Suddenly, heroin is hot. Or rather, talking about heroin, addiction, treatment and non-punitive responses is hot, especially among presidential candidates as they canvass for votes in New Hampshire. A standard part of this year's campaigning has been a visit with a family who lost a child to an overdose, or a confessional talk at a drug clinic.
That's because the explosion in U.S. heroin use that began about six years ago has hit New England particularly hard.
The nation has experienced such drug trends and epidemics in years past, but heroin was then generally associated (in the popular mind, at least) with urban areas, poverty and African Americans. This time it's different: Those candidate visits take place in largely white working-class and middle-class communities, in rural areas and small towns, where farming, fishing and factory-based economies have been devastated by a generation's worth of economic restructuring. There is more talk now about treatment, insurance coverage, recovery and family support than about arrests, crackdowns and incarceration.
That's a welcome change. It may be that as a society we have become more knowledgeable and sophisticated about opiates and other drugs, and that we have learned enough from the blindness, heartlessness and futility of the war on drugs — and the long prison sentences and lost lives it has brought— that we have chosen a different path.
Certainly, though, that old path was hewn through a landscape colored by race and racism. It was easy and comfortable for leaders, lawmakers and voters to vilify and punish black drug users — alongside the violent criminals who fed and profited from their habits. One of the most blatant race-based excesses of the time was the meting out of much harsher sentences for possession of equal amounts of crack, more often used by poor blacks, than powder cocaine, generally preferred by wealthier white users. The new and welcome spirit of charity toward white heroin addicts, as compared with the enduring punitive approach toward their African American counterparts, can be seen in that context.
In the mid-1990s, when the war on drugs and the roundup of crack users were at their peak, pharmaceutical companies began pushing (a loaded but appropriate word) physicians to prescribe a new class of opioids such as OxyContin with a time-release formulation that was attractive to sufferers of chronic pain. It may be that the drug and others like it were over-prescribed, or that patients failed to follow their doctors' instructions, or that pills were shared with friends or relatives without prescriptions, or that clever amateur chemists remanufactured the pills to circumvent the time-release function and pack the full effect of the drug into one powerful punch. Whatever the reason, tens of thousands of Americans became addicted.
A generation that grew up with Betty Ford's courageous acknowledgment of her addiction was prepared to address the problem with at least some measure of understanding. There were snickers when influential conservative radio host Rush Limbaugh — a savage critic of leniency in the drug war — was arrested after getting different OxyContin prescriptions from different doctors. But there was little outrage that he escaped a harsh prison sentence.
By 2010, drugmakers had produced, and the FDA approved, new painkiller formulations that were harder to abuse. It seemed like a smart and obvious step, but it left addicted users desperate for a drug that acted on them in much the same way. They found heroin. Some have been lost to overdose, others are struggling with addiction and recovery.
Meanwhile, the mostly nonwhite users of crack are coming home from prison. Too few were treated there. Many carry felony records that make them ineligible for most public housing or otherwise hinder their efforts to get back on their feet. Until recently, they weren't even eligible for food stamps. Their records put most jobs out of reach.
As communities in New Hampshire and elsewhere wrestle with heroin, and as they work to find and fund the kinds of treatment and recovery that families, friends and neighbors want for loved ones in the drug's snare, Californians would be wise to remember the treatment and the welcome home that a generation of other drug users never got — and that they still need today.