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When a drug epidemic’s victims are white

How racial bias and segregation molded a gentler rhetorical response to the opioid crisis.

Chris Christie Makes Emotional Plea To Rethink Drug Addiction ...

"Somehow, if it's heroin or cocaine or alcohol, we say, 'They decided it, they're getting what they deserved.'" (Read more here:

Posted by HuffPost Politics on Friday, October 30, 2015

When New Jersey Gov. Chris Christie discusses his compassionate approach to the ongoing opioid epidemic, he frequently brings up a close friend from law school. He describes this friend as perfect — incredibly smart, with a successful law practice, with a beautiful and brilliant wife and kids, and both good looking and athletic. “So we loved him, but we hated him,” Christie joked at a 2015 town hall. “Because the guy had everything, right?”

This friend, however, had a drug problem. Starting with a back injury from running, he was prescribed opioid painkillers. That initial prescription eventually grew into a full-blown addiction. And despite Christie’s and others’ attempts to help, the addiction consumed his friend, whom Christie has kept anonymous to protect the family from media attention. Over the next 10 years, despite some stints in rehab, his friend lost his wife, his home, his money, the ability to see his girls, his law practice, and even his driver’s license. Then, he overdosed and died at 52 years old.

“By every measure that we define success in this country, this guy had it,” Christie said. “He’s a drug addict. And he couldn’t get help. And he’s dead.” He added, “When I sat there as the governor of New Jersey at his funeral, and looked across the pew at his three daughters sobbing ’cause their dad is gone, there but for the grace of God go I. It can happen to anyone. And so we need to start treating people in this country, not jailing them. We need to give them the tools they need to recover, because every life is precious.”

This is the kind of story that not just Christie but countless lawmakers across the US have told in reaction to the opioid epidemic: how a close experience with a personal friend or family member drove them to understand drug addiction and the opioid crisis in a much more compassionate way — one that emphasizes treating drug misuse as a public health issue.

Similarly, President Donald Trump, who appointed Christie to a commission studying the opioid epidemic, often brings up the alcohol addiction that consumed and killed his brother. Businesswoman Carly Fiorina, who briefly ran for president in 2016, also mentioned her daughter’s death due to drugs on the campaign trail. Former Florida Gov. Jeb Bush wrote an article on his daughter’s drug struggles on Medium. And that doesn’t even begin to get into the many, many state lawmakers who have shared similar stories about husbands, wives, sons, daughters, friends, and coworkers who struggled with addiction.

This, they all say, has led them to believe in the need for better, comprehensive drug treatment.

These stories show how lived experiences and personal relationships can influence serious policy discussions. After all, politicians bring up the people in their lives who they saw needlessly suffer and die due to drugs for a specific purpose: to call for an approach to addiction focused on public health over criminal justice.

But in this way, these stories also expose the impact of another issue that may not seem related at first: race.

Even after decades of progress on racial issues, America remains a very segregated country. On a day to day basis, most Americans closely interact only with people of the same race. And that impacts our politics and policies.

Heroin preparation. Spencer Platt/Getty Images

Consider the opioid epidemic, which contributed to the record 52,000 drug overdose deaths reported in 2015. Because the crisis has disproportionately affected white Americans, white lawmakers — who make up a disproportionate amount of all levels of government — are more likely to come into contact with people afflicted by the opioid epidemic than, say, the disproportionately black drug users who suffered during the crack cocaine epidemic of the 1980s and ’90s. And that means a lawmaker is perhaps more likely to have the kind of interaction that Christie, Trump, Bush, and Fiorina described — one that might lead them to support more compassionate drug policies — in the current crisis than the ones of old.

Is it any wonder, then, that the crack epidemic led to an incredibly punitive “tough on crime” crackdown focused on harsher prison sentences and police tactics, while the current opioid crisis has led more to more compassionate rhetoric and calls for legislation, including a measure Congress passed last year, to focus on treatment instead of incarceration? (Although some states have passed “tough on crime” laws in response to the opioid epidemic.)

Ithaca, New York, Mayor Svante Myrick, who’s black, told me this has led to resentment in much of the black community in his predominantly white town. “It’s very real,” he acknowledged. The typical response from his black constituents, he said, goes something like this: “Oh, when it was happening in my neighborhood it was ‘lock ’em up.’ Now that it’s happening in the [largely white, wealthy] Heights, the answer is to use my tax dollars to fund treatment centers. Well, my son could have used a treatment center in 1989, and he didn’t get one.”

