The Opioid Crisis has wreaked havoc across America, taking lives and devastating families, neighborhoods, and communities. But this isn’t the first time we’ve suffered a deadly drug crisis. In today’s episode, Dr. Abdul El-Sayed tells the tale of two crises: the opioid epidemic of today and the crack epidemic of the 1980s, contrasting the government’s and media’s responses to these crises—and what they tell us about the nature of drug use and structural racism in America.

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ABDUL VO: I don’t think I need to tell you this — but there’s an opioid crisis roiling our nation…

ARCHIVAL: The Opioid Epidemic has taken thousands of lives. It’s an absolute crisis. Epidemic. Epidemic. Epidemic…

ABDUL VO: For the last — what is it — decade now, the Opioid Crisis has ravaged our communities. First it was opioids in the form of prescription painkillers.. Then it evolved into opioids in the form of Heroin… and now its opioids in the form of Fentanyl. The crisis keeps growing — it keeps… evolving.

We’re nowhere near putting it to an end. Millions of people and their families, from Washington to Florida, are dealing with addiction. Thousands are dying in our communities. And the family  that kicked the whole thing off to line their pockets — the Sackler family, through their company Purdue Pharmaceuticals and their prescription opioid Oxycontin — still walk free, sponsoring ritzy art at places like New York’s Metropolitan Museum. 

But, for what it’s worth, our politicians are at least… trying. 

ARCHIVAL: Famous Republicans and talking heads showing empathy for opioid addicts

ABDUL VO: Now, by now you’ve gotten used to our MO in this series. People ignoring science, government ignoring people. Bad shit happening.

But when it comes to the opioid crisis, government is finally starting to get its shit together.

ARCHIVAL: More of the above.

Politicians on both sides of the aisle are seeing that people affected by opioids are just people in pain and that we have to treat addiction that way. 

I mean, don’t get me wrong, they’re not doing nearly enough — like not even close to enough. But for the love of god, they’re at least starting to move in the right direction. 

Thing is, it’s about God-damn time. See, the Opioid Epidemic isn’t our first drug crisis. Not even close. And so much of what we’re doing this time around is correcting what we did the last time around, when our politicians had a very different response. 

ARCHIVAL: HW Bush back of crack presser, Nancy Reagan “just say no,” Ronald Reagan war on drugs, DARE song

ABDUL VO: The story of the Opioid Epidemic isn’t just the story of one drug, or failing rural economies, or of Big Pharama’s drug-pushing greed. Those stories are all part of it. But actually, the opioid crisis is just a chapter in a much longer story–the rest of which we seem to have conveniently forgotten, or are just choosing to ignore. 

Today, we tell you the rest of the story – through a tale of two crises: opioids–and crack. The similarities and the differences–and the consequences laid bare by our government and society’s response. 

This is America Dissected with Abdul El-Sayed, I’m your host. 

• SERIES TITLE AND THEME

ACT 1: Addiction

INTV – ABDUL: [11:59]  Tell me about what it’s like to be in the midst of an addiction. What does it feel like how do you perceive yourself? How do people perceive you? Can you, can you tell me a little bit about what that’s like? How it feels on the inside. 

INTV – GLORIA: [12:14]  Wow, you know, I haven’t even felt that feeling in a long time.

And when you said that I only think the first was shame and guilt, you know. You just have so much pain that you wish you could disappear, you wish no one could see you.

ABDUL VO: That’s Gloria. Born and raised in Brooklyn, New York. She still lives there. Gloria refers to herself as a grateful recovering addict. 

In order to understand what people with addiction are suffering, I asked Gloria to sit down with me to share her experience with addiction. See, too often, when we talk about addiction, or talk about drug crises — we neglect to center the most important voices: those of the victims, the people who’ve done battle with addiction. They have a lot to teach us.

INTV – GLORIA: [9:36] I like to make sure people understand that not everybody goes and uses drugs with the intent of being no good or not contributing to society, they you know could just be having a good time.

[13:12]  I think I liked getting high initially. I think I thought that I could handle it because I didn’t get drunk like my friends or I could smoke more pot than other people. So, of course when it was time to party at another level I was ready for that as well, but it was the lowest point of my life.

