ISIH S2 E11 / The Opioid Overdose Crisis: This Is America: Race and the War on Drugs

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Ekow Yankah: What I would say is, we too often let drugs stand in for a really dark racial anxiety.

Ekow Yankah: I wish I could come up with an answer that is less cynical, but the answer is that the people who use drugs has changed and...Suddenly, when we have an explosion of drug abuse in the white community, we come to our senses. Suddenly, we have this revelatory breakthrough that drug users are humans who need help, not jail cells.

Celine Gounder: That’s Ekow Yankah. He’s a Professor of Law and Criminal Theory at Cardozo Law School.   

Ekow Yankah:  I often have people tell me, "What's really changed is that we tried one method and it failed." Those people owe us an explanation about why if it's the case, that it took 35, 40 years? Why it took generation after generation, two and a half generations of African Americans and Hispanics being imprisoned. I think we can struggle for other answers, but the answer is plainly in front of us. We care about drug victims if they're… they're white people or if we imagine them to be like the girl next door, so to speak.

Celine GoundeR: Welcome back to “In Sickness and in Health,” a podcast about health and social justice. I’m Dr. Celine Gounder. In the past few episodes of our series, we’ve taken a close look at the roots of addiction, how the opioid crisis is affecting communities in rural America, and how government and even law enforcement officials are testing out harm reduction and public health strategies to help lessen the impact of this crisis. Increasingly, addiction and drug use are now understood as public health issues, not as criminal ones. Last year, President Donald Trump declared the opioid epidemic a national public health emergency. At his White House ceremony announcing the decision, Trump said that “Nobody has seen anything like what’s going on now.” But, the truth is… we have seen something like this before. In the late 1980s… the U.S. went through an eerily similar period of drug addiction… with crack cocaine. But... the response... was very different. Instead of being about harm reduction and rehabilitation… drug policy was punitive... and harsh. Terms like “crack baby,” “super predator” and “junkie” became synonymous with black and brown communities. Drug use was seen as THE moral failure of people of color… and hundreds of thousands... were thrown in jail and prison. So, in this episode… we’re switching gears a bit… to talk about an issue that is so often left out of our nation’s history... but is an essential one to tell… how race and the stories we tell about race... play an important role in how we think about drugs in this country. The story starts well before crack cocaine.

Philippe Bourgois: I'm Philippe Bourgois, I'm a Professor of Anthropology and the Director of the Center for Social Medicine and Humanities, in the Psychiatry Department at the UCLA Medical School.

Celine Gounder: Philippe studies the history of drug epidemics… how they wax and wane… over the course of time.

Philippe Bourgois: It's a long-term historical pattern that's very, very clear when you look at it over a 100-year period, or a 150-year period. And what you see is that there are always, inevitably… what we call now, epidemics of drug abuse that rise and fall historically. And… they take distinct patterns… that depend upon, one, the nature of the drug, the destructiveness of the drug, and also the state's response to it, so to speak: the policies that -- that operate.

Philippe Bourgois: In the late 1800s, cocaine use skyrocketed. Medicinal tonics of cocaine and opium were peddled as cure-alls… to treat everything from hayfever... to hemorrhoids... to shyness. The original formula for Coca-Cola included coca leaves, and you could mail order syringes of cocaine from the Sears & Roebuck catalogue. Employers even gave their workers cocaine to keep them awake longer… so they could put in longer hours… in the mines... and in the fields. Not surprisingly… by the early 1900s… cocaine was becoming associated with the lower classes… most notably… people of color.

Philippe Bourgois: We had a huge cocaine epidemic around World War One, and it -- and these epidemics are inevitably... in the case of the United States, they take racialized patterns, so to speak. They concentrate in specific vulnerable sectors of the population, and then that focuses the state's response to it.

Celine Gounder: At the time, the United States wanted to improve trade relations with China… So… The Harrison Act was proposed. The law sought to tax and regulate cocaine and opium… and to show China that the United States was committed to controlling the opium trade. Initially, some Southern states saw the Harrison Act as an intrusion of state’s rights and didn’t want the federal government telling them what do… and the law failed to pass.

Celine Gounder: To drum up support, proponents of the Harrison Act used sensationalist tactics to incite hysteria around blacks and cocaine use. A 1914 New York Times article proclaimed: “Negro Cocaine ‘Fiends’ Are A New Southern Menace,” and at congressional hearings... so-called “experts” testified that “most of the attacks up on white women of the South are the direct result of a cocaine-crazed Negro brain.” These tactics exploited fears of blacks on white rape..and fueled stereotypes of black men. Two myths… rolled up in one.

