Our country remains in the throes of an escalating overdose crisis, with over 100,000 recorded fatalities in 2021. Especially troubling are the stark racial disparities emerging as these numbers rise: in some age brackets, overdose deaths are up to seven times higher for Black Americans relative to their white counterparts. In New York, where we had more than 2,000 deaths in 2021 alone, Black residents had the highest recorded overdose fatality rate of any other demographic group.
One important driver of racial disparities in substance use harms and broader health and social outcomes has been the set of federal and state policies known as the “war on drugs.” Despite the consensus that substance use disorder is a chronic, relapsing health condition, the predominant U.S. policy approach has been to criminalize and punish those possessing drugs and/or drug paraphernalia.
Historically, this approach has roots in anti-immigrant sentiments directed first at Chinese immigrants and then Latin American and Black communities throughout the 1900s. The official “war on drugs” campaign was launched in 1971, paving the way for policies like mandatory minimum sentencing and sentencing disparities for crack cocaine, which disproportionately penalized Black and brown communities despite no evidence of higher drug use among them.
If these racialized policies were ever intended to curb drug supply and demand, they are failing to do so: demand for drugs remains high, drugs remain readily available, and the illicit drug supply is increasingly volatile and lethal. Public health evidence demonstrates that criminalization actually increases harms by incentivizing riskier drug use behaviors and increasing fear of seeking help in an overdose emergency. Additionally, cycling through the criminal legal system can interrupt other important, stabilizing forces that help reduce risks of substance use disorder such as drug treatment, employment, food security, housing access and educational opportunities.
Indeed, the “war on drugs” has been a central driver of mass incarceration in the U.S., which imprisons more people per capita than any other country. It also serves as a vehicle for the expansion and militarization of police departments and many of the policing practices being called into question today. Lethal episodes of police brutality are often triggered or later rationalized by suspicion of drug activity and use, as in the cases of both Breonna Taylor and George Floyd. Police encounters that do not make news headlines can still impact mental and physical health by incurring chronic stress and trauma in heavily surveilled communities.
Record levels of overdose and police brutality concentrated in Black and brown communities illustrate that a policy paradigm shift is long overdue. As we deal with the intersecting crises of overdose, mass incarceration, and discriminatory policing, it’s more crucial than ever to rethink our approach to drugs as they relate to public health and safety in society.
I am proud to be a core faculty member at GPH’s new dedicated Center for Anti-racism, Social Justice, and Public Health, where rigorous research that centers racial justice is our priority. We’re working to conduct policy implementation and evaluation research to inform and improve alternatives to the racialized “war on drugs” — while explicitly focusing on equity as a metric of success.
Saba Rouhani, PhD
Assistant Professor of Epidemiology