We bring back an episode from Season 1 that remains relevant today: 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, Abdul 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.

Transcipt

Abdul El-Sayed: Dissectors! For the next couple of weeks, I’m going to be on vacation with my family. It’s been a while since we’ve been able to take some nice, quiet time together. So for those weeks, I’ll be logging off and unplugging. Next week, we’ll be taking a full break from the show. There won’t be a new episode in the feed, but for this week, I want to share with you an episode from our first season that aired back in 2019. The opioid crisis has been back in the news lately as Purdue Pharma faces a restructuring in accordance with a huge class action lawsuit they faced as a result of their aggressive marketing of OxyContin way back in the early aughts. But the Sackler family who kicked off the whole epidemic won’t just stay out of jail, they’ll probably still be billionaires. But the opioid epidemic wasn’t the first major drug crisis to hit America. A few decades earlier, crack cocaine hit America’s streets. The response to crack and the people America held responsible, could not have been more different. In season one’s episode A tale of Two Crises, we cut deep into this dynamic, the narrative surrounding opioids and crack, and the way that race and poverty shaped public policy as a result. And today we’re airing that episode for you. For listeners who’ve been with us since the start of America Dissected, you’ll remember that season one of our show was a bit different. It was a bit more of a documentary than the interview series you’re used to today. For listeners who joined after season one, I hope you enjoy the style. We put a lot into it. Remember, we put this together back in 2019, so some of the current fact may have changed, but the underlying narrative is one we tragically continue to see time and time again in this country. All right friends, on the episode. I’ll see you after the July 4th holiday.

Abdul El-Sayed: I don’t think I need to tell you this, but there’s an opioid crisis roiling our nation.

[voice clip] A nationwide epidemic is killing hundreds of thousands of people all across the country every year. We’re talking about the opioid crisis.

Abdul El-Sayed: For nearly two decades 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 it’s opioids in the form of fentanyl. The crisis keeps growing. It keeps evolving. We are 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 the Met. But for what it’s worth, our politicians seem to be at least trying.

[voice clip] Your heart goes out to these families.

[voice clip] It is our responsibility to care for the most vulnerable in our society.

[voice clip] We need to create a society where there is hope, where there is actually a vision of how someone’s life can improve.

Abdul El-Sayed: So by now, you’ve gotten used to our M.O. in this series: people ignoring science, government ignoring people, bad stuff happening. But when it comes to the opioid crisis, government is finally starting to get its stuff together.

[clip of President Trump] I am directing all executive agencies to use every appropriate emergency authority to fight the opioid crisis.

Abdul El-Sayed: Politicians on both sides of the aisle are seeing that people affected by opioids are just people in pain, and 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 damn time. See, the opioid epidemic is in our first drug crisis, not even close, and so much of what we’re doing this time around is correcting what we did last time around, when our politicians had a very different response.

[clip of President Reagan] Drugs are menacing our society, they’re threatening our values and undercutting our institutions.

[clip of President H.W. Bush] If you sell drugs, you will be caught, and when you’re caught, you will be prosecuted. And once you’re convicted, you will do time. Caught, prosecuted, punished.

[clip of Nancy Reagan] Say yes to your life. And when it comes to drugs and alcohol, just say no.

Abdul El-Sayed: The story of the opioid epidemic isn’t just the story of one drug, or failing rural economies, or of big pharma’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 slice deeper into the rest of the story to compare 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. I’m your host, Abdul El-Sayed.

Abdul El-Sayed: Tell me about what it’s like to be in the midst of an addiction. Can you tell me a little bit about what that’s like, how it feels on the inside?

Gloria: 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 El-Sayed: That’s Gloria, born and raised in Brooklyn, New York. Gloria refers to herself as a grateful recovering addict. In order to understand what people with addiction suffer, I asked Gloria to sit down with me to share her experiences 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.

Gloria: I like to make sure people understand that not everybody goes and uses drug with the intent of being no good or not contributing to society. They, you know, could just be having a good time. I think I liked getting high initially. I think I thought that I can 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. I tried it 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. It’s almost like indescribably in quicksand, you know? You might feel like you can move and get around, but you just keep sinking. 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 El-Sayed: Gloria, like most people suffering addiction was desperate to climb out of the quicksand.

Gloria: I was always trying to get clean. You know, my friend had a joke with me. He said, you always stop and 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. 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 hold, because I was now running around and not wanting people to know. Every time I’d look at my mom or I’d come down from getting high or being off a run, I knew I had to stop. So I wind up doing three detoxes and two rehabs. My second stint in rehab really saved my life.

Abdul El-Sayed: Gloria got clean nearly 30 years ago. See, Gloria never struggled with opioids, she survived 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, they’re addicted to opioids. But addiction is addiction. Though each person’s journey is unique, addiction doesn’t discriminate, even though people do.

Gloria: 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 punish people for having illness. And even in how it was labeled, you know, the crack epidemic and then 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 El-Sayed: How we name a thing, changes how we respond to it. The name sets the pace for everything that flows afterward, as our next guests can attest to. Can you introduce yourself?