Philippe Bourgois: In the cocaine epidemic of around 1918, it's just amazing to read about in retrospect. So you had Southern sheriffs absolutely terrified, claiming that cocaine was making African-Americans get superhuman strength. And they actually raised the caliber of their bullet size in order to be able to shoot down and kill cocaine-crazed, you know, black addicts in the Deep South… And so inevitably, you get these moral panics around, you know, around the legitimate, you know, problem of new epidemics of substance abuse, and then -- and then these very virulent state responses that -- that take on a racialized character.

Celine Gounder: The irony is that… at the time… the typical drug user was white… often a kid from a big city tenement district… growing up in tough neighborhood… maybe Irish or German… but definitely working class. And the risk factors for drug use were much the same as they are today… a difficult childhood… growing up with abuse… domestic violence... material deprivations… and… living where there was a ready supply of drugs.

Celine Gounder: But… it was the Jim Crow era… when lynchings were at their peak. Proponents of the Harrison Act used their racist rhetoric of Negro crack fiends and superhuman strength black men… to play off of the South’s fear of blacks… and in 1914, the Harrison Act was passed. It was arguably the first step in our long history of punitive drug policies… and one of the first instances… when racialized depictions of drug use... directly shaped drug policy.

Philippe Bourgois: ... to some extent, what we're talking about is the bizarre fascination and obsession that the United States has around race. ... it's extraordinary when you look at the details of American history, with respect to race. And you know, it goes all the way back to our relationship to slavery. So you know, no other country developed industrial capitalism, you know, in its own country on the back of slavery. They had delegated away to the colony -- you know, Europe had delegated away to the colonies, to Haiti. You know, France to Haiti, you know, England to Jamaica, and so forth. Whereas in the United States, it was right inside our country. So it created these extraordinary rationalities for mistreating people, and making profits off of them, on the basis of their arbitrary skin color. And then to justify that, culturally, as if it was common sense that they were less than human.

Celine Gounder: For Ekow Yankah, the law professor we heard from at the top of the episode… drug policy has been used repeatedly throughout history as a justification for keeping tabs on people of color and immigrants.

Ekow Yankah: So  A huge amount of this is not about drugs at all. A huge amount of this has always been about social and class and in particular, racial control.

Celine Gounder: Ekow points to when marijuana was first effectively banned in 1937. In the early 1900s, there was an influx of Mexican immigrants coming into southern states like Texas and Louisiana. They, of course, brought with them their own customs… including their use of cannabis… later renamed “marihuana” by American prohibitionists… to capitalize on xenophobia.

Ekow Yankah: The reason marijuana was made illegal, not just the illegal, mind you, but a schedule one drug was because police officials and government authorities understood, this was a way to police Hispanic migrant workers. This was a way of policing Brown people.

Celine Gounder: The idea was to have an excuse to search, detain and deport Mexican immigrants.

Ekow Yankah:  It wasn't about the drug itself, which scientists long knew the risk were vastly overblown. It was a convenient leverage for the police. And that pattern repeats itself over and over and over.

Celine Gounder: These initial policies... and the racist rhetoric that surrounded them… laid the groundwork for what was to come. But… changing demographics played a part as well.

David Courtwright: My name is David Courtwright. I am a Professor of History at the University of North Florida.

Celine Gounder: David is an expert on the history of drug use and drug policy in the U.S.

Celine Gounder: As life in the South in the early 1900s was being made more and more unbearable for people of color… The Great Migration started… first as a trickle and then as a mass migration of millions of people. Between 1916 and 1970, an astounding 6 million African Americans moved from the rural South… to the big cities of the North.

David Courtwright: ... African-Americans were leaving the South. About 20 percent of African-Americans lived outside the South and in say, 1930. And by the mid 60s, 40 percent of African-Americans, at least, lived outside the South and they were overwhelmingly moving to big industrial cities like New York, like Chicago, like Cleveland, like Los Angeles. And that, of course, is where the primary narcotic markets were located by the mid 20th century.

Celine Gounder: They were moving into crowded tenement neighborhoods, bad social conditions, faced a lot of discrimination. Wasn't necessarily the migrants themselves who became addicted. Because if they came in their 20s and 30s they were pretty much past the age of drugs experimentation. But the children who grew up in that very difficult environment, which was also very rich in black market drugs, those are the ones who were most likely to become addicted. And so those those twin forces of demography and migration largely account for this shift toward African-American addicts ... in the, in say, the mid 20th century.

