The War on Drugs ‘has created a structurally racist system,’ says top federal drug official

The criminalization of drugs has “created a structurally racist system” in which black people are treated “worse” than others, the head of a major federal drug enforcement agency has said.

National Institute on Drug Abuse (NIDA) Director Nora Volkow has frequently commented on the need for a public health approach to substance abuse rather than strict criminalization and openly addressed racial disparities in the fight against drugs. But in a recent interview, she framed the issue in particularly stark terms.

Part of the reason Volkow accepted the position of director of NIDA was that she “wanted to address the ways in which our society and health care systems overlook addiction and work to change the criminalization of people who use drugs” , she told NIH Medline Plus Magazine. .

“Research shows that when people end up in jail or jail, they are much more likely to overdose, die or relapse,” she said. “The criminalization of people who use drugs has created a structurally racist system that allows us to treat some people, especially black Americans, worse than others.”

The explicit admission has caught the attention of reform advocates and drug policy journalists like Zachary Siegel, who runs the Substack newsletter “Substance.” Volkow is “bluntly saying that the criminalization of drugs is a structurally racist system that does direct harm to drug users,” he said.

The federal drug official also said in the interview that there are “health disparities in all areas of health, especially with respect to substance use.”

“What’s unique about drug addiction is its connection to criminalization,” she said. “Being in prison or prison interferes with physical and emotional health, makes it difficult to get a job, disrupts families and destroys self-confidence. We are trying to solve these problems at NIDA.

Similarly, officials at the Drug Enforcement Administration-run museum recently acknowledged that “racial, ethnic, and class bias” led to the criminalization of drugs and the creation of the agency.

“What was a medical condition has become deviant or criminal,” an official said. “This change led to a wave of laws against heroin, marijuana and cocaine.”

Volkow, for his part, spoke about the relationship between racial bias and drug criminalization last year, saying the United States “currently has a long history of discriminatory and racist policies, many of which still continue.” today”.

“The war on drugs was no exception, and by incarcerating black people at disproportionately high rates, it had radiant effects on health, economic security and mobility, education, housing, families – areas intrinsically linked to the well-being and success of so many black people and other people of color,” she said.

Criminalization also goes hand in hand with stigma, Volkow said in the latest interview, which “seeps into every level, affecting individual and community suffering, the healthcare system and health insurance coverage.”

“Individuals, families and communities internalize the stigma associated with substance use. It’s something everyone is ashamed to talk about and it’s stopping people from getting the help they need,” she said. “It’s created a health care system that doesn’t provide the resources to treat addiction and insurance companies that won’t pay for effective treatments.”

As part of NIDA’s efforts to reduce stigma in drug policy and treatment, the agency is changing its name from the National Institute on Drugs Abuse at the National Drug Institute Addiction. Volkow said we use language “to construct shared realities and to construct identities,” and so it is important to avoid associating drugs with a moral negative (i.e., “abuse ”) and to embrace the health aspects of substance use disorders.

The change was part of recently passed congressional legislation that similarly changes the names of other federal agencies and programs to be less stigmatizing.

Volkow was also asked about the way forward to address the overdose crisis, and she acknowledged that the problem “is not going to go away on its own” and “requires a multi-pronged and tailored approach to targeted interventions at different stages.” “.

This includes educating the public about the risks of overdose from drugs like fentanyl, as well as providing treatment interventions and wider access to the overdose reversal drug naloxone.

“Addiction is treatable, but we have to treat it like a chronic disease,” Volkow said. “It causes long-term changes in the brain that are compounded by behavioral changes. These changes do not reverse when you stop taking the drug.

“The most vulnerable people may be those who are socially disadvantaged, and it is narrow-minded to believe that people take drugs because they want to. For example, you see people experiencing homelessness with high rates of smoking and alcohol consumption and high rates of overdose. These people have nothing else and many of them take drugs to escape, to feel better, because they have no other choice. And many struggle with other mental illnesses.

“Instead of stigmatizing people by saying this behavior is a choice, we need to ask ourselves what we can do to provide alternative behaviors, resources and support so that everyone has real choice,” she said.

Over the summer, Volkow said in a blog post that there was an urgent need to reshape addiction treatment, particularly by devoting more resources to identifying “pre-addiction” to help people before illness.

But addiction “rebranding” alone won’t solve one of the biggest problems keeping people from seeking treatment. There is still stigma and fear among people with substance use disorders about being transparent about their struggles, and this is largely due to the fact that personal drug use is widely criminalized.

In a separate essay last year, the health official reiterated that current federal drug policy leads to disproportionate enforcement against communities of color and may actually increase the risk of overdose deaths. She stopped short of explicitly endorsing decriminalization, but signaled that it was time to adopt this type of approach to effectively combat addiction and overdose.

Meanwhile, NIDA recently announced that it is inviting proposals for a contractor to grow, harvest and analyze millions of grams of marijuana for research purposes.

NIDA released some details of the proposal in July after issuing an initial “wanted sources” notice earlier this year, but it only started accepting bids on September 14. Interested parties have until October 28 to submit their full proposals.

Scientists have repeatedly said that marijuana’s Schedule I status under the Controlled Substances Act (CSA) is unduly prohibitive, discouraging researchers from undertaking cannabis studies. Even Volkow said she was personally hesitant to go through the onerous process of getting approval to study Schedule I drugs like marijuana.

NIDA also announced in June that it plans to provide $1.5 million in funding to support researchers who can develop a medical marijuana registry to track everything from how patients obtain and use cannabis. to their health outcomes.

The agency has further expressed interest in funding studies on the different models of cannabis regulation that are in place in states across the country.

In January, Volkow discussed data from a recent survey and said people will continue to use psychedelics like psilocybin – especially as the reform movement grows and more attention is paid to potential therapeutic benefits – and so researchers and regulators will have to keep pace.

Also that month, the director took part in a panel organized by a prohibitionist group and sponsored by DARE – and she reiterated that the data shows that marijuana use among young people has remained stable “despite legalization in many states. “.

She said the same thing during a Senate hearing in March, much to the surprise of a GOP senator who said he expected otherwise because of alcohol-related trends.

Last November, Volkow also said she had yet to see evidence that casual marijuana use by adults was harmful.

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