A Human Rights Perspective on the Opioid Crisis in America

Pills
Pills. Source: Jamie. Creative Commons.

The opioid crisis in the United States is not something I often hear about in the news nowadays. Or maybe it is so often in the news that the title fades into the background amongst the news about politics. However, the opioid epidemic affects millions of people across the United States, and it has affected them for years. Human rights concerns connected to the epidemic have begun to grow in recent years as controversies regarding the United States health care system and law enforcement systems have come to light.

The crisis began with the expansion of opioids for medical purposes in the 1990s. The initial goal with opioids was to treat pain but the drugs soon became exploited by pharmaceutical companies eager to increase their profit revenue [1]. Before the addictive and harmful properties of opioids became known both to the public and to healthcare professionals, prescriptions for opioid medications increased rapidly across the country.

The introduction of extended-release oxycodone in 1996 along with claims by the manufacturers that it was less addictive and effective for up to 12 hours was a major catalyst for the epidemic. There are three described waves of opioid overdose deaths in the United States. The first wave began with an increase in the prescription of opioids, increasing since at least 1999. The second wave included overdose deaths involving heroin, the increase beginning in 2010. The third wave included an increase in overdose deaths involving synthetic opioids such as illicitly manufactured fentanyl (IMF) in 2013.

Hospital
Hospital. Source: Marissa Anderson. Creative Commons.

The first reaction to the opioid crisis was to limit the number of prescriptions in the market. However, this drove many to use the less expensive and more accessible street heroin. Cheaper and stronger opioids kept reappearing on the market, leading to an accelerated rate of fatal overdoses. Most addictions start with diverted supplies instead of among doctors’ patients. This was the case with heroin, which causes 4% of those who were using prescription opioids to switch to heroin. While 4% seems like a small percentage, 4% of the large number of people taking opioid pills is actually very large and enough to exacerbate the crisis [2]. In 2017, the United States Department of Health and Human Services declared a public health emergency. Over 130 people die every day from opioid-related overdoses and 10.3 million people in the United States misused prescription opioids in 2018. In 2017, more than 70,200 people died from drug overdoses. Of those 70,200, around 68% involved opioids.

White Americans make up roughly 80 percent of opioid overdose victims. The attention of the coverage of the opioid crisis has primarily centered on white Americans, pushing aside the attention on minorities affected by the crisis. Minorities made up 20 percent of opioid related deaths in July of 2019, but that number is growing. The crisis has highlighted the racial disparities in the US healthcare system as many experts believe that the number of opioid related deaths in minority populations would be greater if minorities had access to the same level of health care as white Americans. It is known that people of color have had a significant lack of access to the American healthcare system throughout history and throughout the recent years. This disparity lowers the probability that non-whites in American would be prescribed opioids and thus lowers the chance that the population would suffer fatal overdoses. Despite the low death rates due to the exclusions within the health care system, the abuse of opioids is still abundant in communities of color. Scientists have witnessed a doubling of overdose death rates among African Americans, a factor that is being overshadowed by the media and societal focus on the death rates of whites.

Police
Police Officer. Source: G20 Voice. Creative Commons.

The law enforcement system has failed minorities in the opioid crisis as well. The War on Drugs, an attempt at cracking down on the opioid epidemic, has disproportionately affected African American communities across the United States. Studies have shown that law enforcement officials target black communities for drug violations significantly more than they target white communities. While drug use is similar between white communities and black communities, members of the black community are 13 times more likely to be arrested for buying and using drugs. In 2013, black and Hispanic populations represented 29 percent of the entire United States population. Despite this, the number of black and Hispanic prisoners arrested for drug related charges dominated that of whites. Not only is this true, but the United States Sentencing Commission also released a report stating that black prisoners receive longer sentences than white prisoners, despite both groups being convicted of similar weighted crimes.

The opioid crisis has hurt millions of people and families across the United States, one of the most diverse countries in the world. Despite this, the national attention has primarily focused on how the crisis has affected the white population. It is important to focus not only on how the opioid crisis has affected minorities, but also how the health care and law enforcement systems have responded to the opioid crisis in minority groups. The disparities within these systems must be fixed in order to provide an equal treatment of all groups.

[1] The Global Commission on Drug Policy. The Opioid Crisis in America. 2017.

[2] The Global Commission on Drug Policy. The Opioid Crisis in America. 2017.

The Conflict in Yemen and Trajectories for Peace: Recap

Street photography of Yemen stone alley and buildings
Yemen. Source: Rod Waddington, Creative Commons for Flickr.

Fatima Abo Alasrar, a nonresident scholar at the Middle East Institute and former senior analyst at the Arabia Foundation, joined us on Thursday, Sept. 26, 2019 to shed some light on the crisis in Yemen and advocate a new social contract regarding Yemen as the war has evolved from a local insurrection into an international effort that has exposed greater vulnerabilities of the country, weakened the central government, and emboldened foreign threats to Yemen.

