Medicalizing Vs. Criminalizing
By Albert B. Kelly
When it comes to issues of race and racial bias, for so many years it was about on someone’s personal experience and by that I mean what each individual saw, heard or experienced in their own lives. Beyond that, it often came down to what people heard and discussed within their circle of friends and family. That’s why you could have whole segments of society claim that race or racial bias wasn’t much of factor anymore even though it was factor and remains so today.
But over the last couple of decades, with the advance of technology in the digital age, these questions are less dependent on what people see, hear, and experience personally and are more the stuff of hard data. I suspect that’s part of the reason we now have regular claims of “fake news” because when you can’t argue with the data, you can always dismiss it as a lie and move on. One recent area that the data shows us a glaring example of bias is with respect to drug overdoses, particularly during the pandemic.
A recent report by Brian Mann on NPR discusses new research from studies conducted in Philadelphia and California that provides hard data on bias, namely that black Americans are dying from overdoses far more than white Americans. One study in the Journal of the American Medical Association gathered data in Philadelphia. The upshot of the study was that overdose deaths among African-American residents of that city was over 50% of what it was before the pandemic while it remained either unchanged or even lower during the same timeframe for white residents.
All of this was measured against backdrop where some 83,000 people died of drug overdoses during the pandemic which covers much of 2020 which translates into a 20% increase in overdose deaths from the previous year. A similar study done by a team from Yale focused on California got similar numbers in terms of the disparity between the numbers of black overdose deaths versus white.
As for the reasons why, the main conclusion is that whites are far more likely to be treated for addiction through healthcare and MATs (Medication Assisted Treatment) while black and brown people are far less likely to have that option. This is the difference between treating addiction as mostly a medical problem versus treating addiction as mostly a criminal problem.
This is idea of “medicalizing” versus “criminalizing” addiction is something we have to stop and consider. I say that because to look just at the main headline of these studies, i.e., that blacks are dying of overdose deaths far more than whites, might lead someone to conclude that the problem rests exclusively with the users. But the problem is systemic on a number of fronts.
For example, if white communities were aggressively policed in the same way black communities are, those encounters would be far more likely to result in a “criminalized” outcome. Another systemic inequity is the mechanisms for treatment whether it involves court-ordered treatment or just someone seeking treatment because they know they have a problem. It would be worth knowing how often courts allow white defendants to pursue treatment as an alternative to jail versus black defendants.
In the piece, one specialist in the field of addiction treatment, Dr. Nzinga Harrison who runs a black-owned addiction recovery network in Massachusetts, uses the term “addiction treatment deserts”. The idea of a desert is not new. We’ve often discussed “food deserts” which are communities that do not have a supermarket and must travel a couple of miles or more for fresh fruits and vegetables. These are generally in minority-majority urban areas or very rural areas. If we regularly encounter food deserts, then how much more addiction treatment deserts.
Beyond the idea of a desert, Dr. Harrison referenced a Journal of the American Medical Association study from 2019 that showed that black patients with opioid addiction were 35 times less likely than white patients to be prescribed buprenorphine. If you are not familiar with buprenorphine, it is part of a Medication Assisted Treatment (MAT) regiment that takes away cravings and prevents overdoses. Perhaps we have a “medication desert” as well.
There has been a focus on lowering the number of people in jail through bail reform and similar measures. These reforms are needed, but if we’re serious about justice, then perhaps it’s time to confront the inequality found in our approach to addiction, medicalizing versus criminalizing.