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Framing Addiction: Heroin Then and Now

Updated: Aug 29, 2023

At a press conference on June 17, 1971 then President Richard Nixon informed his constituents of a troubling menace. “America’s public enemy number one in the United States is drug abuse.” Nixon also labeled those associated with drug abuse primary enemies of the state. “In order to fight and defeat this enemy,” Nixon charged, “it is necessary to wage a new, all-out offensive.” Sadly, this all-out offensive has been in full bloom under the modern War on Drugs while drug abuse—keeping in step—has also flourished.

nixon declaring wod

Earlier that afternoon Nixon gave a special message to Congress, providing more details regarding the scope of the problem. Declaring the “tide of drug abuse” a “national emergency,” Nixon reminded Congress that, “narcotic addiction is a major contributor to crime.” Nixon continued, establishing what is now an oversimplified, rarely analyzed cultural truth: “Narcotic addicts do not ordinarily hold jobs. Instead, they often turn to shoplifting, mugging, burglary, armed robbery, and so on. They also support themselves by starting other people-young people-on drugs.” The addict, and the peddler—often doubling as the same shadowy figure—became cemented as cultural boogeymen. Addicts were either hooking our youth on dangerous drugs or committing other crimes to cop.  Addicts, not society, caused the problem and bore the threat to public safety. Despite his well-documented fiscal commitment to rehabilitation efforts, Nixon’s public rhetoric designed to sway silent majority voters advanced the march towards an ethos of punishment and condemnation. For example, in his same message to Congress, Nixon asked for additional funds to support enforcement efforts “to further tighten the noose around the necks of drug peddlers.”  To borrow from our Managing Editor Emily Dufton, Nixon, “transformed the public image of the drug user into one of a dangerous and anarchic threat to American civilization.”

"They bought it."

“They bought it.”

Drug scholars often discuss the problematic frame of the War on Drugs as an issue of criminal justice. Scholars argue that we must view drug abuse as an issue of public health. Despite his policy, Nixon’s public law and order rhetoric encouraged the nation and its policymakers to view drug abuse as a problem of criminal justice. Nixon explicitly and intentionally emphasized links to drugs and crime. This naturally obscured larger, more complicated problems of social and economic inequality, diminishing manufacturing strength, and broader social unrest.

When Nixon spoke of rising drug abuse, crime and disorder, he typically condemned urban districts. After all, this is where the drug abuse and sales happen—in places like the Bronx or Bed-Stuy, Baltimore, or Oakland. This too has become a cultural truth throughout our modern War on Drugs. As Khalil Gibran Muhammad has argued in passionate detail, when we talk about drugs and crime we tend to generalize and condemn minorities and urban districts. But when crime or drug use becomes a large and visible problem in white suburban or rural districts, conventional logic and explanatory tools pivot to alternate explanations. When heroin abuse befell a state that is 95% white, boasting the nations fifth-lowest unemployment rate it naturally aroused curiosity, and concern. Vermont’s heroin problem is not just interesting because it confuses and challenges our standard narratives regarding drug abuse. With a different set of users, Vermont’s case is re-framing the problem of drug abuse. While re-framing the problem, Vermont is also still applying many troubling, enduring tropes of the War on Drugs.

David Courtwright has long reminded us that what we think of particular drugs and how to respond to them as a society is often dictated by how we view its particular sets of users. When cocaine was the party favor for Wall-Streeters and Rockstars our policymakers did not yell fire. When a marketing innovation brought crack-cocaine to the poor, all parties sounded the alarm. Similarly, our explanations and responses behind heroin abuse have now changed. Sound policy steeped in punishment—it turns out—make much more sense when applied to 1970s Harlem rather than the land of maple syrup, autumn foliage, and good neighbors.