David Courtwright: ...so if you rewind the tape to the mid 20th century, 40s, 50s, 60s. When we're talking about narcotic drugs, the primary markets were located in big industrial cities like New York, Chicago, Cleveland, Detroit, Los Angeles, and that's where the heroin was. No supply, no addiction.

Celine Gounder: Inner cities were increasingly populated by people of color… where they were exposed to the same risk factors for drug use as their earlier white counterparts in the tenement districts. ...and this led to a shift in the demographics of inner city drug use. Drug-related crime went up… and… especially when conflated with the violence of the race riots that characterized much of the 60s… this served to reinforce notions about criminality and race. Concerns about law and order created a deep rift in the Democratic Party… and were a big part of the southern strategy that helped propel Richard Nixon to the presidency in 1968.

David Courtwright: … he was concerned about the connection between drugs and crime, because it's perfectly clear, especially in cities like New York, that a major driver of crime was the behavior of addicts who were hustling and stealing and so on to support their habits.

Celine GoundeR: But, according to David, it wasn’t just concerns about crime that drove Nixon’s drug policies.

David Courtwright: ... Nixon considered drug use among young people as a form of social rot and a real handicap for the United States in a competitive world. I mean, this was the era of the Cold War. Nixon was very old school about drugs. He considered them a form of decadence. He thought that countries that develop serious drug problems, especially among the young, were at a competitive disadvantage. And he wanted to do something about it.

Celine Gounder: But Nixon’s war on drugs was about something even bigger than crime... bigger than the Cold War. In 2016, John Ehrlichman, one of Nixon’s policy advisers, told Harper’s Magazine, “The Nixon campaign in 1968, and the Nixon White House after that, had two enemies: the antiwar left and black people. ... We knew we couldn’t make it illegal to be either against the war or black, but by getting the public to associate the hippies with marijuana and blacks with heroin, and then criminalizing both heavily, we could disrupt those communities. We could arrest their leaders, raid their homes, break up their meetings, and vilify them night after night on the evening news. Did we know we were lying about the drugs? Of course we did.” The war on drugs was a much bigger war.

David Courtwright: ...by the late 60s, it was clear that lots of people were using drugs. That this overlap with the counterculture and also with protests against the Vietnam War. I mean, in the late 60s, marijuana use was not just about getting high. It was also politically potent as a symbol. You fired up a joint, you know, that was an expression of your disgust with American foreign policy, with your affinity for the counterculture. It was an expression of a lot of things. And Nixon didn't like that.

Celine GoundeR: As we all know… the 60s and 70s… when Nixon was president… was a time of tremendous cultural change in this country. The Civil Rights Era. The Women’s Liberation Movement. Anti-Vietnam War protests. Gay rights. The environment.

David Courtwright: … It becomes a culture war football. It's tied into a general sense that American society has become too permissive, that it's the fault of the liberals, but that there are all kinds of things that are going on that are are detrimental to the social fabric and, from the standpoint of religious conservatives, ungodly. And so there's an important symbolic dimension as well. So part of the logic of the war against cannabis was that it's part of this larger culture war. This attempt to rid America of permisiveness and to turn the moral clock back to the 1950’s.

Celine Gounder: In 1971, President Nixon formally launched the “war on drugs,” calling for the eradication of illicit drug use. Over the next few decades, police efforts to stamp out drug use escalated, terrorizing communities of color. Here’s Phillipe Bourgois again:

Philippe Bourgois: Nixon… basically relaunched a war on drugs, in this move to capture the, sort of, moral majority spirit of… what we now understand to be the culture wars.  Philippe : ...basically what went on with Trump, you know, started happening with who Nixon… and then Ronald Reagan put that on steroids... where there was specifically an appeal to these, sort of, vague cultural values that are often very racist, or primarily very racist, in fact, that basically get people naively excited and distracted from, sort of, their pocketbooks to instead focus on -- on, sort of, vague cultural values of family values, or patriotic values, or -- and racist fantasies.

Celine Gounder: By the time crack cocaine hit… and became mainstream news… the groundwork had been set… and a very specific narrative of Black America had taken hold.

Ekow Yankah: I think the crack epidemic ...was traumatic. Not just in how it affected things on the ground which are devastating enough, but it was traumatic in the national psyche.

