According to Burstein (2003), public opinion influences policy most of the time, often strongly. In a 2016 survey of 1,000 Virginia residents, it was found that factors such as race, education, and political affiliation are predictive of support for treatment over arrest for heroin and prescription pill abusers. The results of this poll coincided with legislative policies the following year, supporting this notion that public support has an influence on the policymaking process (Cook and Brownstein 2019).
Making public policy entails making decisions about whether or not something is a problem, and the appropriate ways to respond to the issue. The fact that heroin is considered an illegal drug, sold through illicit markets to users who are highly stigmatized, while other opioids are legally manufactured and sold through doctors raises the question if the distinction in policy reflects people’s different views about these drugs (Cook and Brownstein 2019).
Heroin was introduced as a cough suppressant and a treatment for people with serious lung disease in the beginning of the 19th century, a period of unregulated drug use and distribution. Unfortunately, it was proved to be as addictive, and policies were introduced first to control and eventually to outlaw their use. By the end of the century, heroin addicts were most often used by middle-class, white women. Heroin use continued to spread, achieving “confined to the periphery of society and the outcasts of urban areas.”
In the middle of the 20th century, the use, misuse, and abuse particularly of heroin was spreading across the country, though it was observed to be geographically limited to low-income urban communities and socially limited to poorer, minority male users. A succession of epidemics of heroin abuse from the 1960s through the 1980s mostly among young black and minority males living in major American cities were each recognized as a serious problem and responded to by policymakers with strict law enforcement policies and initiatives.
The main difference is that heroin is an opioid that has been prohibited by law and heroin users have been stigmatized for using it for more than a century. As a result, despite the pharmacological comparability of heroin and other opioids, they have not necessarily been treated the same way in drug policy. Some observers have argued, or claimed, that today the inconsistency between the legal restrictions placed on heroin as compared with the legal access to other opioids reflects political and moralistic concerns related to race, class, and gender rather than to scientific and unbiased considerations related to relative harm or benefit. For example, in his study of opiate use and morality, sociologist Duster (1971) wrote, “middle America’s moral hostility comes faster and easier when directed toward a young, lower-class Negro male, than toward a middle-aged white female.”
The people using opioids today come from a wide range of geographical areas and social categories. Studies of the use of heroin and other opioids offer evidence of its spread from cities to suburban and rural areas and from poorer, minority users to more affluent white users. Additionally, today’s drug epidemic involves multiple opioids, many of which are prescription opioids diverted from their intended use and users. Official records of drug use show an increasing number of people using both heroin and prescription opioids.
This has drawn attention from federal and state policymakers police departments in several major cities in the United States. Recognizing the failure of the traditional arrest and release cycle typical of addicts (Oxley, 2017), law enforcement began offering assisted diversion programs that consist of treatment rather than arrest for users. Considering the shift from enforcement to treatment, it is reasonable then to conclude that there is a contemporary opioid epidemic and it is unlike earlier heroin epidemics.
