In 2016, around 64,000 people in the United States died of an overdose—more deaths than from gun homicides or traffic accidents. Overdose is now the leading cause of death for people under 50 in this country.
Addressing this crisis will require focus and collaboration—especially under our current administration. Despite President Trump’s public commitment to “liberate” Americans from the “scourge of drug addiction,” his inaction has been criticized by members of his own opioid-epidemic commission. Only a handful of their proposals have been adopted, the 90-day public-health emergency was squandered, and the crisis is wildly underfunded. The only place where Trump has excelled is in elevating stigmatizing views that drug dependency is a moral failing, and that tough-on-crime policies are the only solution. Most terrifying are his positive remarks about the murderous assault on drug users by President Rodrigo Duterte of the Philippines, and his suggestion at a White House opioids summit that drug dealers be executed.
And all this in the face of predictions that our overdose crisis is worsening. But there is another way forward. It begins with a reckoning, and a decision to learn from our past.
The history of the left is marred by a pattern of silence, exclusion, and inaction around stigmatized groups. The reasons differ, but the result is always the same—a weakened movement unable to help those who most need it. But there’s also a history of overcoming assumptions and blind spots.
Farmworkers were considered “unorganizable” by the very unions that should have seen them as a new base in the labor movement until Cesar Chavez, a former migrant worker turned union leader, proved otherwise.
When the civil-rights movement fell prey to respectability politics, ignoring the plight of the African Americans most likely to suffer the brutality of the state, legendary activist Ella Baker did not sit silent. She reminded her fellow organizers that “If you’re not reaching out to the town drunk [or the] folk who were getting rounded up and thrown in jail,” then “you’re not really working for the rights of black people.”
When HIV/AIDS ravaged New York City’s gay community during the 1980s, many organizations were unwilling to address the epidemic. I remember my brother saying, “These nonprofits only care about the ‘good’ poor people.” He and his friends—who were struggling to save their own lives—felt abandoned by the left.
Attitudes can shift for the better over time. Many community organizers who fought for stricter sentencing and more aggressive law enforcement during the 1980s, for example, have begun speaking out against the mass incarceration and biased policing practices that were fueled in part by their earlier advocacy.
Here’s why this bears remembering now—progressives are being tested again in their response to the overdose epidemic. Few doubt the urgency or scale of this crisis: 22 percent more Americans died from a drug overdose in 2016 than they did the previous year. That’s higher than the peak years of deaths due to AIDS, gun violence, or car crashes in this country. Overdoses are causing unprecedented declines in life expectancy: 2015 and 2016 were the first consecutive years since 1962 and 1963 that we saw two back-to-back years of shortening life spans in the United States. The vast majority of these overdose deaths involve opioids, whether prescription drugs, heroin, or synthetic versions like fentanyl.
Yet as devastating as the overdose epidemic is, it also has the potential to unify communities across race and class lines. And just as AIDS activists forged new policies that transformed our health-care and drug-development system, advocacy to address the overdose epidemic can have ripple effects in health-care, criminal-justice, and economic inequality. But only if we learn from our past.
Here are some lessons from the AIDS crisis:
§ Overdose is a political crisis. Early in the AIDS epidemic, when many Americans viewed through the filter of homophobia and racism, the virus was cast as a product of reckless personal behavior. But then ACT UP reframed it as a political crisis, focusing on demands like accelerated drug development and medical research, health-care access, and anti-discrimination protections. Similarly, there are policies elected officials should be supporting to prevent overdose deaths. Those include funding distribution programs for naloxone (an opioid-overdose antidote); authorizing safe-consumption rooms that provide on-site care in the event of an overdose; and rapidly scaling up access to medication-assisted treatment, like methadone and buprenorphine. These are evidence-based interventions that are currently being ignored or underutilized.
§ Overdose is a social-justice issue. Preventing overdose deaths requires more than harm reduction and evidence-based treatment. It requires an intersectional approach acknowledging the vulnerabilities of people who are most susceptible. From the Bronx to West Virginia, opioid-overdose rates are highest in economically depressed areas with too few jobs. People who cycle in and out of jail, especially if they lack access to treatment and medically assisted detox, are at exceptionally high risk.
§ People who use drugs must be at the center of our response. It’s usually taken for granted on the left that those who are most affected by a problem should be at the forefront of our efforts to address it. Yes, it may be harder organizing people who are at risk of an overdose because they use drugs. Yes, involving drug users in leadership may challenge common assumptions about who’s capable of acting on their own behalf. But it’s not just common sense that says people who use drugs will have some of the best insights into how to end the overdose epidemic. It’s also about recognizing how marginalizing them from the response, and from the political process, will further exacerbate the crisis and reinforce stigma and isolation.
§ Organize across race and class. Families and individuals across the country are affected by the overdose crisis, not just in white rural or suburban areas. We need to organize in homeless shelters, reentry programs, houses of worship, health-care clinics, and anywhere else we can reach people who use drugs and their loved ones.
There will be a day when our demands for justice and our calls for compassion stretch to those whom movement politics have largely left out over the past half century. A day when we do not ask, “What did they do to themselves to end up here?” And instead ask, “How did we let this happen?”