ABSTRACT
Chapter 5 switches the focus to the opioid epidemic and the states. The chapter begins by making several points. First, those affected by the opioid epidemic differed from those affected by the war on drugs. The opioid epidemic, at least in its beginning years, was largely a white, rural phenomenon. The drug problems in previous decades were largely, though clearly not entirely, located among people of color in urban areas. Second, both sets of communities, rural and urban, were areas of economic decline. But the people involved were treated differently. For the earlier epidemics, people of color were treated as criminals and frequently incarcerated. Opioid addicts were treated more sympathetically, as victims, with appropriate remedies more frequently treatment- and prevention-oriented. Third, unlike earlier drug issues (crack cocaine, meth, heroin), the opioid epidemic began with a legal drug that had a medical purpose. That it morphed into something else is the avoidable tragedy of the epidemic. The chapter expands on these points. The states, like the federal government, were slow to respond. Indeed, the chapter argues that states were enablers, legitimizing pain relief utilizing opioids. When states did act, apart from trying to stop the illegal selling and distribution of opioids (prescription, heroin, synthetic), the focus was on treatment and prevention. The chapter covers various policies adopted by states and by the federal government to help them. It concludes that while the policies were well intentioned, the scope of the policies was small compared to the scope of the problem.
