All eyes were on President Trump Thursday last month while he formally declared the opioid crisis a public health emergency. But how many people noticed the woman to his left? Dressed in neutral tones, firmly in frame throughout the speech, stood Sara Dean Collier, a woman in recovery from opioid addiction who First Lady Melania Trump cited during her introduction. Collier was the single source mentioned from the recovery community, the token addict—and she looked as uncomfortable standing there as that designation sounds.
I understand why she was invited. A tidy white woman, ten years in recovery, positioned neatly behind the president’s shoulder gives the impression that the White House is listening to the people most affected by the crisis—people like Collier and myself who know firsthand the struggle of addiction. But is the White House listening? I’m asking because the “just say no” rhetoric and emphasis on arresting and imprisoning drug dealers is exactly the opposite of what those of us in recovery—or those still engaged in an active addiction—most need to hear. It’s the opposite of what we should be doing to stem the epidemic of opioid addiction.
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It was at that late October announcement that Trump outlined his response to the opioid drug epidemic sweeping the country—a plan that’s inadequate at best, and more likely counterproductive. Let’s start with the funding: At that address, Trump declared the opioid crisis a public health emergency, opening up a mere $57,000 in funds to cover everything from telemedicine to naloxone distribution expansions—partial solutions for a crisis the Centers for Disease Control estimates carries a $78.5 billion price tag. If Trump had declared it a national disaster, which several on his staff were pushing for, he would have unlocked up to billions of dollars in FEMA relief funds. That massive funding shortfall, paired with Medicaid cuts the White House supports, means that the addiction community will be less able to access the care they need, from medication-assisted therapy to substance abuse counseling.
These funding shortfalls, though, are nothing compared with moves his administration has taken to return to the ruthless criminalization of drugs that we saw in the 1980s and 1990s. Trump’s emphasis at that October speech on a Nancy Reagan-style ad campaign—ads likely to cost in the hundreds of millions of dollars—is enough to bring back memories of the golden age of the war on drugs. Trump’s attorney general, Jeff Sessions, has asked prosecutors to pursue the “most serious, readily provable offense,” ending an Obama-era reform that aimed to charge nonviolent drug offenders with less serious crimes.
This return to the criminalization of drug users will set back efforts to solve this epidemic. I know this not only because of what almost every measurement shows us about the failure of the war on drugs, but because of my own life. When I was addicted to heroin, I avoided treatment for years in fear of being labeled an addict or treated like a criminal, the way I saw my friends were–most of whom eventually relapsed due to the pressure of that stigma. Kids (and adults) can say no to drugs all they want—but that’s not going to help us solve the addiction problem we already have on our hands.
To be sure, Trump did make some treatment-focused recommendations that could help, if not coupled with Medicaid and other public health funding cuts. Exploring non-addictive painkillers, loosening requirements for receiving medication-assisted therapy, better training for prescribers—these are all structural, full-picture solutions that might have a lot of impact, if realized (and that’s a big if). But overall, policy recommendations have been heavily weighted toward an anachronistic understanding of drug addiction that condemns anyone who uses opiates long term—many of these new regulations also force chronic pain patients to unfairly shoulder the burden of addiction stigma—rather than taking a hard look the Drug War-era laws that kept some of us addicted for much longer than we should have been.
I am just one example of why these laws failed. I was addicted to heroin for five years. Before my addiction, I shared the common belief that injection drug users were dangerous, dirty and generally inferior to the rest of us.
The criminalization of drugs and drug users has led our social imagination to conjure a vision of the addict as a hollow-eyed fiend overwhelmed by drug-lust. Today’s archetypal “heroin junkie” mirrors the absurdity of the pot-crazed teens from the Reefer Madness era, except that the idea of addiction sufferers as criminals is now so embedded into our culture that even those of us with addictions have stopped questioning it.
I was a senior in college when I became addicted to heroin. I had good grades and a mounting publication record. I was also a mom. Before our relationship ended, my son’s father physically and sexually abused me; leaving me with post-traumatic stress disorder that became so overwhelming I decided to place my son in the care of family. I retained legal rights, a carefully planned decision made in the hopes of avoiding involvement from his abusive father. Shortly after that, I began using opiates. Drugs weren’t new to me—I’d certainly done more than my fair share as a teenager, though my use mostly focused on psychedelics. Before developing PTSD, opioids had always been occasional and in the form of prescription pills. But when a new boyfriend introduced me to heroin, which I initially smoked, I was immediately transported to a world in which I was no longer afraid or angry or numb, a world in which I was capable of falling in love once again. These were feelings I thought my abuser had forever robbed from me. Imagine the seduction of seeing them returned.
