The opioid painkiller and heroin epidemic has produced another grisly image: photos of a couple passed out in a car on heroin, with a 4-year-old child watching in the back of the vehicle.
The image — posted on Facebook by the local government in East Liverpool, Ohio — quickly took off on social media and Google.
“We feel it necessary to show the other side of this horrible drug,” the city wrote. “We feel we need to be a voice for the children caught up in this horrible mess. This child can't speak for himself but we are hopeful his story can convince another user to think twice about injecting this poison while having a child in their custody.”
It’s a noble goal to get the public to see and understand the opioid epidemic, which led to a record number of drug overdoses — more than 47,000 — in 2014. And the pictures are haunting — when you look at them, you feel awful about what that child is going through, and you feel anguish that the epidemic is so bad that it can lead to images like these.
But here’s the thing: Shaming the parents, as many people were quick to do on social media, won’t help them break their drug addiction. Getting them — and other drug users — medical care and treatment for a drug abuse disorder will.
Addiction is a serious illness that requires medical care
The responses to the photos have, unfortunately, taken the shaming approach. Several people on Facebook responded that addiction is “a choice” — meaning all the blame should fall entirely on the adults in the situation for, according to their view, getting themselves addicted. A few people also suggested that users like those adults should be allowed to die by not receiving the lifesaving overdose antidote naloxone.
The reaction is deeply troubling. Addiction is not a choice; it is a serious illness. It can physically change the brain to drive people to do drugs, even if it leads to their deaths or puts others in dangers. Major medical groups recognize this, from the American Medical Association to the World Health Organization.
In fact, the best evidence shows that the most promising way to deal with opioid addiction is by treating it as an illness — and even giving people medicine to treat it. Such medicines, known as methadone and buprenorphine, are opioids that effectively tame people’s cravings for opioids like painkillers and heroin without producing, when taken as prescribed, the kind of euphoric high that painkillers and heroin do.
Decades of research have deemed these medicines effective for treating drug abuse. And the Centers for Disease Control and Prevention, the National Institute on Drug Abuse, and the World Health Organization all acknowledge their medical value and recommend their use. Yet they remain generally restricted — something the federal government is only now working to change.
Treating drug abuse as a crime has led to awful outcomes before
Reactions to photos of the opioid epidemic matter, because how we view addiction helps shape how we deal with it.
When the country stigmatized crack cocaine users in the 1980s, it led to a massively punitive crackdown on drugs that dealt with addiction as a crime, not an illness. Much of the reaction back then focused on “crack babies” — the idea that kids with mothers who used crack would turn out to have serious birth defects. Later studies found it was not solely crack but more so poverty and the ills attached to it that caused these kids to suffer later in life. Still, the myth took hold — often used as a means to shame black mothers and severely punish crack users.
At one point, the federal sentence for crack possession was 100 times harsher than it was for powder cocaine, even though the drugs are pharmacologically similar. The big difference between crack and powder cocaine: Black Americans are more likely to use crack, while white Americans used the more expensive powder version.
This helps explain the massive racial disparities in drug sentences: Although black and white people use and sell drugs at similar rates, black Americans are much more likely to be arrested and incarcerated for drug offenses.
At the same time, drug users have languished without care: According to 2014 federal data, at least 89 percent of people who met the definition for a drug abuse disorder didn’t get treatment. Patients with drug abuse disorders also often complain of weeks- or months-long waiting periods for care. These are people who can’t get access to care for an illness that could kill them. (Even Prince, a fairly wealthy musician, died of a drug overdose after he couldn’t secure an appointment for treatment.)
The federal government now admits the criminal justice approach was a mistake. As White House drug czar Michael Botticelli recently said, “We can't arrest and incarcerate addiction out of people. … Not only do I think it's really inhumane, but it's ineffective and it cost us billions upon billions of dollars to keep doing this.”
This is tough. Looking at the picture of the adults and child in that car, it’s obvious the kid is not in a safe environment. But the evidence suggests fixing that environment and preventing similar situations — not just for these adults but for other drug users as well — will require compassion and care, not disdain.