Celine Gounder That’s Ekow Yankah again.

Ekow Yankah: The idea of crack became almost as terrifying as drug addiction itself. It meant that people thought of the inner city as more or less a sealed off war zone full of nothing but “super predators.”

Celine Gounder: Crack was seen as an inner-city street drug… a drug of gangs, guns and street corners… far away from the safety of white suburbia where powder cocaine was being used. Although crack and powder cocaine are essentially the same drug… the effects of crack were wildly exaggerated… while cocaine was a symbol of affluence and luxury.

Ekow Yankah: The idea of drug dealers, crack peddlers and thugs became very racialized. If you're young and Black, especially young Black men, you just remember how much that stuck to all of us no matter who you were. There's a way in which were in your college t-shirt was a way of signaling to people that you were one of the good ones or the way that if I grow out my hair, suddenly little ladies would cross the street. I think every young Black men was deeply aware that they were only, to invoke the one of the more recent crisis we've had, that we were only a hoodie away from being seen as a thug. That was really attributable to the image of the young Black crack dealer stalking the land.

Celine Gounder And… although it’s of course true that the crack epidemic ravaged communities of color… it’s also true that the legal and criminal response to the crisis compounded the epidemic. In 1986… while Reagan was President... Congress passed the notorious Anti-Drug Abuse Act. This law set penalties that were 100 times harsher for crack than for powder cocaine and imposed mandatory-minimum sentences.  It also allocated millions of dollars to building more prisons. Here’s Phillipe.

Phillipe Bourgois: Instead of increasing treatment access, they just massively invested in law enforcement, zero tolerance law enforcement, and in building up… the prison infrastructure. And the United States then had the fastest rise in incarceration rates that have -- that has ever happened in the history of humanity, making us the country with the highest per capita incarceration rate in the world. And when you look at the graph, it's just terrifying to see, it starts in 1980 and it just shoots up like a volcanic mountain and then plateaus off in the 2010s -- what happened was that in response to crack, a choice was made to institute a policy that we now understand to have been mass incarceration, which primarily hit African-Americans and Latinos and poor whites.

Celine Gounder: These policies ripped apart families and communities… and often for very minor offenses. A person caught with 50 grams of crack would be sentenced to 10 years in prison. For cocaine, the equivalent would be a possession of 5,000 grams. The sentencing ratio of crack to cocaine was an astounding 100 to 1.

Phillipe Bourgois: We had a whole generation that got swept off its feet and started cycling in and out of jail, or just stayed in jail, on super long sentences for trivial drug charges. And that experience is extremely negative for you. It makes you very hard to reintegrate into society. And it sets you up for an even longer-term problem, once the person gets out of jail, and all of a sudden, all there are are minimum wage jobs. No one wants to hire an ex felon. And so they're at great risk of falling back into the same cycle of substance abuse that may have gotten them into prison in the first place. So you get a very vicious cycle, with -- with this mass incarceration response.

Celine Gounder: For Ekow, mass incarceration and punitive drug laws are part of a racial bias that is steeped in our nation’s history.

Ekow Yankah: I think it is part of a large web of things that are, in one way or the other, about controlling the poor, the African-American and now, of course, the Hispanic….The same pathological place that makes them criminals, that makes them lazy, that makes them shiftless. Once you have this view, this view that has frankly been the long undercurrent of our nation since its birth, it's very easy to use drug laws as just one more of a million things that allows you to dominate African-American and Hispanics. Of course, it's not coincidental that you can use these same laws to control huge swathes of poor and struggling white people as well, but I think there's no question that the desire to control minorities is a huge part of why drug laws are convenient.

Celine Gounder: And, Ekow believes these laws have also fundamentally changed the legitimacy and power of our institutions.

Ekow Yankah: When we consistently use our political institutions to pretend and avow one value while serving another, it loses its moral force. It loses the way in which we have any faith that the laws are about anything other than a thin veneer of power.

Celine Gounder: Ekow places the blame for this squarely at the feet of the unfair policing of black communities. Hypocritical laws and law enforcement are incredibly corrosive.

Ekow Yankah: For example, the black kid who is well aware that in the suburban neighborhood next door, all the kids can use whatever they want, that their white colleagues in the suburbs use the same drugs they do, often they use the same drugs they do, often at the same rate they do. That if they're caught, the cops either let them go or they get a diversion sentence that disappears from their record or more likely, their parents are talked to quietly and they go into rehab. That young kid learns that these laws are not about drugs, these laws are about the way in which his neighborhood can be controlled by the cops. It's not surprising that that cynicism spreads to his view of law enforcement generally, that it spreads to his view of the law generally, and that eventually, it spreads to his view of the country generally.

