The War on Drugs in Contrast to the War on Big Pharma
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Claremont Colleges Scholarship @ Claremont CMC Senior Theses CMC Student Scholarship 2019 The aW r on Drugs in Contrast to the War on Big Pharma: Contextualizing Shifts in Drug Policy During the Opioid Crisis Alexandra Carter Claremont McKenna College Recommended Citation Carter, Alexandra, "The aW r on Drugs in Contrast to the War on Big Pharma: Contextualizing Shifts in Drug Policy During the Opioid Crisis" (2019). CMC Senior Theses. 2263. https://scholarship.claremont.edu/cmc_theses/2263 This Open Access Senior Thesis is brought to you by Scholarship@Claremont. It has been accepted for inclusion in this collection by an authorized administrator. For more information, please contact [email protected]. Claremont McKenna College The War on Drugs in Contrast to the War on Big Pharma: Contextualizing Shifts in Drug Policy During the Opioid Crisis Submitted to Professor Jon Shields By Alexandra Carter For Senior Thesis Year-long 29 April 2019 2 Table of Contents Abstract……………………………………………………………………………………4 Acknowledgements………………………………………………………………………. 5 Introduction ……………………………………………………………………………….6 Chapter 1: Drug Policies Past and Present……………………………………………… 13 Chapter 2: Cost-Benefit Analyses and Political Considerations………………………... 33 Chapter 3: Drug Policies and Socioeconomic Disparities ………………………………45 Chapter 4: Context of Today’s Opioid Epidemic………………………………………. 55 Conclusion……………………………………………………………………………….71 Citations………………………………………………………………………………… 73 3 Abstract New drug epidemics often unleash punitive campaigns to end them- highlighted by the 1980’s drug wars. However, the opioid crisis has been met with public-health driven policies, like clean needle programs and community-based substance abuse therapy. This thesis asks why policy responses to the opioid crisis are so different than those of the War on Drugs. First, as the cost of the drug war became clearer, policy makers across the political spectrum became less inclined to wage a new punitive war against opioids, especially as public-health responses proved to be more effective while also less costly. Second, the demographics of those addicted to opioids is different than those who were addicted to crack cocaine. The brunt of War on Drugs policies was felt by those in the lowest socioeconomic brackets and perpetuated poverty in low-income communities. Today’s softer approaches have been informed by a greater percentage of middle- to upper-class individuals affected by the opioid crisis. Third, as opioids have legitimate medical purposes, they are harder to demonize or ban, rendering it more difficult to declare total war against them. Further, the influence opioid manufacturers have has made policy makers less inclined to declare war, taking supply-side action. Public-health driven policies and policies that minimize supply-side action against pharmaceutical opioid manufacturers are duplicate representations of the United States’ departure from War on Drug tactics. As long as the “medical model” of health care, which emphasizes drugs, medical treatment, and surgery is ingrained in society and the economy, these patterns will continue. 4 Acknowledgements First and foremost, I am grateful for my parents Scott and Anita. Everything I have accomplished is because of their support. I am appreciative of the opportunity to attend Claremont McKenna College. Being part of a community that emphasizes intellectual curiosity, critical analysis, and thinking outside of the box has inspired personal growth and has driven home the importance of continual learning. To those who have supported and grown with me during our time in Claremont, thank you. I reflect fondly on these relationships, knowing that they will continue for the years to come. Lastly, special thanks to my thesis reader Professor Shields for continual guidance throughout the writing of this thesis. 5 Introduction Formally declared by President Richard Nixon in 1971, the War on Drugs is commonly referred to as “America’s longest war.” Spanning a number of decades, the tough-on-crime drug policies that characterized the War on Drugs caused irreparable harm that was by no means parallel to the harm that could be ascribed to drug use. The War on Drugs failed to minimize drug use, nor did it address the problems that accompany drug addiction. It also exhausted billions of tax dollars through heightened law enforcement and the expansion of the prison complex without creating any justifiable results. Policing during the War on Drugs was disproportionately done in low-income urban communities, despite the common knowledge that drug use is significantly higher in middle- to upper-class communities. Drug charges were extremely stringent, as low- level offenders