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Policing the Opioid Crisis Thesis Presented in Partial Fulfillment of the Requirements for the Degree Master of Arts in the Graduate School of The Ohio State University By Brookes Grant Hammock Graduate Program in Geography The Ohio State University 2019 Thesis Committee Mat Coleman, Advisor Kendra McSweeney Elisabeth Root 1 Copyrighted by Brookes Grant Hammock 2019 2 Abstract Accidental drug overdose is now the leading cause of death for Americans under 50 years of age. In 2017 alone, more than 70,000 persons died in the United States due to a drug overdose. Indeed, it is estimated that the opioid epidemic has now killed more people than the U.S. wars in Vietnam and Iraq, combined. Although most analysts agree that the origins of the crisis stretch back more than a decade, and the uptick in opioid deaths is detectable as early as the turn of the century, the crisis narrative is more recent and likely stems from the persistence of overdose deaths despite pervasive media attention and policy interventions. This thesis first argues that the opioid crisis is best understood not as one crisis but three overlapping crises or epidemics: prescription opioids (1990 – present), heroin (2010 – present), and synthetic opioids (2013 – present). The three phases of the crisis constitute an intertwined epidemic where the phases coexist temporally and sometimes spatially. Second, the thesis presents a critical overview of the policing literature, with special attention to policing as the fabrication of social order. Third, the thesis confronts the policing literature with the example of the opioid crisis to explore how policing sometimes fails to cohere as a state project. Finally, interspersed throughout the thesis are three interludes—on deaths of despair, the politics of naloxone distribution, and J.D. Vance’s Hillbilly Elegy—that examine dominant ways of thinking about the opioid crisis. iii Dedication To my parents and to Eric—condiciones sine quibus non. iv Acknowledgments I’d like to thank my advisor for seeing me through this project, my committee members for agreeing to serve, my parents for their decades of support, and my husband for reminding me that this was worth doing. v Vita 2010. J.D., Moritz College of Law, The Ohio State University 2006. B.A., Comparative Cultural Studies, The Ohio State University 2002. .Miamisburg High School Fields of Study Major Field: Geography vi Table of Contents Abstract .............................................................................................................................. iii Dedication ........................................................................................................................... iv Acknowledgments ............................................................................................................... v Vita ..................................................................................................................................... vi List of Figures .................................................................................................................. viii I. Introduction: One Opioid Crisis, Or Three? .................................................................... 1 First Interlude: Deaths of Despair and the Dismal Science ............................................... 19 II. A Critical Introduction to Policing ............................................................................... 37 Second Interlude: Naloxone, Moral Hazard, and Necropolitics ........................................ 55 III. Policing the Opioid Crisis ........................................................................................... 69 Third Interlude: Hillbilly Elegy ......................................................................................... 74 Conclusion ......................................................................................................................... 90 Bibliography ...................................................................................................................... 96 vii List of Figures Figure 1. Prescription drug and heroin OD hospitalization estimates (left panel) and crude death rates due to prescription and heroin ODs (Unick et al. 2013) ................................... 4 Figure 2. OD hospitalization estimates by race (top panel), gender (middle panel), and age (bottom panel) (Unick et al. 2013) ................................................................................ 5 Figure 3. POD rates by region (top panel) and HOD rates by region (bottom panel) (Unick and Ciccarone 2017) ................................................................................................ 9 Figure 4. Age-adjusted drug overdose death rates: United States, 1999-2017 (Hedegaard, Miniño, and Warner 2018) ................................................................................................ 12 Figure 5. Age adjusted drug overdose death rates, by state: United States, 2017 (Hedegaard, Miniño, and Warner 2018) ............................................................................ 13 Figure 6. Age-adjusted drug overdose death rates, by opioid category: United States, 1999-2017 (Hedegaard, Miniño, and Warner 2018) ......................................................... 13 Figure 7. All-cause mortality by race and ethnicity for age 50-54, 1999-2015 (Case and Deaton 2017) ..................................................................................................................... 22 Figure 8. White non-Hispanics reporting excellent or very good health, by survey year (Case and Deaton 2017) .................................................................................................... 24 Figure 9. All-cause mortality and median household income per member for white non- Hispanics, 1990-2015 (Case and Deaton 2017) ................................................................ 26 Figure 10. Year margins for all-cause mortality and median household income per member for white non-Hispanics age 30-64, 1992-2015 (Case and Deaton 2017) .......... 27 Figure 11. Percent change in wealth, 2007-2016 (Cooper and Bruenig 2016) ................. 30 Figure 12. Miamisburg, Ohio, family mourns loss of their son to an opioid overdose (Montgomery and Talbot 2017) ........................................................................................ 94 viii I. Introduction: One Opioid Crisis, Or Three? Accidental drug overdose is now the leading cause of death for Americans under 50 years of age (Katz 2017; Katz and Sanger-Katz 2018). In 2017 alone, 70,237 persons died in the United States due to a drug overdose (Hedegaard, Miniño, and Warner 2018, 1), a yearly incidence that exceeds peak years for car crash deaths (1972), peak gun deaths (1993), and peak HIV/AIDS deaths (1995) (Katz and Sanger-Katz 2018). Indeed, it is estimated that the opioid epidemic has now killed more people than the U.S. wars in Vietnam and Iraq, combined (Sinha et al. 2018). Although most analysts agree that the origins of the crisis stretch back more than a decade, and the uptick in opioid deaths is detectable as early as the turn of the century, the crisis narrative is more recent and likely stems from the persistence of overdose deaths despite pervasive media attention and policy interventions. Stepping back from the present emergency to take a longer view, a recent CDC Data Brief illustrates how drug overdoses have changed remarkably over the last two decades (Hedegaard, Miniño, and Warner 2018). In 1999, the age-adjusted death rate due to drug overdoses was 6.1 per 100,000. In 2017, it was 21.7 per 100,000 (1). Nationwide numbers smooth out overdose hot spots in the Midwest and Northeast. In 2017, the highest age-adjusted overdose death rates were seen in West Virginia (57.8 per 100,000), Ohio (46.3), and the District of Columbia (44.0) (1). Many narratives of the origins of the 1 opioid crisis trace its origins from Mexico to California to Appalachia, where it settled for a while in the mid-late 2000s before spreading to the rest of the country. We will complicate this narrative below, but it is axiomatic that the spatiality (and temporality) of the opioid crisis is key to grasping it as a totality. The opioid crisis is not one crisis, but instead a series of three crises or epidemics. Although related, intertwined, and in some senses causal, it is useful to keep these crises analytically separate for purposes of understanding their root causes and evaluating potential solutions. Following Dasgupta, Beletsky, and Ciccarone (2018), I will characterize the opioid epidemic as having three defined phases: prescription opioids (1990 – present), heroin (2010 – present), and synthetic opioids (2013 – present). As Dasgupta et al. argue, the three phases of the crisis constitute an “intertwined epidemic” where the phases coexist temporally and sometimes spatially; that is, the heroin epidemic did not “replace” the prescription opioid epidemic, nor did synthetic opioids replace heroin in turn. All three epidemics are currently unfolding in different ways and places across the U.S. The first phase of the opioid epidemic—the one dominated by prescription opioid misuse—is typically understood to be driven by both supply- and demand-side factors. On the demand size, analysts locate the source of demand in an epidemic of pain stretching back to the 1980s (or even earlier). The pain epidemic reflects a combination of patient characteristics, trends in the treatment of pain, and drug company strategies.

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