Biden’s drug overdose strategy pushes treatment for some, prison for others

This year marks the 50th anniversary of the War on Drugs, and as a doctor who cares for people who use drugs, I am grateful for the tremendous advances in addiction medication and treatment that have helped so many people attain healthy and fulfilling lives. But while the public health field has come a long way, our federal government, sadly, has not. 

At a time when we’re losing 96,000 people a year to drug overdose, it’s imperative that we embrace a public health-centered approach to substance use, free of bias and stigma, that encourages people to get compassionate and effective medical attention. Treatment, not criminalization, is the only method proven to save lives and strengthen communities. 

Regrettably, Congress, following President Biden’s lead, is quietly trying to pass one of the most aggressive drug-enforcement laws of the past 20 years in a move that threatens to expand mass incarceration, exacerbate racial disparities and cost lives. A class-wide scheduling of fentanyl-related substances may sound wonky, but you don’t have to be a doctor to know the dangers of this policy.  

A fentanyl-related substance (FRS) has a similar chemical structure to fentanyl, but its effects on the body and mind vary significantly, including no effects at all. The list is long: anesthesia administered after surgery, the over-the-counter anti-diarrheal medication loperamide and thousands of other substances that have not yet been catalogued by the government.

As a medical professional, I believe in a public health approach to addiction. And as an advocate for racial justice, I fight to ensure everyone is able to receive the treatment they need. As lawmakers debate the best way forward, they could learn a thing or two from the work on the frontlines of the overdose crisis. 

It’s not the rise in fentanyl cases that give me the most concern, but rather the fact that more and more people who need treatment aren’t getting it. The reality is that many Black and Latino communities tell me they fear medicine and the health care system because their health needs are seen as threats and their addiction problems are treated as crimes. 

The crackdown on FRS began in 2018 when then-President Trump issued a temporary order to place FRS in Schedule I, the most restrictive category of substances and the one that carries the harshest punishments. Trump’s action didn’t save any lives, but it did increase stigma and help send a lot of people to prison — 70 percent of whom were people of color — and scared off others from seeking the treatment they so desperately needed. While Trump’s original scheduling order expired in 2020, Congress has repeatedly voted to extend it for a few months at a time, kicking the can down the road until they came up with something better.  

Seeing how this plan failed miserably and did not reduce overdose rates, you’d think we would have learned our lesson and tried something else. On the contrary, Biden appears to have double down on Trump’s failed tactics, proposing to permanently classify FRS as Schedule I.

Not only is Biden’s tough-on-crime proposal at odds with his campaign pledge to reform the criminal justice system, but it contradicts his own Department of Health and Human Services, which just last month released its own overdose prevention strategy emphasizing harm reduction and compassionate care.

Biden is trying to have it both ways. While publicly supporting public health strategies, he’s zealously pushing new laws that disproportionately harm Black and Latino people by sending them to prison and discouraging them from getting treatment. The overdose crisis is a racial justice issue and until everyone is able to get the medical treatment they need, we will never dig ourselves out of this hole. 

The STOP Fentanyl Act is a bill currently sitting in Congress that, if passed, would change the course of drug policy in the United States. It does so by investing in public-health measures that are proven to save lives, such as expanding research into substance use disorders, improving access to overdose-reversing drugs like naloxone and foregrounding equity in treatment. 

We’ve seen from the pandemic that our leaders are capable of making big investments in the name of public health. Like COVID-19, substance use disorder doesn’t discriminate, but unfortunately our treatment options do. To ensure no more lives are lost to overdose, we as a country must ask ourselves: Who is worthy of care?

Kimberly Sue, M.D., Ph.D., is assistant professor of medicine in the Program in Addiction Medicine at Yale University School of Medicine. She is the medical director of the National Harm Reduction Coalition, a national advocacy and capacity-building organization that promotes the health and dignity of individuals and communities impacted by drug use and the racialized War on Drugs.