[10:24]  I tried it as well and you know, six months later, I’m still you know seeking that hit and not realizing that I’m knee-deep in something that I have no idea how I’m going to get out of and what was really.

INTV – GLORIA: [14:16] And you know, you’re chasing something you’re never going to get. You feel horrible about yourself. 

[13:52] It was… it’s almost like indescribable in quicksand. You know, you might feel like you can move and get around, but you just keep sinking…

[11:55]  You wish no one could see you, you know, one of the differences would crack. That was really it just didn’t give you a chance to rest your mind. So you couldn’t recover before you were just out there running after it again, so you let yourself go. You couldn’t care about people who you truly loved and there was no way to show them because your mind was focused on your next hit.

ABDUL VO: Gloria, like most people suffering addiction, was desperate to climb out of the quicksand. 

INTV – GLORIA: [18:20] You know, my friend had a joke with me. He said you always stop it. You just can’t stay stopped. So yeah, it was one of those things that you know, when you’re educated you sort of like your own barrier because you think you can do more than you can do for yourself.

[18:36] So in the beginning I used to, you know, play with myself and think you know, I don’t have to use, and then every time, I would go back out – it would get worse. I’d end up somewhere further into the dark hole because I was now running and not wanting people to know… Every time I’d look at my mom or I’d come down from getting high… I knew I had to stop.

[22:24] So I wind up doing three detoxes and two rehabs. My second stint in rehab really saved my life.

ABDUL VO: Gloria got clean…. way back in 1994. See, Gloria never struggled with opioid addiction. She struggled with crack addiction.

Gloria’s been empowered by her experience–which she uses to empower others. She’s the Executive Director of the Coalition of Positive Health Empowerment — cleverly abbreviated as COPE. Gloria’s work centers on ensuring that underserved populations get the quality care they deserve for their chronic conditions — HIV, Hep C, substance abuse.

She never thought she’d stay in the community where she grew up, but her experience changed all that. She’s there, doing the work to help people – because she understands. 

Many of the people that Gloria serves today through COPE aren’t using crack, like she was–they’re addicted to opioids. But addiction is addiction. Though each person’s journey is unique, addiction doesn’t discriminate. Even though people do…

INTV – GLORIA [03:19]: if you just look at the comparison of how it was viewed from a national response was – one, was to attack and be punitive and you know punish people for having the illness, never looking to figure out why they had the illness, to consider the social determinants which drive everything – and even in how it was labeled, you know the crack epidemic and it’s the opioid crisis, right? So if you look at just words one breeds empathy and the other one is sort of saying this is a nuisance that we have to deal with and I think the protocols and the policies followed the same sentiment.

ABDUL VO: I bet you’ve never heard anyone call it the “the crack crisis.” How we name a thing changes how we respond to it–the name sets the pace for everything that flows afterward.

INTV – ABDUL: [4:12]  Can can you introduce yourself?

INTV – GERMAN: [4:15] My name is German Lopez. I’m a senior reporter at vox.com.

ABDUL VO: German writes about drug policy and politics. He’s spent the last several years focused on national drug policy in the context of the opioid crisis. He’s one of our guides to show how federal policy has evolved. 

Our other guide? 

INTV – SONIA: [2:55]  my name is Sonia Canzater I am a senior associate at the O’Neill Institute for National and Global Health Law at Georgetown Law Center. 

ABDUL VO: You’ll be hearing from both Sonia and German throughout this next chapter. 

They both came of age, like me, in the DARE era. I remember police officers in my classroom, scaring me about drugs – and I remember wearing that oversized shirt I got–that said “to prevent drugs and violence” years later.

Having grown up in the 80s and 90s, they’ve focused their professional attention on dissecting the era in different ways, helping us diagnose what went down, with the power of hindsight. 

INTV – ABDUL: [6:41] What was the federal response to crack cocaine and the epidemic of the 80s and 90s? 

INTV – GERMAN: [6:49] The federal response was overwhelmingly focused on tough-on-crime initiatives. We’re talking about like escalating mandatory minimums for drug sentences, and also just other sentences prison sentences, jail sentences for drugs and it was focused on really building up police…I mean often when when you talked about the federal response to drugs back in the 80s and 90s it was just assumed that you were talking about like doing getting as tough as possible.