Still, Myrick added, “I’m as angry about this as anybody. But just because these are now white kids dying doesn’t mean we shouldn’t care, because these are still kids dying.”

Stories like Christie’s, Trump’s, Fiorina’s, and Bush’s show one of the many ways we got to this point, where a political response can vary largely based on a victim’s race. They demonstrate that it’s not just personal racism that can lead to racially disparate politics and even policies, but structural factors like segregation as well.

Segregation blinds us to others’ experiences, robbing us of empathy

Rachel Godsil, co-founder and director of research at the Perception Institute, said that the empirical literature shows this to be the case: People are more likely to associate with and relate to people in their own racial group. And they’re more likely to run into people in their own racial group in their day-to-day lives, over time building a personal connection with them. As a result, they’re more likely to feel compassion and empathy for people in their own group and community who stumble and suffer — and demand policy solutions to ease that suffering.

“Not seeing people in casual contexts — like in your neighborhood and your place of worship and your school — it just completely changes the nature of the dynamic that you experience,” Godsil said. “And people [of other races] seem very othered.”

Godsil pointed to a 2007 study, which she did not take part in, that looked at the aftermath of Hurricane Katrina in 2005. In that study, researchers found that people tended to believe that victims in racial outgroups suffered fewer “uniquely human” emotions like anguish, mourning, and remorse than victims in racial ingroups. And, in the aftermath of a natural disaster, that perception of fewer “uniquely human” emotions led participants to be less willing to help victims in racial outgroups.

In short, people showed more empathy to victims of the same race than they did to victims of a different race — in a way that affected people’s willingness to help after Katrina.

Hurricane Katrina. Robert Galbraith/AFP via Getty Images

The Katrina research is just one example. A 2009 study found that, when looking at images of others in pain, the parts of people’s brains that respond to pain tended to show more activity if the person in the image was of the same race as the participant. Those researchers concluded that their findings “support the view that shared common membership enhances a perceiver’s empathic concerns for others.” Other studies reached similar conclusions.

Another analog: same-sex marriage. Before marriage equality became law of the land, surveys showed that Americans who had personal relationships with gay people were more likely to support same-sex marriage rights. Just ask Sen. Rob Portman, a Republican from Ohio, who announced his support for marriage equality in 2013, two years after his son came out as gay.

Really, it seems like common sense: Once someone can relate to the person who’s suffering, it becomes much easier to empathize. And, when it comes to politicians, empathy can then translate to more sympathetic policy preferences and outcomes.

With this in mind, let’s go back to the opioid epidemic. The data shows that the crisis has hit white communities harder than minority communities, leading to many more overdose deaths among white Americans than their black or Latino peers — making it largely unique in the history of drug epidemics in America.

Chart showing that white Americans have disproportionately died from drugs in the last 16 years, but that might be changing given spikes in 2014 for black and Hispanic Americans

We also know that the US is very racially segregated, which is something that’s readily apparent in just about any map of racial demographics in America. Look, for example, at this map from the University of Virginia Weldon Cooper Center for Public Service of Washington, DC, which is very obviously divided between its white residents (blue dots) and black residents (green dots):

A map of racial segregation in Washington, DC. University of Virginia Weldon Cooper Center for Public Service

Washington, DC, isn’t an exception. Zoom into just about any part of the map, and it’s clear that there are racial divisions across most of America.

Godsil said she drives this home to people through a personal thought experiment: “Think about who your neighbors are. Think about who you see walking down the street in your neighborhood. Think about who you see when you go to the grocery store — not when you’re checking out, but who’s buying vegetables next to you. If you’re in a religious organization, who you see in your places of worship. Who you see when you take your kids to school. Who you talk to when you’re in the playground.”

This means that people in white communities are much more likely to encounter a friend or family member struggling with opioid addiction, since the crisis has hit white Americans harder. Since that person struggling with addiction will be of the same race and social network, these communities are going to approach that person with a much more empathetic perspective. And that empathetic perspective can lead to softer policies that emphasize treatment for addiction.

