America needs to find a new way to talk about drugs. Clearly, not all illegal drugs are bad—more than half of US states have bucked federal rules banning marijuana. And the prescription opioid epidemic proves that the regulated pharmaceutical system is wide open for abuse. 2016 told a tale of these two drugs, and how people using them circumvented the way America thinks about getting high.
It took longer than a year to get to this point, of course. President Nixon and his staff crafted the 1970 Drug Abuse and Control Act to rein in the excesses of the previous decade’s counterculture. It established five classes of drugs, called Schedules, ranked according to potential for abuse and medical value. Marijuana and heroin were especially targeted, and listed as Schedule I, the most restrictive category. That means they both had high potential for abuse, and no redeeming medical value. Perps busted buying, selling, using, or transporting these substances could get multi-year jail sentences.
The 1970 law also created the modern pharmaceutical system. Compounds with less addictive potential and greater medical value were placed in lower schedule categories, where doctors could prescribed them. Prescription opioids, like oxycontin, met this more regulated capacity.
Clearly, the system isn’t working great. Marijuana is the most widely used drug in the country, and its annual deaths are in the low zeroes (although people have died because of stupid decisions they’ve made while high). Meanwhile, prescription opioids like oxycontin kill about 20,000 people each year.
In a legal sense, the backlash against federal weed prohibition began in 1996, when California legalized medical marijuana. This year, the state also voted to allow recreational cannabis use. Four days before that vote, on November 4, President Obama told Bill Maher that California’s full spectrum weed legalization could make federal enforcement against weed untenable. And indeed, as of this election, 28 states (plus Washington, DC) now have laws legalizing weed medically, recreationally, or both. Those states contain nearly two thirds of the US population.
Donald Trump’s election changes things a bit. His pick for attorney general, Jeff Sessions, is a fervent anti-drug hawk. Under his rule, the DEA, FBI, and other federal agencies could prosecute cannabusinesses and citizen tokers in post-prohibition states. The medical marijuana movement weathered these kinds of attacks for decades, and as a result has accumulated a lot of legal precedent in state and federal courts. However, recreational use—first legalized by Colorado and Washington in 2012—hasn’t really been tested like that. And if Sessions, or other anti-drug advocates do go on the attack, they’ll be doing so with the possibility that their cases could reach the Supreme Court, where Trump has vowed to fill Antonin Scalia’s vacant seat with someone equally conservative.
The prescription opioid problem is a bit more complicated. It has hit particularly hard in economically-stressed rural areas, places where Republican lawmakers can’t easily demonize inner city foibles. It began as a result of pharmaceutical companies gaming the FDA’s rules for prescription drugs. Purdue Pharmaceuticals, maker of Oxycontin, is the epidemic’s easiest villain. In the 1990s, the company started a marketing campaign targeting a so-called epidemic of chronic pain. As a result, doctors started prescribing Oxycontin, and other opioids like it, in droves.
Purdue made billions on this strategy. And in the process, got millions of people hooked on drugs, which led to hundreds of thousands of deaths. (As proof that federal drug policy isn’t complete FUBAR, Purdue paid $600 million to the federal government for misleading the public about its drug.)
The bright side to the opioid epidemic, if there is such a thing, is that it has changed the way people think about drug addiction. “This current form of opioid addiciton is more relatable than the past stereotype of heroin junkies lying in the street,” says Katherine Neill, a drug policy expert at Rice University. “Not that that stereotype was ever accurate, but now that it’s suburban and rural kids getting hooked, they aren’t getting demonized in the same way.”
That’s led to a changing attitude in how to deal with the addiction. “Big trends to watch is how states are treating drug use as a medical, or public health problem, rather than something criminal,” says Neill. This attitude is still catching on, but moves like Ithaca, NY’s proposed safe space for heroin users shows that parts of the country are moving towards a health-focused, rather than criminal, mentality.
It’s also led to strange situations, like the kratom uprising earlier this year. In late August, the DEA announced it was putting this herb—related to coffee, but triggers a mild opiate-like response—on the Emergency Schedule 1 listing. The kratom community, purportedly in the millions, responded in droves. A lot of former opioid addicts use kratom—which is really difficult to overdose on—to treat their pain and the effects of coming down off harder drugs. They even got congressional allies involved. The DEA backed off, momentarily, and opened up a public comment period (which ended December 1). The federal enforcement agency’s ultimate decision is still pending.
If the DEA’s reaction tells you anything, it’s that the public’s attitudes towards use and addiction are changing. Simple messages don’t work anymore—but states and their constituents are ready to see the nuance in their neighbors’ stories of drug use and addiction. Whether the country’s new political regime adopts that changing mentality is a blind guess.
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