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We need an all-of-the-above strategy to fight the opioid crisis


The U.S. remains mired in an opioid crisis, with dangerous synthetic opioids such as fentanyl dominating the illicit drug market and driving steep increases in overdose deaths. Last month, the Centers for Disease Control and Prevention reported that over 106,000 Americans died from drug overdoses in the last 12 months, another record number and a grim reminder that the decades-long opioid epidemic rages on. Today, fentanyl is the leading cause of death for Americans aged 18 to 45—more than car accidents, firearms and COVID-19.

As communities across the country grapple with the effects of the opioid crisis and policymakers consider a potpourri of enhanced enforcement, harm reduction and treatment options to help bring it under control, it is instructive to look at how prior drug outbreaks finally drew to a close. In the U.S., the closest antecedent would be the 1980s' crack epidemic, when the explosion of crack cocaine led to a sudden and dramatic increase in drug addiction, violence and death in many areas around the country.

There are important differences between the crack epidemic of the 1980s and the opioid crisis of today—for one thing, the crack epidemic disproportionately impacted urban, African-American communities, while the opioid crisis has ravaged nearly every cross-section of America. However, reflecting on that dark period of American history may yield some important insights to understand how the current drug crisis may end.

In a 1999 post-mortem of the crack epidemic, a reporter asked a reformed crack dealer and longtime resident of one of New York's most notorious drug neighborhoods what happened to his regular customers over the years. The former dealer's response was as sad as it was prescient: "Some of them died. Some of them went to jail. The others are still using crack, but they're getting old."

Mike Davis, Associate Special Agent in charge, Los Angeles division of the Drug Enforcement Administration (DEA), carries containers of pills and prescription drugs to be boxed for disposal during the Drug Enforcement Administration (DEA) 20th National Prescription Drug Take Back Day at Watts Healthcare on April 24, 2021 in Los Angeles, California. - According to the Centers for Disease Control and Prevention, the US has seen an increase in drug overdose deaths during the Covid-19 pandemic, accelerating significantly during the first months of the public health emergency, including deaths from opioids and counterfeit pills containing fentanyl.PATRICK T. FALLON/AFP/GETTY IMAGES

The crack epidemic didn't end because cocaine suddenly disappeared. In fact, South American cocaine production is higher now than at any point during the crack epidemic. And it wasn't because the U.S. got "tough on crime" or adopted any particularly effective counterdrug strategy. While more aggressive—and questionable—law enforcement tactics may have played some role in crack's decline, the crisis didn't really end until people "grew tired" of the drug.

That is not to say we should simply sit back and wait for the opioid crisis to fizzle out. Hope, as they say, is not a strategy.

The U.S. must employ an "all-of-the-above" approach to the drug crisis that includes counterdrug measures like supply reduction, harm reduction and treatment. A comprehensive counterdrug strategy is needed to protect vulnerable Americans from unscrupulous drug traffickers, to minimize the risk of death or other harm to drug users and help those caught in the throes of addiction obtain treatment they need. However, without a significant decrease in demand, these measures alone are unlikely to bend the curve.

The truth is, the opioid crisis will only end when people stop abusing opioids. This will require a paradigm shift in the perception of opioids, especially among young people. Like crack before it, there must be a "generational revulsion" to these drugs and a greater awareness about how destructive they really are. And so while the U.S. continues to explore and debate new strategies to combat the opioid crisis, it must not neglect perhaps the oldest and most effective strategy of all: prevention.

Jim Crotty is the former Deputy Chief of Staff at the US Drug Enforcement Administration. He is currently an Associate Vice President at The Cohen Group, as strategic advisory firm based in Washington, DC.

The views expressed in this article are the writer's own.

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