INTV – GERMAN: [7:15 ] there’s this really compelling speech by President George H.W. Bush where he – I call compelling just because it’s so, like looking at how we react to the opioid epidemic today and putting it in contrast to the two like that like this speech, he talks about how we need to punish everyone involved in drugs and specifically says that people who use drugs are to blame for this epidemic, the crack epidemic, and so the federal government needed to go after them.

ARCHIVAL: Clip from speech… [can intercut with his story]

[8:13]  He held up this bag of crack and then basically just demonized everyone involved in with drugs including people who use drugs who as we now very clearly know are people who have a medical condition, are struggling with addiction and they need help not incarceration or punishment.

INTV – SONIA: [17:31]  The crack epidemic which kind of was rooted in the pronouncement of a War on Drugs by President Nixon back in 1971 and and he called drug abuse Public Enemy Number One. And so just again if that language … you know, this is an adversary, there is no kind of inherent good in somebody who is your, you know, your enemy and you just need to be swift and you know adverse against them and so framing it like that and then that was supported by policies and laws passed during the Reagan Administration. 

ABDUL VO: Tough on crime. In the context of terrible human suffering. That’s just inhumane. 

This crackdown… it gave us tougher policing, harsher sentences, and burgeoning jails. It paved the way for another epidemic–the epidemic of mass incarceration–that has robbed society of so many young black men, today.

 INTV – SONIA: [27:05] We still have a lingering problem. If you’re going to look at these at both ways that the government address these issues, we still have a lot of people in we have 300,000 people in state and federal prisons in this country for drug-related offenses and many of them were users themselves or you know, kind of small-time kind of drug dealers are drug traffickers and had addiction issues of their own that are not being properly addressed well in incarceration and so we still have this problem. 

INTV – ABDUL: [8:31] How has that contrasted with the federal response to the opioid epidemic? 

INTV – GERMAN: [8:37] So the federal response to the opioid epidemic has been fairly different in that there’s a lot more talk of treatment and the Obama Administration in fact and the Trump Administration have both scaled up funding for addiction treatment…

ABDUL VO: Over the past decade, investment in addiction treatment has skyrocketed. In 2017, for example, congress passed with bipartisan support a $3.3. Billion dollar package of opioid crisis grants– to provide addiction treatment and recovery support. Communities across the country have even supported harm reduction strategies that politicians in the past have balked at as too controversial, like needle exchange. 

Pretty different. Rather than focus on policing, prison, and punishment–we’re funding treatment and support. 

INTV-GERMAN: [9:00] In fact, one of the cliches at this point in this drug crisis is you can’t arrest your way out of this problem. I mean, you hear this practically every level of government down up from like the president to Congress people to local police chief like it’s a cliche that you hear time and time again, and it really shows the contrast of the eighties and nineties. 

ABDUL VO: Just like the way we name a thing matters, the way we talk about a thing – the dominant narratives being shared about it – matter too, maybe even more. They set the stage for the government’s response. 

This difference in narratives–it was reinforced in the media.

INTV – GERMAN: [14:59] you can look through some like old TV news clips of the time and the way that they talked about crack and how its this terrifying thing that makes people violent. 

ARCHIVAL – old TV news clip talking about violence associated with crack… 

INTV – GERMAN: [15:11] I mean, it’s really astounding that they’re doing everything possible to first of all make this make it seem like this drug is like some sort of like super powerful unheard-of thing that’s just like making people act in ways that they other, like they never acted like before.

[00:15:56] I mean everyone just just from like local newspapers all the way to like the the TV news to the New York Times, you you saw these kinds of reports everywhere. 

The opioid epidemic on the other hand, I mean there have been like multiple many many many stories written about in the just this very sympathetic framing of hey, look at this person… [00:16:16] They got addicted after they had like a sports injury and they were prescribed opioid painkillers. And yes, they eventually moved on to heroin or fentanyl, but if only someone had helped them before that point, if only they have gotten this addiction treatment before that point, they might not have gone down that path.

ARCHIVAL – sympathetic new story about opioid user… 

INTV – SONIA: [36:23] there are you know, Whole New York Times reports and NPR, you know weekend edition specials on the effects on the foster care system the effects on extended families who are having to take in children whose parents are caught up in in the substance use the current substance use crisis. 