Before the country appointed a president, the Zaydis, an Islamic sect, were dominant in Yemen where they resided for thousands of years. Its Imams controlled the north of Yemen, as the theocratic Yemen Arab Republic, as the south slowly turned into the People’s Democratic Republic of Yemen. When the president in the north, Ali Abdullah Saleh and his regime proposed to unite the north and south under one government, unification was not based on democratic principles, but on state, rhetoric-accentuated polarization and identity politics. For northerners, the war ended succession, but the southerners grieved as they became second-class citizens who were exploited under occupation. Meanwhile, the Houthi Movement organized Zaydi-Shia fighters against underdevelopment and political marginalization as they protested the dilution of Zaydi influence and identity. Inequality built resentment among civilians and some of the dissatisfied joined extremist groups or protest as people lost faith in the state. As more states and non-state actors got involved and introduced differing political and ideological orientations and promoted their interests, efforts deepened sectarian divides.

Saudi Arabia continued to assist the government against the Houthi rebels, especially motivated by their Shiite rival, Iran who supported the Houthi insurgency; however, Ms. AlAsrar revealed Saudi shortcomings in the military’s lack of warfare experience, increase in spending, and media coverage criticizing domestic failures.  She explained that Saudi Arabia has only aggravated this already dire humanitarian crisis and now faces ramifications.  She urged, instead of encouraging Saudi intervention, international attention should shift focus.

AlAsrar stressed Iranian intervention and influence in Houthi insurgency -evident as the group’s propaganda and style mirrors the others’- where Houthis considered themselves proud members of the Iran-led Axis of Resistance alliance (resisting the West and Israel). The Houthis act as Iran’s proxy to advance their goals in Yemen just as the Iranians act as Houthis’ proxy to get power in their own political agenda and this relationship has only festered.

Group holding sign Reading "STOP US SAUDI WAR CRIMES IN YEMEN"
Felton Davis. Creative Commons for Flickr.

The US is complicit in war crimes as it supports Saudi Arabia, a major ally, who is threatened by Western antagonizers including Iran and Houthi rebels in the counter-terrorism narrative. This alliance has clouded Americans’ knowledge of Yemeni objectives and continues to kill, repress, and threaten civilians. Now all players may use the counter-terrorism narrative to attract the international community, which is not as informed and interested in the domestic conflict consuming Yemen.

Radicalized and terrorist groups concentrate and compete for the spotlight and the conflict has amplified as it is linked to the war on terror for international attention. Al-Qaeda is such a group who has acted as a gang for hire in the Yemen conflict. The intervention of regional powers also threatens to draw Yemen further into the broader Sunni-Shia divide. Iran exploited the conflict to increase its influence in the region becoming the most beneficiary actor for its relatively low cost. Whereas, U.S. backed Saudi Arabia suffers reputational damage which is creating more friction.

All sides of the conflict have been accused of violations of international humanitarian law and organization which are pushing Yemeni civilians out. AlAsrar questions whether the UN can hold the Houthis accountable for their end of the bargain. The UN’s plan for Yemen has been shaped in Houthi favor, “confident in their power of destruction,” accepting Houthi demands and encouraging their extraction of concessions so the deal does not collapse. The desire to keep the Houthi involved in the peace process has only legitimized a violent non-state actor.

Children standing over ruins in Yemen.
343 Searching Through Ruins. Felton Davis. Creative Commons for Flickr.

The speaker’s concern was in the international community’s engagement regarding the conflict in Yemen, misguided, misinformed, and disconnected narrative on which international actors base their policies. Political engagement continues to be overshadowed by limited propaganda and media coverage of the war.

AlAsrar elaborated with frustration concerning the overwhelming use of the humanitarian narrative to explain the conflict in Yemen. A lot of humanitarian work is fast-paced and reaches for an emotional narrative. There is a lack of comprehensive policy instruments when the audience sees humanitarian assistance as the primary tool. International humanitarian organization has hijacked the voices of the local civil society to provide immediate relief which cannot speak for the broader political factors that have created and perpetuated the crisis.

Other regional governments have interceded to pursue and protect their own interests, but the root of the Yemeni conflict was a domestic one. These foreign powers may encourage their partners to engage in a political process for peace but have instead overshadowed the conflict in Yemen which was driven by concerns in sectarian marginalization, economic underdevelopment, and displeasure at governmental political distraction in cooperation with foreign powers, the United States and Saudi Arabia. In response, AlAsrar’s narrative encourages broader education and analysis on the different motivations, perspectives, and grievances of each actor to establish a more comprehensive and consistent strategy and policy to deal with the exasperated and dire Yemen Conflict.