A, B & C
and HIV case are the highest ever. In one small city of 50,000, 70 new cases of HIV were reported over a 4-month period.
Syringe exchange can stop the spread of HEP A, B & C and HIV. That’s what harm reduction is all about. It prevents an
already bad situation from getting worse.

Currently, health officials are fighting the current opioid epidemic on three fronts, preventing opioid OD deaths, helping
people recover from addiction, and preventing new cases of substance use disorders. By studying the history of drug
epidemics in the US, experts now know what doesn’t work. Today, many including law enforcement believe the “war on
drugs” is ineffective in the fight against drug epidemics. Data indicates that incarceration drug users serves to add to the
problem. Society is beginning to understand that we cannot arrest our way out of the opioid crisis. Health officials
recommend prevention and stigma awareness education & reduction as the best tools to combat substance use
disorders. Co-dependency movements like “tough love” ostracize and isolate people who are already suffering and does
little to help them. Stigma is the biggest barrier in recover and may impede them from seeking treatment.

Society needs to support people and families suffering with substance use disorder better. The first step is to address
the stigma of addiction and open our hearts and minds to new treatment tools and tactics. Recognize that MAT
(Medically Assisted Treatment) or MOUD (Medication for Opioid Use Disorder) plus behavioral therapy is the best
treatment and allow MAT / MPUD in jail. All Americans need to support harm reduction like Narcan training &
distribution, syringe exchange, and support data-proven methods and tools like MAT and MOUD.
Dr. Kimberly Sue is the medical director of the Harm Reduction Coalition, a national advocacy group that works to
change U.S. policies and attitudes about the treatment of drug users. She’s also a Harvard-trained anthropologist and a
physician at the Rikers Island jail system in New York.

The idea that substance use is a disease of the will is very heavily entrenched in American ideology. We have a hatred of
people who are dependent on anything — including the government — for support. The idea of people being on
welfare, the idea of people not working. We have these very strong puritanical roots and the idea that we make our bed,
we lie in it, and you pull yourself up by your own bootstraps. It pits people against each other in a way.
People who use drugs — they have a physical dependence on a substance. It doesn’t necessarily mean that they’re bad
people, but our society tells them that they’re bad people.
Sue thinks it’s a huge mistake to put people with drug use disorder behind bars. “Incarceration is not an effective social
policy,” she says. “It’s not an evidence-based policy. It’s not effective in deterring crime. But we continue to rely on it for
reasons that have to do with morality.”