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Opioid Crisis Is Struggle Between David and Goliath of Trump’s White House

In Malcolm Gladwell’s nonfiction book, “David and Goliath,” he guides us to think beyond the courage of David. While surely that was at work, he had something else working for him: Giants have poor vision; they can be nearly blind.

“Justice is blind.” This expression is meant to convey that proper justice is rendered impartially and objectively. It is a value we hold dearly in the USA. But it is not meant to be taken literally, as the kind of blindness that characterized Goliath. Blinded justice shuts its eyes to what is real, fair and useful. What does this tell us about succeeding in ending the opioid epidemic?

The bigger government is, the more likely it is to be blind. Government scales up from towns, to cities, to counties, to states (and districts and territories) and then to the federal level. As the dimensions of government grow it can have more trouble seeing the light, or it is powerfully refracted and distorted by political and ideological forces.

As citizens, we recently witnessed several, overlapping events and claims that should give us ever more foreboding of the blind giants now dwelling in Washington, D.C. There is little sanguine going on to save lives, families and communities from the consequences of opioid (and other) drug dependence.

Cartoons on President Donald Trump

The most outlandish, blind swing at the opioid epidemic came from the president himself. On March 1, 2018, Trump proclaimed at a White House summit on opioids that “some countries have a very, very tough penalty – the ultimate penalty. … And, by the way they have much less of a drug problem than we do.” The “ultimate penalty” is of course capital punishment. According to The Economist, 32 countries have the death penalty for drugs (including trafficking) in their laws, but only six employ it: Malaysia, China, Iran, Saudi Arabia, Vietnam and Singapore. Offenders in these countries are executed. Are these countries models for the “law and order” we wish for our country? And who would get caught in this capital vise, should it ever happen? They are principally people with addictions who are selling to support their habits, primarily people of color and those living in poverty. But now this dragnet will reach white, middle-Americans – more of our family, friends and neighbors, as the opioid epidemic has gripped the Midwest, the South and the northeastern states. This is not equitable or impartial justice, as evidenced by the demographics of those already the inmates of our prisons, where, by the way, we have the largest (and most expensive) corrections system in the world.

Joining the blind and heavy-handed melee is Attorney General Jeff Sessions, our chief justice officer. This Goliath’s punitive and myopic views about addiction and how to mitigate its ravages are as vast as is his judicial estate. Sessions had ordered his attorneys general to prosecute, to the limits of the law and its punishments, federal violations related to drug use and distribution (at the street level, and including nonviolent offenses). He wants to “build a wall” (even though the deadliest drugs like Fentanyl are coming in from China and Russia), and make headlines with drug busts.

At the urging of the president, Sessions also wants to go after drug manufacturers and distributors. The precedent for this exists in the suits won against Big Tobacco. States and cities are also pursuing this strategy, building their cases on deceptive marketing and the consequences (financial and social) of promoting addicting substances, especially OxyContin. This approach, legal without executing anyone, may indeed succeed. But if the current administration recovers the settlements, rather than smaller governments, what can we expect?

Sessions likely would use litigation awards to further build his enforcement capabilities, a practice he has already demonstrated. More agents, more raids, more federal incarceration. The attorney general remarked on Feb. 27 that “we will use whatever laws and tools we have to hold people accountable if they break our laws.” When you have a hammer, everything is a nail, so he wants to nail people with substance use problems. Not to prevent the development of this medical condition or use resources to provide these people with effective treatments.

A clear-eyed view of history shows us that efforts to arrest ourselves out of the current opioid (and other drug) epidemic or battle with smugglers will be as futile as was Prohibition. Remember the legacy of that misguided, police-enforced “temperance” movement? It gave birth to organized crime of a scale that had never before existed in this country.

Who are the other White House Goliaths?

Trump has proposed Richard Baum to fill the long-empty position of director of the Office of National Drug Control Policy. Called the nation’s “drug czar,” the ONDCP director has a White House position. The last director, Michael Botticelli, was in recovery himself from a substance-use disorder and was disposed to reduce drug demand by focusing on it as a disease. But Baum is a law school professor and criminal policy expert who was selected by the president, we must imagine, to embrace control strategies for drug use, the other side of the demand/control coin.

Then we have the newly appointed secretary of Health and Human Services. An(other) attorney and former chief executive of the giant Eli Lilly pharmaceutical company, Alex Azar does not bring a perspective of and experience with addiction as a chronic, relapsing disorder to this position atop HHS. In his decade at Lilly, Azar tripled the price of insulin, not a drug of abuse and life-saving for so many people with diabetes. During his tenure, Lilly was fined for colluding to keep the price of insulin high in Mexico. Where is the humanitarian vision in this new administration Goliath?

Finally, let’s not overlook Kellyanne Conway, the mendacious presidential apologist, who months ago was named by Trump to lead the national campaign to reduce opioid use and its deadly consequences. Has she done anything towards that end? Don’t think so – as she knows nothing about public health, and is busy on the airwaves trying to protect the president from his tweets and other incontinent utterings. She too, while appearing diminutive, is a big, blind giant.

I was once told that the horizon for change from city-based initiatives is one year, for state-based initiatives two to three years, and for federal five to 10 years. We have reason to be hopeful as (some) states, cities and counties, the ‘Davids’ of government, approach the opioid crisis using the lessons of public health. Think about how public-health methods have beat epidemics of cholera, polio and smallpox, reduced tobacco use and popularized seatbelts to decrease car fatalities. Municipalities and states may gain some ground in the next year or two despite the Washington Goliaths.

But the current federal Goliaths in the White House and other executive offices are not mobilizing the nation’s public health capabilities. Instead, they blindly seek to exercise their immense legal and police power in ways that will do far more harm than good, while over 170 people (that we know of) die daily of drug overdoses.

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