America’s War on Drugs has been raging for decades, with specific implications for people with substance use disorders (SUDs). However, recent trends in marijuana legalization and opioid addiction are spurring more public conversations about drug use and related policy. We spoke to Dr. Eric Schneider, a historian at Penn and author of Smack: Heroin and the American City, to understand what historical evidence informs his opinions, and how this relates to philanthropic donors.
1) In your Politico article earlier this year, you wrote that U.S. anti-drug efforts for the past century have been costly and futile. What evidence led you to this conclusion?
In the past, demand for drugs has largely been among economically and socially marginalized people, such as ethnic minorities and sex workers. Therefore, to reduce demand, we should have dealt with conditions that disproportionately affected these groups, such as racism, unemployment, and political alienation. Instead, we have mainly increased criminal penalties for drug buying, selling, and use. This approach has been ineffective and led to largely unanticipated consequences. Prohibition of smoking opium, for example, backfired by leading users to shift to more powerful and more easily abused drugs, namely morphine and heroin. Additionally, the spread of heroin among low-income African Americans and Latinos in American cities following World War II, and then among young whites during the late 1960s, fueled an increase in crime that politicians exploited to promote their political fortunes instead of addressing the root causes of the problem. We even see the effects of criminalization today: currently, the US has roughly 25% of the world’s prisoners, despite having only 5% of the world’s population.
2) Given your area of expertise, can you provide us with the historical context for the recent opioid epidemic?
My own work is about the history of opiates- specifically opium, morphine and heroin, all of which have great medical value and great potential for abuse. Unfortunately, efforts to control opiate supply have been an utter failure because opium poppies can be grown in a variety of geographic locations and only require water and cheap labor for harvest. Opium production has shifted across continents in response to control efforts and thrives on political instability—weak states, political turmoil, and economic stress are perfect conditions for poppy cultivation. Political actors seeking to fund their causes and peasant producers eager to enter world markets find opium to be an ideal product. We are no closer to a stable international order than in the past, so opium production is going to remain high. Therefore, efforts to control opiate use should focus on demand instead of supply. That said, we can’t be naïve about supply. The recent increase in heroin use has been spurred by the introduction of powerful, new opiates, such as oxycodone, that have been over- produced and over-prescribed. Users switch to heroin because it is less expensive than black market pharmaceuticals.
3) How do substance use stigmatization, criminalization, and drug policy influence one another?
Drug prohibition, like the prohibition of alcohol, attempts to regulate individual consumption of popular yet harmful goods. However, we have to ask whether the costs of prohibition outweigh the social harm produced by drug use. That discussion rarely drives the public policy debate. Substance abuse is more frequently associated with a stigmatized minority, which turns law-making into a moral crusade. Historically, when we analyze the views expressed by prohibitionists, we see examples of xenophobia (Chinese opium dens hosting interracial smoking parties), anti-urbanism (political machines operating through immigrant-owned taverns), and racism (crack babies who allegedly would grow up to be criminal predators) that wildly exaggerate the harms associated with the substance. Public discussion of substance use/abuse has focused on fear-mongering and moral panics, with legal penalties that are too harsh for the harms being prevented. Occasionally, as with the end of alcohol prohibition in 1933, we recognize and act on the idea that regulation and treatment for abusers is a more sensible policy.
4) How can philanthropists help move the sector towards evidence-based policy?
Here’s an example from history: Researchers Vincent Dole and Marie Nyswander ran the first methadone treatment project at Rockefeller University in the mid-1960s to study opioid replacement therapy. However, the Federal Bureau of Narcotics considered their project to be an illegal drug maintenance activity and tried to stop them by threatening the university, interfering with the publication of their research results, and breaking into their labs. Meanwhile, the university remained steadfast in its support of Dole and Nyswander, and their work eventually showed that methadone could help users lead productive lives and even lower crime rates. Ultimately, under the Nixon administration, methadone maintenance became an accepted part of American drug treatment efforts. While Dole and Nyswander exaggerated the benefits of methadone, and there were abuses of the program, the creation of methadone maintenance would have been impossible without the support of a strong advocate such as the university.