I don’t recall any of that in the 80s or 90s, what I recall is communities getting completely upheaved as a result of that and I didn’t see a whole lot of call to action to address kind of the holistic concept, you know, collateral damage of of that epidemic.

ABDUL VO: These dominant media narratives echo and reinforce the rhetoric of politicians.

Remember that Bush 41 speech? Contrast that with how politicians–even Republican politicians–talked about opioids a few decades later… 

INTV – GERMAN:  [12:06] when you listen to lawmakers talk about the current opioid epidemic, they often talk on personal stories, anecdotes so like New, the former Governor of New Jersey Chris Christie, he had this speech that went viral a few years ago where he talked about his friend who got addicted to opioids and alcohol and eventually died as a result of that…

ARCHIVAL: Christie story about friend… 

INTV – GERMAN: [12:46]… And it’s a really compelling story you can tell that Chris Christie was really moved by his friends experience and seeing his friend just fall into his addiction, but one reason that he was able to do that is because he knew this person. This was an addiction crisis that affected his community. 

INTV – SONIA: [21:45] because it is starting to affect their Inner circle or you know their constituency that’s when it suddenly became a problem…

[23:02] So what we’re seeing now is the reaction when it becomes a problem to them that it becomes a problem period. When it wasn’t something that kind of affected their neighborhood and their backyard it was something that you could kind of sweep under the rug or you know, maybe not give that much that much support and that much attention to. 

INTV – SONIA: [12:05] The general messaging that is coming even more so from government from the Authority, you know from kind of the the the authorities so to speak —  is approaching the opioid epidemic more as a public health concern, as that substance use disorder, as an illness. And I will even go to say that the use of terminology such as substance use disorder that is something that was not a term that turned in exist in the 80s

ABDUL VO: The about-face is striking: a crisis hitting home, an ability to put yourself in the shoes of the person suffering. Empathy. And just like that – it’s no longer a problem for law enforcement. Now, it’s a problem for public health.

That leaves us two questions: First, is there something deeper behind the difference between these reactions? 

And second, what impact did our response to crack have on the opioid epidemic 20 years later?

We’ll look for answers, after the break.

• MID ROLL BREAK

INTV – GERMAN: [11:00] In so many ways, I think the opioid epidemic shows just how systemic racism perpetuates itself. So on one level is the the the fact of the matter is like a lot of the people using opiates today, who are addicted to them and dying and overdosing from them, these are people who are for most of those questions have been predominantly white.

ABDUL VO: We hear the words “structural racism,” quite a bit these days. It’s the kind of racism that goes beyond people using racial epithets, or denying people of color service. It’s the way that race shapes the very contours of American society. 

The strikingly different responses to crack and opioids is an example of structural racism at play. The victims of crack were usually Black and Brown people in stereotypically black and brown communities. The early victims of opioids were rural white people in stereotypically white communities. 

The people our society relies on to shape narratives and make decisions–they tend to be overwhelmingly white because of the obstacles that people of color have had to both breaking into the media and getting elected for so long. 

And so when the same disease hit two different communities, there were two very different responses. 

This shaping of narratives and responses–it’s how structural racism works, creating and perpetuating racial inequity.  And it has a long history in shaping narratives about drug addiction. After all, it’s easy to see the other as morally compromised–the kind of person who quote unquote falls into something like that.

INTV – SONIA: [15:15] This country has a history of I guess associating drug policies or laws with you know, to marginalize ethnic groups.

We saw it kind of in the turn of the 20th century when it started to become apparent that heroin was a very addictive drug and it was causing sort of like you know Moral Moral, you know down swings across the board and different populations anybody who was using ii and but the target for kind of who is responsible for this, you know this opium and heroin scourge in the in the United States was kind of dumped upon Chinese American Chinese immigrants who you know on the west coast who were running opium opium dens and things like that. And yes, you know those that drug did originate in certain parts of the world, but it was definitely not the case that they were the only ones using in this country. In fact, you know opium was used medicinally it was put in in you know products and everybody was using it.