As Michael Botticelli, President Barack Obama’s drug czar, put it to the New York Times in 2015, “Because the demographic of people affected are more white, more middle class, these are parents who are empowered. They know how to call a legislator, they know how to get angry with their insurance company, they know how to advocate. They have been so instrumental in changing the conversation.”

Syringes on a dirty mattress. Derek Davis/Portland Press Herald via Getty Images

In contrast, the crack epidemic, because it largely hit black, urban communities, was often framed as a drug problem of “other” people. The problem in much of the public eye, in fact, wasn’t that people were suffering from crack addiction, but that people’s crack addiction and the black market for crack led to crime and murders that could, in turn, damage white communities. So the focus fell on controlling crime — and that led to more punitive “tough on crime” policies, largely affecting communities of color.

This applies not just to lawmakers, but the media, which is also disproportionately white, and the public, which is majority white, as well. Consider the media coverage of the crack versus opioid epidemics: While the crack epidemic gave rise to headlines like “New Violence Seen in Users of Cocaine” in the New York Times, the opioid epidemic has led to sympathetic headlines like “In Heroin Crisis, White Families Seek Gentler War on Drugs” in the same newspaper 28 years later.

“The media portrayals during the crack epidemic were exceedingly hostile,” Godsil said. “When they talked about mothers who were crack addicted, there wasn’t ‘what kind of treatment can we provide for them?’ but ‘what kind of criminalization can we impose upon them?’”

The result: different policy discussions for similar kinds of problems.

Race has permeated the opioid epidemic

Of course, the effect of racial segregation isn’t the only way that race has impacted the opioid epidemic.

For one, the reason that white Americans have been disproportionately harmed by the epidemic is, in part, racism.

The epidemic began with doctors prescribing far too many opioids, leading the drugs to proliferate not just among patients, but children rummaging through their parents’ cabinets, family members and friends getting the drugs as gifts, and the black market, where patients sold excess pills.

Yet studies show that doctors have generally been more reluctant to prescribe painkillers to minorities, because doctors mistakenly believe that minority patients feel less pain or are more likely to misuse and sell the drugs. In a perverse way, this shielded minority patients from the tsunami of opioid painkiller prescriptions that got white Americans addicted to opioids, including heroin, and led to a wave of deadly overdoses.

More explicit kinds of racism probably affected the policy response as well. Studies show, for example, that Americans in general are more likely to associate black people with violence and criminality. There is really no end to this kind of research — from a 2014 study that found people were more likely to view black children as less innocent to a 2017 series of studies that found white people are more likely to view their black peers as larger and more threatening.

A white person with a syringe. Pictures Ltd./Corbis via Getty Images

Considering this research, it’s sadly not surprising that when Americans saw a drug crisis that disproportionately affected black folks in the crack epidemic, they were more likely to demand “tough on crime” policies — especially given the higher crime rates of the era. And it’s sadly not surprising that the more white drug crisis of the opioid epidemic has led to more of the opposite response.

As Anna Lembke, a Stanford psychiatrist and author of Drug Dealer, MD, recently put it to me, “This opioid epidemic in particular has penetrated the white middle class, and because of that it’s now being conceptualized as a disease instead of a moral failing.”

But even beyond personal biases, there are political and socioeconomic structures in place that are simply more likely to punish black people. Police, for example, are more likely to be deployed in minority neighborhoods (in part because they have higher crime rates) and resort to dragnet tactics like “stop and frisk” that focus on stopping, interrogating, and locking up as many people as possible. This is just one example, but it shows the kind of mechanisms that are in place to punish, as opposed to help, black people when problems arise in their communities.

Of course, race isn’t the only factor in the response to the opioid epidemic. Since the Great Recession, the opioid epidemic coincided with a criminal justice reform effort that largely began before the current drug crisis was well-known in the mainstream — with dozens of states passing laws loosening their prison sentences, particularly for nonviolent drug offenses, to save money on prison spending. So before the public and lawmakers knew much about the opioid epidemic, they were already preparing to draw down the harsh anti-drug policies of the past.

But since the opioid epidemic was the first major drug crisis to hit since those reforms, the disproportionately affected white drug users have been the first to really benefit.

