Published May 27, 2021
Key words: Drug consumption, public health policy, drug access policy, racialized drug policy, regulatory drug policy, repressive drug policy, drug abstinence, harm reduction, addiction management.
Title: Why is there a War on Drugs?
Article by: Caroline Funk, PhD
In 2019 The Baldy Center was able to sponsor a symposium organized by Herzberg, entitled “Addiction as a chronic illness? Promises and perils of a new drug policy paradigm.” Marie Jauffret-Roustide was a panelist at that conference.
Ordinary people seeking relief or pleasure chose to consume drugs, according to David Herzberg in his new book White Market Drugs: Big Pharma and the Hidden History of Addiction in America (The University of Chicago Press). Yet drugs, or more properly, addictive pharmaceuticals, are dangerous and should be controlled. But how? In White Market Drugs, Herzberg tracks the influence of physicians and pharmacists, politicians and activists, moral crusaders, the pharmaceutical industry, and federal agencies such as the U.S. Food and Drug Administration (FDA) and the Federal Bureau of Narcotics (FBN) on the development of policies that control access to drugs such as opioids, barbiturates, and methamphetamines. He describes a troubling history of social injustice that underpins these policies, with safety and care as the focus for white professionals and the war on drugs for racialized individuals who live in urban environments
Herzberg demonstrates in White Market Drugs that the management of risks associated with consuming dangerous drugs in the U.S. has bifurcated into regulatory policies for white “responsible” drug users designed to support safe use, and into repressive policies for racialized users who live in urban environments. This creates two contexts for drug use: under care and regulated, or criminalized and unregulated. Everyone consumes the same drugs, but the racialized history of criminalized access for people without opportunity for consistent medical care fosters a wildly unregulated and dangerous context for them and as Herzberg points out, mass incarceration of racial minorities. Herzberg calls these two contexts the “white market” and the “informal market,” and the white market supplies drugs from within medical care contexts, while the informal market does not. In the painful history of this process, those within social and economic settings that allow for consistent health care are victims of their pain, and those outside of that comfort are defined as immoral, weak, criminals who must be jailed to control their drug use.
Herzberg and Jauffret-Roustide both take the perspective that repressive drug policies will always fail. Wealthy, or white, or “respectable” people are free to continue drug use, while all others experience an increase in ancillary negativities such as unmanaged addiction, prison, violence, and drug-associated disease.
People using drugs in the two contexts must balance relief with risk, and dependence with addiction. Herzberg raises questions about what he says is a well-intended, but possibly problematic, distinction between “dependence” and “addiction.” The critical difference lies in care and access – it is challenging for people accessing drugs in unregulated, criminalized markets to maintain the balance, Herzberg says. He points out that people with access to drugs in the white market can continue to consume drugs more safely. This means that social and political policies that define drug access contribute to public health drug crises.
Defining informal market drug use as criminalized moral failing made it difficult to identify a method for treating people who consume from these markets and do not successfully balance the risks associated with addictive chemicals. To be clear, Herzberg points out that “no one in either market set out to become addicted.” But once addicted, the different regulatory contexts for users resulted in care or jail. Herzberg notes that this difference between care or not is “profoundly unequal.”
Herzberg believes that there were good and bad drug policies established in the U.S., rather than good and bad people consuming drugs. He thinks that bad policy, legally forced abstinence, and punishment (jail) contrasted with good, effective policy that “robustly regulated availability.” He points out that the pharmaceutical industries preferred one type of bad policy: insufficient regulations that permitted full-bore marketing to produce maximal sales and profits, regardless of the public health.
Another type of bad policy involved systematic anti-drug propaganda by federal agencies that fed and maintained public hysteria about unregulated, informal market drug users and their supposed moral turpitude. Fostered over generations, this propaganda has made it difficult to respond in healthy ways to drug use related public health crises. Contempt for drug users has become a part of our social context, and few people understand that this is a historic fabrication, built on racism and exclusivity. So, addiction is a socially and politically complex problem to address.
Baldy Center Senior Fellow Marie Jauffret-Roustide takes on the challenge of addiction as a global public health crisis. She specializes in studying the public health approach of harm reduction. Harm reductions include various strategies for managing addiction, mainly for people who are of the social segment that has been criminalized and left to fend for themselves in the unregulated “informal” drug markets.
According to Herzberg, drug use management in the United States has rarely included policies for intervention and care, instead, these mainly have occurred as ad hoc measures taken by individual physicians or on an individual level. Care measures have mainly been available for white “responsible” people living in suburban areas. In the U.S., as in many other countries, measures for intervention and care for all others included prison or institutionalization most of the time.
Harm reduction is a broad approach to care, and it does not require membership in any particular social setting. In theory, anyone with drug addiction is considered a vulnerable person and can access harm reduction facilities that protect them and perhaps help them to manage their addiction.
Harm reduction strategies require that “we change the representation, the vision we have about people who use drugs.” This is a challenge for societies to confront openly and cooperatively.
Now, however, harm reduction is increasing as a mechanism for responding to addiction management. Harm reduction is a broad approach to care, and it does not require membership in any particular social setting. In theory, anyone with drug addiction is considered a vulnerable person and can access harm reduction facilities that protect them and perhaps help them to manage their addiction.
Harm reduction approaches include drug consumption rooms, access to clean injection equipment, and in some cases access to alternative prescribed drugs – opioid substitutive treatments. Because harm reduction facilities are placed in areas where the most vulnerable and endangered people buy and use drugs, Jauffret-Roustide points out that it takes significant effort to demonstrate to people in the areas that these are places that benefit neighborhoods.
Jauffret-Roustide explains in her recent podcast with The Baldy Center, that harm reduction strategies require that “we change the representation, the vision we have about people who use drugs.” This is a challenge for societies to confront openly and cooperatively. This requires a significant shift in the perceptions formed during decades of “war on drugs” criminalization policies. Like white market versus informal market drug regulation, harm reduction policies remain fraught with the baggage of a century of moral judgement, racial bias, economic bias.
Jauffret-Roustide has co-authored 200 publications focusing on drug use practices, the biomedicalization of addiction, the impact of repression on drug users, and harm reduction with international research teams. She explains in her podcast, that in a recent media analysis of newspaper articles focused on harm reduction in France, she and her colleagues learned that 1) people who live in neighborhoods where drug consumption rooms have been set up feel like they live in an area abandoned by their government – they are concerned about the number of homeless people and people begging, but they do not differentiate clearly between drug users and non-drug-users; and 2) the drug-users are themselves not consulted during harm reduction planning or analysis. They are not asked about their experiences or for their opinions. They are again judged harshly and assumed to be less because of their drug use.
Herzberg and Jauffret-Roustide both take the perspective that repressive drug policies will always fail. Wealthy, or white, or “respectable” people are free to continue drug use, while all others experience an increase in ancillary negativities such as unmanaged addiction, prison, violence, and drug-associated disease. As Herzberg points out, we must navigate a path between prohibition and “free markets,” yet racism prevents acceptance of what would otherwise be an obvious fact: for most of history, white people are seen as so virtuous that they are not at risk of addiction and thus need few regulatory protections, whereas racialized people are seen as already defective and thus unable to use drugs safely even with regulations.
The Baldy Center Podcast. Jauffret-Roustide, Marie. 2021. Episode 12: Marie Jauffret-Roustide discusses harm reduction as an effective response to the opioid overdose crisis. Published March 9, 2021. http://www.buffalo.edu/baldycenter/multimedia/podcast/jauffret-roustide.html.
Herzberg, David. 2020. White Market Drugs: Big Pharma and the Hidden History of Addiction in America. The University of Chicago Press.