But again, they were scapegoated and then we kind of saw that through time with like with marijuana marijuana was kind of in the 30s and 40s It was used It was popular with Mexican immigrants and African-Americans kind of in the music scene and the Jazz scene and so  it was kind of a drug associated with them but again, and then as time went on with the hippies the counterculture in the 60s, and so it was used to marginalize those groups that I guess, you know, the government thought were were kind of counter to kind of the moral messaging and like the the what they wanted to kind of the American culture to portray and so It was like, you know, it was put it was framed that you use these drugs.

ABDUL VO: Epidemic after epidemic, we’ve associated drug use with people of color. See, the War on Drugs – waged largely against Black people in urban communities– has had many obvious consequences, devastating whole communities. But structural racism can also come back to bite you in the ass in other ways.  There’s at least one side effect that doesn’t get talked about as often… 

INTV – GERMAN: [39:18] if we had addressed the crack epidemic in a public health framework, chances are we would not be dealing with the opioid epidemic as badly as we are today.  

INTV – GERMAN: And what I mean by that is… if you imagine the 80s and 90s, we saw the crack epidemic and we were like, okay, let’s build up our addiction treatment infrastructure. Let’s really do that. Let’s commit all the resources to it, the tens of billions of dollars, whatever is necessary. Then we would have this infrastructure today that where people who get addicted to opioids could have just gone to these treatment centers, they probably would have been run just as well as like hospitals and if they’re  state-of-the-art would have been just just great. 

[40:49] … it’s just kind of an interesting dynamic because it’s…  like I said, like racism is self-defeating. If we had built a treatment infrastructure before we would be in a much better place today.

ABDUL VO: Like German said, racism is self-defeating. Our failure to empathize with those suffering addiction during the crack epidemic–to leverage a public health approach to supporting those individuals who were suffering– may have helped to pave the way for the opioid epidemic. 

Truth is: the War on Drugs led us on a decades-long distraction tour away from the central cause of drug epidemics to begin with… 

INTV – ABDUL: [15:18] What do people get wrong about how we ought to deal with drug use?

INTV – GLORIA: [15:36] it’s the sister of mental illness, you know, something’s not quite right and you just may need a little tweaking to fix it in all your life. You’ve probably found things to do that and sometimes they just escalate…

Like all of us are dealing with some mental health issue now whether it’s debilitating us or prohibiting us from having a quality of life is different.

I think if we start there will start to understand that, you know, everything gets little knicks and bruises and you you need you need tweaking along the way and everybody’s not perfect.

[16:54] So we gotta first deal with mental health – get people, you know, stably housed… give people a real chance to have, you know, the American dream.

INTV – GERMAN: [6:10] These are people who are for whatever reason in their lives probably not doing well. They might have some sort of emotional mental health economic whatever issue and drugs are a means to alleviate those problems. 

ABDUL VO: Instead of focusing only on the drugs, we need to focus more on the people who use them. These are people in pain, often suffering mental health challenges that routinely go unaddressed in our society. And pain does not discriminate. 

INTV SONIA: people who have this, you know have substance abuse they have a they have a problem. They need to be prioritized. They need to be taken care of, not thrown in jail and just kind of forgotten about.

INTV – GLORIA: [6:35] they use a clear enemy in the opioid crisis, you know, they go after the drug companies and their production of the medication. They’re not looking at the increase of all of these opioids as an indictment of what’s going on in America, but yet an indictment on the pharmaceutical companies as if they flooded the country with something the country didn’t need. But you know, we didn’t take care of mental illness and most of these drugs were used … to manage pain or to manage a mental illness and just never administered correctly, never educated people on how to use and and that’s sort of the underlying effect now.

ABDUL VO: If we zoom out–past the particular drug, past the demographics and communities affected, we seem some awfully familiar parallels between the crack epidemic of the 80s and 90s, and the opioid epidemic we’re battling today. 

First, both occurred after a wholesale disinvestment in our country’s mental health infrastructure–the mental health clinics and hospitals, psychiatrists and psychologists and social workers, the needle exchange centers–that care for people with mental illness. 