German Lopez Sure. My name’s German Lopez. I’m a senior reporter at Vox.com.

Abdul El-Sayed: German writes about drug policy and politics. He 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 evolved. Our other guide:

Sonia Canzater: 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 El-Sayed: You’ll be hearing from both Sonia and German throughout this episode. Sonia grew up in the ’80s and ’90s in New York at the height of the crack epidemic, and German was raised in Ohio, where opioid abuse was common. Having grown up in the shadow of these drug epidemics, they’ve focused their professional attention on dissecting those eras in different ways, helping us diagnose what went down.

Sonia Canzater: The crack epidemic was rooted in the pronouncement of a war on drugs by President Nixon back in 1971. He called drug abuse “public enemy number one.” And, 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 adverse against them. And so framing it like that was supported by policies and laws passed during the Reagan administration.

German Lopez 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, there’s a speech by President George H.W. Bush where he held up this, this bag of crack and then basically just demonized everyone involved with drugs.

[clip of President H.W. Bush] This . . . this is crack cocaine, seized a few days ago by drug enforcement agents in a park just across the street from the White House. It’s as innocent looking as candy, but it’s turning our cities into battle zones.

German Lopez 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.

[clip of President H.W. Bush] If you sell drugs, you will be caught, and when you’re caught, you will be prosecuted. And once you’re convicted, you will do time. Caught, prosecuted, punished.

Abdul El-Sayed: Tough on crime in the context of terrible human suffering—that’s just inhumane. This crackdown, it gave us tougher policing, harsher sentencing and burgeoning jails. It helped pave the way for another epidemic—the epidemic of mass incarceration—which has robbed society of so many young Black men today.

Abdul El-Sayed: How has that contrasted with the federal response to the opioid epidemic?

German Lopez Sp the federal response to the opioid epidemic has been fairly different in that there is 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 El-Sayed: Over the past decade, investment in addiction treatment has skyrocketed. In 2017, for example, Congress passed with bipartisan support, a $3.3 billion package of opioid crisis grants. It, among other things, provided 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.

German Lopez In fact, one of the clichés at this point in this drug crisis is, you can’t arrest your way out of this problem. You hear this at practically every level of government, down, up from like the president to Congresspeople, to local police chiefs. It’s a cliché that you hear time and time again and it really shows the contrast to the ’80s and ’90s.

Abdul El-Sayed: This difference in narratives and approach, it was reinforced in the media.

German Lopez You can look through some like old TV news clips of the time and the way that they talked about crack and how it’s this terrifying thing that makes people violent . . .

[news clip] A drug so pure and so strong, it might just as well be called crack of doom.

German Lopez I mean, everyone just from like local newspapers all the way to like the TV news to The New York Times—you saw these kinds of reports everywhere. The opioid epidemic on the other hand, I mean, there have been many, many, many stories written about in just this very sympathetic framing of: hey, look at this person, 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 had gotten this addiction treatment before that point, they might not have gone down that path.

Abdul El-Sayed: 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.

[clip of Chris Christie] The people that you’re closest to from law school are those people who are in your first year study group. One of the guys that was in my study group, he was running one day in his normal routine and he hurt his back.

German Lopez 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.

[clip of Chris Christie] And so he went to the doctor because he was having trouble working, really hurt. And so he said: listen, we’re going to give you some treatment, whatever, but in the meantime, just help to get you through, we’re going to give you Percocet, help numb the pain.

German Lopez And it’s a really compelling story. You can tell that Chris Christie was really moved by his friend’s experience and seeing his friend just fall into his addiction.

[clip of Chris Christie] But they found him dead in a motel room with an empty bottle of Percocet and an empty quart of vodka. He had everything. He’s a drug addict, and he couldn’t get help, and he’s dead. And so we need to start treating people in this country, not jailing them. We need to give them the tools they need to recover, because every life is precious. Every life is an individual gift from God. And we have to stop judging, and start giving them the tools they need to get better.

German Lopez But one reason that he was able to do that is because he knew this person. This was an addiction crisis that had hit his community.

Sonia Canzater: Because it is starting to affect their inner circle or, you know, their constituency—that’s when it suddenly became a problem. And so what we’re seeing now is when it becomes a problem to them, then it becomes a problem, period. Approaching the opioid epidemic more as a public health concern, that substance use disorder is an illness.

Abdul El-Sayed: 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.

[ad break]

Abdul El-Sayed: Welcome back. We’re talking about the different responses to the crack and opioid epidemics and in the second half, we want to dig deeper to uncover the larger forces at play. German Lopez, a reporter who’s covered the opioid epidemic with Vox, gets right down to it.

German Lopez In so many ways, I think the opioid epidemic shows just how systemic racism perpetuates itself. The fact of the matter is, like a lot of the people using opioid today, who are addicted to them and dying and overdosing from them, these are people who are, for most of this crisis, have been predominantly white.

