Stephen M. Taylor, MD, MPH, DFAPA, DFASAM is board-certified in general psychiatry, child and adolescent psychiatry, addiction psychiatry, and addiction medicine. He is president-elect of the American Society of Addiction Medicine (ASAM). He served as co-chair of ASAM’s Public Policy Committee’s writing subcommittee on advancing racial justice.

Right now in the US, a Black man is living with the disease of addiction after being released from prison for possession of cocaine (for which there has long been a racist sentencing sentencing disparity between its rock and powder forms). Chances are, he did not receive he did not receive evidence-based addiction treatment while incarcerated addiction treatment while incarcerated. Furthermore, notwithstanding the physical and emotional trauma he likely endured while in prison, he returns to the community without any resources to secure housing, health care, or employment.

Unfortunately, recurrence of drug use and recidivism are probable outcomes for him. As he applies for a new apartment, a loan, or a job, he is asked to disclose his conviction for drug possession. Often, he is discriminated against -- denied the means to improve his lot in life— for he lives in a country that elects to punish their disease’s core symptom. Feeling despair from the lack of opportunities and continuing to remain untreated, he may use illegal drugs again. The stigma that people like him face every day can perpetuate a vicious cycle in which their punishment is prioritized over their wellbeing.

Structural barriers like these affect millions of millions of Americans with substance use disorders with substance use disorders. Combined with the enduring impact of policies and practices like redlining, segregation, racial discrimination, xenophobia, and voter suppression, however, it’s clear that people of color with addiction face even more inequities caused by systemic racism and entrenched structural stigma. Despite similar rates of illegal drug use across racial groups rates of illegal drug use across racial groups, people of color are more likely more likely to experience drug-related arrests and convictions experience drug-related arrests and convictions—and, thus, bear the brunt of their subsequent impacts.

As documented throughout the American Society of Addiction Medicine (ASAM)’s three-part policy series on advancing racial justice, our nation’s “war on drugs” has caused irreparable harm to the lives of Americans who use certain drugs, their families, and their communities. It has achieved this by diverting much-needed resources away from health and wellness, disproportionately restricting opportunities for people of color, and fueling racial health disparities. It has perpetuated stigma, which manifests itself structurally through policies and practices that work to label, stereotype, isolate, and remove power and status from its targets. And, for more than a century, US drug policy has served to codify the stigmatization of individuals who use certain drugs, especially those coming from marginalized communities. In short, the overreliance on criminalization in the face of drug use and addiction has failed this nation and all its people.

This Black History Month, I urge all ASAM members to reflect on the third policy statement of that series, in which ASAM makes it clear that policymakers must continue to advance policy reforms that end the overreliance on criminal law when it comes to drug use and promote reparative justice. Federal, state, and local policymakers can start by: 

• eliminating criminal penalties and onerous civil penalties for drug and drug paraphernalia possession for personal use, as part of a larger set of related public health and legal reforms designed to improve carefully selected outcomes; 

• supporting robust policies that facilitate access to evidence-based prevention, early intervention, treatment, harm reduction, and recovery support; 

• making financial investments in social determinants of health; and 

• considering new clemency efforts for individuals in jails or prisons for non-violent drug offenses, many of whom are BIPOC. 

In the end, it will take all of us – working together – to dismantle the structural racism and stigma that is so deeply woven into the fabric of US drug policy. America’s addiction specialist physicians stand ready to help with solutions to address the structural and social determinants of addiction. By bringing racial justice to US drug policy, we can finally achieve a future when addiction prevention, treatment, remission, and recovery are accessible to everyone who needs it – profoundly improving the health of all people.