A person prepares heroin. Universal Images Group via Getty Images

Class likely plays a role as well. The meth epidemic was predominantly linked to white Americans, yet it invited a punitive “tough on crime” response. That may be because it was also linked to poor white Americans, while the opioid epidemic is associated more with middle-class white Americans. And economic segregation is an issue in the US too, so it likely played a role in the public reaction to the opioid epidemic versus the meth epidemic.

Another issue is that the opioid epidemic is fundamentally rooted in the health care system, giving it a natural starting point to becoming a public health issue. After all, the epidemic began with doctors prescribing too many drugs. That over time led to opioid addiction that evolved from painkillers to other opioids like heroin and fentanyl — and tens of thousands of deadly overdoses annually for the past several years.

“Doctors can no longer ignore addiction,” Lembke argued, “when they themselves are complicit in the process.”

All of this, along with advocacy and advances in the public understanding of addiction, helped push the country in a direction where addiction, particularly in the frame of the opioid crisis, is viewed more as a disease that needs to be treated than a moral failure that needs to be punished.

But when you put all the evidence together, it’s clear that, despite some of the other factors in play, race played a big role in why the crack epidemic produced a crackdown focused almost entirely on “tough on crime” strategies while the current crisis has not to the same extent.

People need to get out of their own bubbles

If there’s a lesson in any of this, it’s that people, particularly white Americans, need to do more to get out of their racial bubbles and confront their racial biases — or else they’ll risk succumbing to more policy demands and solutions that don’t account for the suffering of other communities.

There is evidence this can be done. In The Science of Equality, Godsil and her co-authors proposed several tactics that seem, based on the research, promising: presenting people with examples that break stereotypes, asking them to think about people of color as individuals rather than as a group, tasking them with taking on first-person perspectives of people of color, and increasing contact between people of different races. All of these interventions appear to reduce racial biases, while interracial contact appears most promising for reducing racial anxiety more broadly.

The key, then, seems to be personal contact that helps build empathy.

“What individuals can do immediately is really begin to be mindful of how they’re interacting with people who are in their orbit,” Godsil said. “If we’re not cognizant of the way we may be seeing people with a kind of filter bias, we might not be treating them with the dignity or respect that we would be if they were in our group — and we might not even know it.”

Anti-Trump protests. Mark Makela/Getty Images

In some cases, activists interested in tearing down discriminatory barriers may be able to take on the work themselves. A 2016 study, for example, found that canvassing people’s homes and having a 10-minute, nonconfrontational conversation about transgender rights — in which people’s lived experiences were relayed so they could understand how prejudice feels personally — managed to reduce voters’ anti-trans attitudes for at least three months. Perhaps a similar model could be adapted to reach people with other kinds of prejudiced views, although this idea needs more study.

At a more systemic level, it also means better integrating communities — encouraging policies that better diversify neighborhoods, schools, and other places where people come together.

Whatever approach is taken, Godsil argues it’s necessary — to make lawmakers more sympathetic to constituents outside their social networks, to make the media more likely to cover people of all racial groups in an equally empathetic way, and to make the public more understanding in approaching problems that happen in neighborhoods outside of their own.

Looking back at Christie’s comments, there’s a clear criticism of the drug policies of old. Christie has explicitly suggested that the old war on drugs has been a failure, previously saying that “what we’ve seen over the last 30 years is it just hasn’t worked.” At this point, this isn’t a new argument from politicians; it’s almost a cliché for them to say that the old drug war has obviously failed — with people from Christie to Botticelli, Obama’s former drug czar, to Vermont Sen. Bernie Sanders now making the claim.

Yet based on the evidence on race and policy, these policies may very well have been prevented if people had social networks that crossed racial barriers. That would have let them see the real pain that previous drug crises were inflicting on black Americans, just like the current drug crisis is inflicting so much pain on white Americans. And that may have led them to demand drug treatment instead of prison time, just like Christie, Botticelli, and Sanders do today.

To put it another way: It is good that politicians are taking a more compassionate view toward the opioid crisis. But if we want to avoid the crueler policies from popping up again during future crises, the research suggests that tearing down racial boundaries will need to be a part of the solution. Otherwise, history may just repeat itself when a problem inevitably hits a neighborhood that we consider different from our own.

Watch: The opioid epidemic, explained

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