Celine Gounder: And these policies, affect not only black communities but filter their way into many aspects of our society and too often affect our basic assumptions about people… We end up basing our judgments, often unconsciously… on the color of someone’s skin.

Ekow Yankah: Too often what we think about when we think about drugs is so deeply racially tinged. If if you ask people, think of a drug dealer. Too often, the image that comes up in their mind is a racial one. It's some Black kid on a corner with a backward hat on or something like this. It's some shady Hispanic character.. Given just the demographics of the country, there are just many, many more White drug dealers than Black drug dealers. Yet still, the image is too often that of the dangerous Black predator or some dangerous Hispanic predator... That is to say, we just think of drugs as a way of thinking about dangerous people of a certain type. Dangerous racial stereotypes that allow us to call the police and control certain populations and control certain populations.

Celine Gounder: When Ekow isn’t being a law professor, he also does work in organizing and on community boards… and sees first-hand… the troubling relationship communities of color have with police.

Ekow Yankah: People want policing. They just want good policing. It's really remarkable when you see the young man in the group say, "I would never call the cops. These people aren’t here to help us", or when you hear people say, "Don't talk to the cops. Don't snitch on our neighborhood." Those ways of speaking are a deep sign of a total breach between citizen and police. It's a deep sign that there are entire communities that view the police as an occupational force. It's also a deep sign of the problems that come from that. The police simply can't do their job if large swaths of the community view them as an occupational force.

Celine Gounder: In our current epidemic… the opioid epidemic… the narrative of drugs and addiction has morphed yet again. But this time, it’s really different. Many more of us now view addiction as something to be met with compassion and rehabilitation, instead of seeing it as a moral failing. Staunch ‘war on drug’ hardliners have changed their tune... and more and more police and elected officials are pushing for public health solutions to the opioid crisis. So, what changed? For Ekow, it comes down to race.

Ekow Yankah: We can see that our responses to too many social problems split on the color line. That is to say, it's too often the case that when we think about jobs programs or social welfare benefits, healthcare, they're just too many things where if the community we imagine is white, we think, "This is a social problem that needs our help together,” but if the community is black, we think, "Oh, there's something wrong with them, it must be a criminal law problem."

Celine Gounder: For Ekow, although he’s happy that our country is moving towards a public health approach to drug addiction… he can’t help but feel a bittersweet sting.

Ekow Yankah: What's become obvious is that our response when we perceive drug users to be White "average Americans," has been terrific humanization, speaking about the need for rehabilitation... which is a slap in the face of minority communities that begged for that kind of humanity when drug use was rampant in our communities.

Celine Gounder: In the earlier part of this season… we talked a lot about efforts to humanize the opioid epidemic… to reduce the harms of addiction… and getting people the help they need. But it’s taken us a long time to get there… much longer than it’s taken most other developed countries… in no small part because of the way that race… drugs… power… and control have become entwined in our nation’s history. We’re only just beginning to disentangle it all.

Celine Gounder: Until now… we’ve laid the blame for addiction… and its downstream effects… by and large… on people who’re really just victims caught in the crossfire… or low-level foot soldiers… in a bigger war. When we went after the big dealers… we limited ourselves to drug kingpins… not doctors… or pharmaceutical executives who didn’t meet our typical ideas of what a criminal is. But now… lawyers across the country are teaming up to bring these white-collar criminals to justice. That’s next time... on “In Sickness and in Health.”

Celine Gounder: Today’s episode of “In Sickness and in Health” was produced by Nora Ritchie and me. Our theme music is by Allan Vest. You can learn more about this podcast and how to engage with us on social media at insicknessandinhealthpodcast.com, that’s insicknessandinhealthpodcast.com. If you like what you hear, please leave us a review on Apple Podcasts. It helps more people find out about the show!

Celine Gounder: If you or a loved one needs help, you can reach out anonymously and confidentially to SAMHSA’s National Helpline at 1-800-662-HELP, that’s 800-662-4357. SAMHSA stands for Substance Abuse and Mental Health Services Administration. You can also find information online at www.findtreatment.samhsa.gov, that’s www.findtreatment.samhsa.gov.

Celine Gounder: I’m Dr. Celine Gounder. This is “In Sickness and in Health.”