As a long-time activist celebrating the 50th Anniversary of the Stonewall riots and as a drug policy reform activist, I am struck by the similarities between the AIDS crisis and the overdose crisis.
Fundamentally, HIV and substance use disorder are both significant public health challenges. But the U.S. government’s response to both challenges has been to sit in judgment of the people most at risks rather than act to reduce suffering and save lives.
Silence = Death became a rallying cry as HIV activists pleaded with political leaders to give a damn about the people who were dying. Between 1981 and 2000, nearly 450,000 people died of AIDS complications in the U.S. President Reagan did not even acknowledge the epidemic killing countless people in the prime of their lives until 1985. We will never know whether a more proactive response could have contained a virus that now has now killed 35 million people globally. What we do know is that when government officials did speak – they stigmatized people perceived at risk of HIV: gay men, Haitian (originally detainees in Guantanamo Bay… but that’s another story) and people who inject drugs.
The response of political leaders during today’s overdose crisis is eerily similar. Despite slightly more compassionate rhetoric – in response to many of the initial victims being young and white – their actions do not match their words. Political leaders have made a conscious choice to reject proven practices that save lives such as syringe access programs (SAP) that prevent the spread of disease or over-the-counter access to Naloxone that reverses the effects of overdoses.
SAPS remain illegal in 11 states, and where they are permitted they are desperately underfunded. Law enforcement agencies throughout the country threaten to put a limit on how many times they will use naloxone to revive overdose victims. And in the most appalling inaction, political leaders are refusing to allow safe consumption services (space where people can use their drugs in the presence of health professionals) despite being proven to save lives.
The federal government has acted to prevent a safe consumption facility from opening one in Philadelphia; political leaders in New York, Maryland, Washington and California are ducking and dodging rather than leading.
Their justification for resisting adoption of proven ways to reduce suffering and saves lives comes down to their decision to stigmatize people who suffer from substance use disorder as somehow morally corrupt – much in the way that earlier generations of politicians decided to condemn people for their sexual orientation as deserving of HIV.
The similarities do not stop there. When the high mortality and morbidity rates of HIV became evident, politicians rushed to adopt laws criminalizing the “knowing transmission of HIV” knowing full well that such measures would drive people further away from seeking assistance and education about how to prevent transmission. As overdose deaths have mounted – 72,000 people died in 2017 -- politicians are pushing through “drug-induced homicide” laws that, at best, deter people from calling 911 to save someone’s life because the risk that they may be charged. In the worst cases, there are homicide prosecution of people who shared drugs with a friend, a spouse, a sibling.
The drug overdose crisis of today demands immediate, evidence-based, compassionate responses from all levels of our government. The first steps they can take is adoption of accessible harm reduction services. To do so will save lives in the short term (access to fentanyl test strips and naloxone alone would make a significant difference). Harm deduction services will also save lives by creating safe spaces for people who are at risk to seek help and know they can engage with people who do not judge them.
So far this overdose crisis has been primarily limited to the U.S. but there is no guarantee that it will remain so. The U.S. failed to lead in the HIV crisis and today the World Health Organization estimates that nearly 40 million people are living with HIV today but a large number of them have no access to anti-retroviral treatments that can turn HIV from a deadly disease into a manageable disease. Nor do they have access to comprehensive harm reduction education and services that can dramatically reduce transmission.
I do not want to wake up a decade from today and have that feeling of déjà vu yet again. We know how to save lives today. Let’s demand that our government just do it.
Widney Brown is the managing director of policy at Drug Policy Alliance.