were charged with lengthy sentences and punishment were often equivalent to that designated to violent offenders. Without adequate resources in low- income communities, defendants were left underrepresented by public defenders and susceptible to unfair plea bargains. Prisons became overcrowded by citizens who were unable to afford legal resources and the treatments and medicine necessary address addiction and mental illness- given the tremendously high cost of healthcare. Jails and prisons therefore became the holding grounds for low-income mentally disabled men and women for this reason. Further, upon being released, offenders faced obstacles impeding them from securing welfare, employment, healthcare, and voting rights. When sentenced for a drug charge, low-level offenders were simultaneously sentenced to a life of poverty and 6 misfortune. A report by the United Nations concluded: “Getting drug policy right is not a matter of theoretical or intellectual debate- it is one of the key policy challenges of our time.”1 At the same time that President Clinton was ramping up the War on Drugs in the 1990’s, the media was flooded by pharmaceutical advertisements for any potential ailment. Thus, a strange new tension was born: a righteous movement against illicit drug use increasingly coexists with a more tolerant, even pro-drug pharmaceutical industry. Today’s opioid crisis is point in case. Even though illicit heroin and fentanyl are responsible for overdose deaths at a greater frequency than prescribed opioids, licit prescription drugs like OxyContin are responsible for one-third of opioid-related overdose deaths. These prescribed narcotics are often the first opioid a victim has used before developing a dependency.2 Today, over 40 Americans die from an opioid overdose a day.3 To address this, action has been necessary by all accounts. A number of policies have been implemented that emphasize public health over incarceration. Examples include diversion programs, community-based substance abuse therapy and vocational training to prepare for reentering their communities. This ideological and bureaucratic shift is welcomed for a myriad of reasons, as it is more cost effective, has reduced rates of recidivism and 1 Boggs, C. (2016). Drugs, Power, and Politics: Narco Wars, Big Pharma, and the Subversion of Democracy. London and New York: Routledge. 2 Thompson, D. (2019, January 18). Big Pharma's Marketing to Docs Helped Trigger Opioid Crisis: Study. Retrieved from https://consumer.healthday.com/bone-and-joint-information-4/opioids-990/big-pharma-s- marketing-to-docs-helped-trigger-opioid-crisis-study-741705.html 3 Derse, A. (2016). The Opioid Epidemic: New policies, Treatments, Non-opioid Alternatives. Atlanta, GA: AHC Media. 7 addiction in former offenders, and reflects moral considerations that were absent for so much of the War on Drugs. The inherent dissimilarities between the War on Drugs and policy responses to the opioid crisis are marked. This thesis seeks to answer why policy responses to the opioid crisis are so different than those of the War on Drugs. First, as the cost of the drug war became clearer, policy makers across the political spectrum became less inclined to wage a new punitive war against opioids, especially as public-health responses proved to be more effective while also less costly. Second, the demographics of those addicted to opioids is different than those who were addicted to crack cocaine. The brunt of War on Drugs policies was felt by those in the lowest socioeconomic brackets and perpetuated poverty in low-income communities. Today’s softer approaches have been informed by a greater percentage of middle- to upper-class individuals affected by the opioid crisis. Not only has the United States moved away from War on Drugs policies used to address drug use, it has also moved away from tactics used for supply-side enforcement. In particular, drug policies today reflect regulatory and disciplinary leniency towards the pharmaceutical companies that manufacture licit opioids, directly defying the bureaucratic aim to minimize drug use and addiction. As this thesis seeks to answer why policy responses to the opioid crisis are so different than those of the War on Drugs, it must also address why supply-side enforcement during the opioid crisis looks so different than that of the War on Drugs. While there are striking parallels to the tactics used by the pharmaceutical companies that manufacture licit opioids and illicit drug dealers, these corporations have 8 sway over the American bureaucracy, affording them the authority to influence regulatory and legislative policies. It is this influence that has made supply-side responses so different during the opioid crisis than those of the War on Drugs. Supply-side enforcement against drug dealers