Abdul El-Sayed: We hear the word 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 trusts 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.” Here’s Sonia Canzater of Georgetown Law Center again:

Sonia Canzater: This country has a history of, I guess, associating drug policies or laws to marginalize ethnic groups. 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, you know, this opium and heroin scourge in the United States was kind of dumped upon Chinese immigrants who on the West Coast, who were running opium dens and things like that. And, yes, you know, the drug did originate in certain parts of the world, but it was definitely not the case that they were the only ones using it in this country. In fact, you know, opium was used medicinally. It was put in, you know, products and everybody was using it. With marijuana, marijuana was kind of in the ’30s and ’40s it was popular with Mexican immigrants and African-Americans in the music scene and the Jazz scene and then as time went on with the hippies, the counterculture in the ’60s and so it was used to marginalize those groups that the government thought were counter to the moral messaging, and like what they wanted the American culture to portray.

Abdul El-Sayed: Epidemic after epidemic, we’ve associated drug use with people of color. As we just discussed, the war on drugs waged largely against Black people in urban communities has had dire consequences, devastating whole communities. But structural racism can also come back to bite you in other ways. There’s at least one side effect that doesn’t get talked about as often.

German Lopez 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. If you imagine we were like: OK, 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 where people who get addicted to opioids could have just gone to these treatment centers and they probably would have been run just as well as like hospitals and if they’re state of the art, would have been just great. It’s just kind of an interesting dynamic because, like, racism is self-defeating. If we had built this treatment infrastructure before, we would be in a much better place today.

Abdul El-Sayed: 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 support those individuals who are suffering, it may have helped pave the way for the opioid epidemic we’re struggling with today. Truth is, the war on drugs led us on a decades-long distraction tour away from the central causes of drug epidemics to begin with. Which Gloria Searson whom you heard from earlier, has seen time and again firsthand.

Abdul El-Sayed: What do people get wrong about how we ought to deal with drug use and addiction?

Gloria: 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. 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. And I think if we start there, we’ll start to understand that, you know, everything gets little nicks and bruises, and you need tweaking along the way, and everybody’s not perfect. So we got to first deal with mental health, get people, you know, stably housed, you know, give people a real chance to have, you know, the American dream.

German Lopez 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.

Sonia Canzater: 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.

Abdul El-Sayed: Sonia brings up an important point. Our prisons and jails in this country have become the repository of our failure to deal with mental health problems. In 1880, for example, less than 1% of incarcerated people had diagnosable mental illness. By two 2005, that had skyrocketed to more than 20%. Putting people in pain, in jail or prison, isn’t the answer. Once we shift our understanding of the issues at the heart of drug use, the ways in which we respond should shift too.

Gloria: 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 on what’s going on in America, but yet an indictment on the pharmaceutical companies. 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 that’s sort of the underlying effect now.

Abdul El-Sayed: If we zoom out past the particular drug, past the demographics and communities affected, we see a clear parallel between these two epidemics—something that helps to point to where the pain could be coming from. Both epidemics came on the heels of serious economic downturns: the recession of the early ’80s and the Great Recession of the late aughts. Those recessions drove job loss and home loss and economic despair and insecurity, and that can lead to drug use.

German Lopez 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 someplace like Baltimore, which has 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, but I think it’s also notable here because Baltimore is suffering from this opioid epidemic and it’s also had this job flight in some areas. If you look at some of these communities, they clearly never have recovered from the damage that globalization caused. That despair is the barrel, like the powder keg ready to explode, and these drugs then come in and cause it to explode.

Abdul El-Sayed: At the end of the day, drug use will continue. The problem isn’t a function of the demographic of people who use, or with the type of drug they use. And the solutions aren’t either. What we do know now, though, is that we’ll never be able to police or incarcerate our way out of drug use or the mental illness that drives it. We have the opportunity to do this time around, what we failed to do last time: prevent the next drug crisis. And that means destigmatizing drugs. Drug addiction isn’t a moral failing. It’s a disease. We’ve got to keep finding the humanity in people who are affected, Black, brown or white. And that means we’ve got to break down the structural and institutional stigma of drugs, overgrown police forces and private prison contracts that continue to devastate Black and brown communities. With the money we save by deconstructing these institutions of mass incarceration, we’ll start to build the infrastructure we need to take this epidemic head on. And we’ve got to realize that building out that infrastructure means saying a flat no to the protests of people who say: not in my backyard! Drug addiction happens everywhere, after all, and treatment should, too. It’s time now for a mass mobilization of the mental health resources we need to take on this drug crisis and to prevent the next one.

Abdul El-Sayed: I hope you enjoyed that episode from season one. You can binge all 10 episodes wherever you get your podcasts. I’m off next week, but we’ll see you back here on July 6th. From all of us here in America Dissected and Crooked Media, have a fantastic holiday. Oh, and don’t you forget to pick up some of our new merch. We’ve got two new lines of T-shirts, including one with our cover art, and one with a simple message: Safe and effective, like your vaccine.