The reasons for this disinvestment are complex – Starting in the early 60s, after the book One Flew Over the Cuckoo’s Nest dramatized to America some of the mistreatment in psychiatric hospitals, the goal became empowering people living with severe mental illness to live outside of psychiatric hospitals, in their communities. That meant shutting down large inpatient psychiatric hospitals, and building outpatient mental health facilities in their place.

One problem: the mental health centers never got built, even though the hospitals got shut down. By the mid 1970s, only about half of the centers our country needed were operating. And Reagan, architect of the war on drugs, canceled plans to build the rest in 1981. 

Where did those folks end up? Jails and prisons. In 1880, less than one in 100 incarcerated people had diagnosable mental illness. By 2005, that had skyrocketed to more than one in 5. 

Second, both epidemics came on the heels of serious economic downturns, including the recession of the early 80s, and the Great Recession of the late aughts. Those recessions drive job loss, home loss, and economic despair and insecurity–which can lead to drug use.

INTV – GERMAN: [30:18] If you look at like West Virginia, it has seen a lot of jobs leave and it’s the state hit hardest by the opioid crisis. If you look at some place like Baltimore, which is also also has really high opioid overdose death rates, even though it’s predominantly black and it doesn’t get as much attention as a result… it’s also had this job flight in some areas. If you look at some of these communities that clearly never have recovered from from like the the damage that globalization caused.

INTV – GERMAN: It’s kind of like this powder keg and then the supply comes in and it explodes…. [29:59] That despair is the barrel, like the powder keg ready to explode, and these drugs then come in and cause it to explode. 

ABDUL VO: At the end of the day, what we need to understand is that drug crises may come and go. The problem isn’t with the demographic of people who use or with the type of drug. And the solution isn’t either. We will never be able to police our way or incarcerate our way out of mental illness. 

We need to do this time what we failed to do last time. Prevent the next drug crisis.

First, that means destigmatizing drugs. Drug addiction isn’t a moral failing, it’s a disease. We have to keep finding the humanity in people who are affected–Black, Brown or White. But that’s not enough. We also have to break down the structural and institutional stigma of drugs–like overgrown police forces and private prison contracts that continue to devastate Black and Brown communities across the country. 

With the money saved by deconstructing the institutions of mass incarceration, we can start to build the infrastructure we’ll need to take this epidemic head on. That means rebuilding that mental health infrastructure we never built out. 

And how else are we gonna do it? One important source of funding are the settlement payouts emerging from major lawsuits to hold opioid manufacturers accountable for what they’ve done–rendering billions of dollars.

ARCHIVAL – new report about settlements… 

ABDUL VO: But the process of allocating these funds has been disorganized, and the money’s at risk of being squandered, nobody the healthier for it. 

Finally, one of the biggest challenges we’ve got in delivering addiction treatment and harm reduction services in our communities is the quote unquote not in my backyard problem–or NIMBY. In theory, we all want to solve the opioid epidemic–but people are less likely to want to build the services we’ll need in their own communities. Not in my back yard, they say. But here’s the thing, the opioid crisis isn’t relegated to any one community–it’s happening in all of our communities, all of our backyards. And that’s where we need services, too. 

Today, we talked about the opioid epidemic–in the context of the structural racism that shaped our response to the crack epidemic. Next week, we’ll talk about what happens when structural racism poisons a whole city. We’re taking our Healthy Skepticism to Flint, my backyard.

America Dissected is a production of Crooked Media. Our producers are Austin Fisher, Cary Junior II, and Katie Long. Andrea B. Scott is our story editor. Our sound designer is Daniel Ramirez. Production support from Alison Falzetta (Fall-ZET-ta), Elisa (AY-lisa) Gutierrez, Kara (CARE-ah) Hart, Daniel Porcerelli (PORE-sir-el-ee), and Tara Terpstra. Fact-checking by Dr. Nicole Aiello (aye-YELL-low). The theme song is by Taka Yasuzawa (TAAK-ah Yaas-oo-ZAH-wah) and Alex Sugiura (SOO-ghee-er-ah). Our executive producers are Sarah Geismer (GUISE-mer) and Mukta Mohan (MO-haan). Special thanks to Jon Favreau, Jon Lovett, Tanya Somanader (SOW-men-ay-der) and Tommy Vietor. And I’m your host Dr Abdul El-Sayed. Thanks for listening.