Opioids, Care, and Addiction

Addiction has long been caught in a culture war between the camp that sees it as a moral failing indicative of societal collapse, and those that see it as a facet of the human condition, as old as human life itself. Regardless of divergent opinions, the reality is that our response to addiction has been formulated around moral issues, and framed as a war or a crisis at every turn.

Punitive responses and systems have evolved from this framing, aimed at individuals and groups struggling and living with addiction. But here again, two camps emerge. While addiction transcends class and status, access to affordable treatment and the meting out of punishment are not as equally distributed. 

For those who are wealthy and often white, an expansive and expensive system of support and recovery programs are available. At the lower end of the economic ladder, access to assistance is more difficult, which frequently leads to increasingly complex challenges and consequences for individuals and families. Money buys privacy, leaving the poor and marginalized as the public faces of addiction. 

As a result, governmental responses to addiction have focused on that public perception and generated programs that led to disproportionate punishment of minority communities. This has put more minorities in prison for drug-related crimes, and has caused many people to not seek help from systems they feel they cannot trust. This includes medical professionals who witness the consequences of a system designed around punishment and not care.  

Wars and crises are events we expect to end. As such, they are poor metaphors for the ongoing and recurring challenges that come with the development of new substances and the human predilection to addition. Whether or not we can agree that addiction is a reality of the human condition and that all of us are at risk, we should be able to see that the systems that have been built extract a greater human and economic toll than addiction itself. Lack of access to quality care increases the problem. Punishment and imprisonment do not solve the problem. Addiction persists. 

We need to address this as a systemic problem, requiring intentional, long term, and collective redesign that includes people living with addiction in the creation of new solutions. We need to see people in these problem spaces as partners and not pariahs. We need to consider how we define “success” around topics of addiction. By maintaining assumptions based on ideas that people with addiction are suffering, that they need help, that they are somehow less than those of us who see ourselves as immune, we position the people with lived experience as further dependent, and not just on substances. If success cannot be defined as the eradication of addiction, or the continuous imprisonment of increasing numbers of people, what might it look like? If we eliminate the language around curing and incarcerating, how can we reframe our thinking and redesign our systems, together?