Most of my senior year is lost to the haze of heroin, but what I do remember is fear. Fear that if I revealed my addiction to my doctors and counselors—the very people who could have helped me—it would trigger a call to child services. Fear that this would potentially endanger my son’s living arrangement, or lead to contact with my abuser. Fear that even though I never used around my son, I would end up marred for life by a child endangerment charge. Because of those fears, it took me five years to seek treatment. Now, four years into recovery, I am still repairing my finances, relationships and body from the ravages of a years-long addiction. The worst part is that my fears were founded.
1.7 million children in the United States have at least one parent in prison—more than half of whom are incarcerated on drug charges. The Department Health and Human Services reports that over 85,000 children were removed from their homes in 2015 for parental drug use alone. Under the Federal Child Abuse Prevention and Treatment Act, hospital workers are required to report newborns who show signs of withdrawal, even if the symptoms are the result of appropriate prescription drug use, like methadone. In some states, mothers face stiff prosecution for using illegal drugs while pregnant, a discovery that sometimes occurs because these women seek medical care. Speaking to me for an article I published on The Fix, Loretta Finnegan, the executive officer for the College on Problems of Drug Dependence, says that she has seen mothers charged with harming their children because they took methadone while pregnant. “[The courts] ruled that harm has been done if the baby experienced Neonatal Abstinence Syndrome, even if she was compliant on methadone,” explains Finnegan, adding, “That mother had no intention of harm and abuse.”
In his speech Trump referred to these children as “opioid orphans,” and promised to protect these “beautiful, beautiful babies.” But his administration has only focused on punitive measures, neglecting to acknowledge the emotional harm that comes from separating infants from their mothers, and failing to address the consequences these laws have in the lives of addicted women.
The war on drugs has failed. It has failed parents. It has failed children. It has failed Black and Latino communities, which are disproportionately targeted by law enforcement. It has failed tax payers, who unwittingly foot the exorbitant cost of incarceration: $28,000 per inmate yearly, according to the National Institute of Drug Abuse. Not to mention, drug convictions have encouraged a rate of recidivism that alone should justify an immediate and permanent cease-fire: 77 percent of drug offenders are re-arrested within five years of release, according to a report published by the Bureau of Justice.
Even the drug court programs that were supposed to curb the negative impact of drug arrests have been a massive disappointment. Drug courts were introduced in the late 80s but rose to popularity more recently as a means of sending non-violent drug offenders to rehabilitation programs instead of jail or prison. The problem is that some of these people have no desire to stop taking drugs—making treatment a moot point—and even those who do often get mandated to peer groups like 12-step meetings instead of actual, evidence-based therapies. Although several health agencies, including the World Health Organization, have lauded methadone and buprenorphine as the most effective treatments for opioid addiction, about half the many drug court systems in the country will not allow offenders to use either medication. If a person involved in one of these programs that disallows MAT decides to engage in medication treatment anyway, he is considered in violation and may be sent to jail or prison—which is exactly what has happened to users across the country. Because less than 40 correctional facilities in the United States offer methadone or buprenorphine to inmates who are not pregnant, offenders will most likely be forced through a harsh detox that often leads to relapse.
We do not need to hear more drug war rhetoric, or see any more of our lives ruined by drug charges. We do not need promises from our government officials to crack down on low-level drug dealers, many of whom are simply supporting their own addiction. We do not need to hear our lives and our disease described by our president as a “plague,” “scourge,” or “ruination.” We do not need to be bullied by laws that promote recidivism rather than recovery. Even where treatment is offered for addiction, those of us who use it are considered criminals before patients. Would a diabetic be taken off insulin for eating a cupcake? Yet those of us in recovery lose privileges and are sometimes kicked out of treatment for relapsing. The truth is that even if more methadone clinics open, or rural communities gain better access to buprenorphine, these expansions won’t matter if the people who need them still feel as though they do not deserve respect, or that those very treatments are somehow “dirty.”
We created the opioid epidemic not by focusing too little on drug supply and sales, but by focusing on them too much, instead of fighting the stigma that leaves addicted populations feeling hopeless, helpless and afraid. We won’t end it until we change that. Unfortunately, our president doesn’t seem up to the task.