Emerging to give a much different speech about heroin over forty years later, Governor Peter Shumlin gave his State of the State Address on January 8, 2014. Shumlin devoted the entire address to heroin, and what to do about it. Initially, Shumlin sounded like any other tired drug warrior, railing about the “rising tide of drug addiction and drug-related crime spreading across Vermont.” Drug warriors love tides and fires. Both out-of-control forces of nature designed to remind listeners that the “crisis” is spreading. Drug warriors also like linking drugs with crime. “In every corner of our state, heroin and opiate drug addiction threatens us.” Highlighting the threat of drug abuse is nothing new. Where Shumlin distinguishes himself is in how he frames the threat. Rather than paint drug abusers or drug peddlers as the threat to be contained, Shumlin points to heroin itself, and addiction.

vermont. heroin

Formerly a threat, drug abusers have been transformed by Shumlin’s rhetoric as victims. Shumlin explained to his constituents exactly how this problem came to be in their quaint Northeastern hamlet: “What started as an OxyContin and prescription-drug-addiction problem in Vermont has now grown into a full-blown heroin crisis.” Packaging OxyContin as a gateway drug to heroin, Shumlin glosses over a horribly unspoken assumption in United States drug culture: that prescription drugs like OxyContin are somehow more benign and less problematic than their illicit cousins. Rather than dangerous criminals, Vermont’s heroin abusers were everyday people, victims caught in a downward spiral. To offer the requisite human interest and anecdotes to his speech, Shumlin invoked the words of Dr. Fred Holmes, a pediatrician of 43 years in Vermont. Holmes emphasized that these weren’t the junkies of old: “these kids don’t look different, walk different, talk different. It’s just the nature of their disease is different. A relentless relapsing illness that is potentially fatal.”

The major goals of our modern War on Drugs have been quite simple: reduce the accessibility of problem drugs by attacking supply, thus reducing supply and thereby raising street prices. Enter unintended consequences. First, policymakers naively believed that they could price addicts out of the market. This, not drug use, lead to petty street crime. Second, in other cases, addicts simply found substitutes when their drug of choice became inaccessible or too costly. In a rare “success” story from the perspective of drug warriors, we have recently reduced the accessibility of OxyContin and significantly increased its street prices. While this may have signaled less abuse of OxyContin, this development inevitably led to the rise of its natural substitute, illicit heroin. And so the perpetual game of narcotic whack-a-mole continues. Like a child pushing uneaten vegetables around his plate, we are simply re-apportioning problems, not diminishing them.

Following his narrative of victimization over condemnation, Shumlin also sought to re-frame the heroin problem in terms of public health. “The theory has been that if we just arrest users and put them away, then we’re going to make progress. Public policymakers have refused to say not only that this has failed, but that it’s failing miserably.” The concern now rests upon who our policies are failing. With a new face of heroin abuse, different, more compassionate responses follow. “We must address it as a public health crisis, providing treatment and support, rather than simply dolling out punishment, claiming victory, and moving onto our next conviction.” Referring to Vermont heroin abusers as “desperately sick,” Shumlin reminded his constituents of an old problem—a lack of treatment centers and open beds. Even better, Shumlin chided his constituents for blocking the construction of such centers near their neighborhoods in the past. Perhaps most crucial, Shumlin did not simply appeal to fuzzy ideas about compassion and morality that too often fall on deaf ears. Reminding voters of outrageous prison costs, Shumlin argued, “it is also the right thing to do for our pocket books.”   Under the Affordable Care Act (as Shumlin noted), states will finally have help on this front previously limited by paltry block grants for treatment and rehabilitation. The legislation requires coverage for substance abuse disorders and treatment. Most importantly, it pledges federal support to pay for it.

hoffman. od

Rising heroin abuse is not new. Nor is it unique to Vermont. Reported heroin overdoses in New York City went up 84% between 2010 and 2012. Governor Cuomo has yet to dedicate a State of the State Address. Fentanyl-laced heroin has long been a problem—even locally in my hometown of Buffalo, NY. However, national discussions about such a problem were only prompted when a high-profile actor suffered the same fate. With a new face to heroin abuse, even Attorney General Eric Holder has echoed Shumlin’s rhetoric deeming heroin “an urgent public health crisis.”

It seems clear that Governor Shumlin and others want to frame the heroin issue in terms of public health. Dr. Fred Holmes, a man treating the same children from the same families for 43 years, illustrates the point. According to Holmes, we must view the problem, and deal with the problem much as we would, “diabetes or epilepsy or asthma or ear infections.” Regardless of individuals personal beliefs regarding addiction and drug abuse, we can all agree that punishment has failed. In the face of this failure, Governor Shumlin is pushing for alternatives. With conspicuously white, non-urban Vermonter’s as the new face of heroin abuse, he may stand a chance. Ultimately though, we must create a culture of collective empathy for addicts—not scorn. Moreover, this empathy must extend to all addicts—not just Shumlin’s constituents.

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