Inside America's Opioid Crisis

Richard J. Baum is Adjunct Professor at Georgetown University. He served as Acting Director of the White House Office of National Drug Control Policy (ONDCP) and Executive Director of the President’s Opioid Commission (2017-2018) during his 28 years working at the agency. Baum is also a former Congressional staffer, NGO executive, and journalist. He has earned degrees in Government, National Security, and Public Administration. Raised in New York City, Baum has two adult children and resides with his wife Linda in Falls Church, Virginia.

• AcknowledgmentsIntroduction1. The Longest War: America Launches Drug Fight with Supply Control, Propaganda and Prejudice Chapter Introduction: What can Iron Man teach us about the early war on drugs?Hard Lesson: We must confront the two original sins of the drug war – racism and the stigmatization of addiction – to effectively combat today’s crisisThe Ancient Power of Opioids to Heal and to HarmThe Unregulated American Drug Market Results in Misuse, AddictionAmerica Helps Launch the Global War on DrugsCracking Down on Doctors, Dealers, and ConsumersThe Trouble with Drug Treatment – There Isn’t AnyThe First Federal Drug Agency Focuses on Supply Control and PropagandaThe Ugly Racism of Harry AnslingerGrowing Drug Use in the 1960s Raises Anxiety in a Troubled TimeRichard Nixon and his Psychiatrists Launch the White House Drug Czar’s OfficeNixon Era Drug EnforcementAssessing the Racism in the Early Drug WarThe Harsh Legacy of the Stigmatization of AddictionRecommendations2. Coked Up: Building Washington’s Drug War Infrastructure in the Crack Cocaine EraChapter Introduction: This Scourge Will Not EndHard Lesson: Drug policies and programs, built for the crack cocaine epidemic, must be overhauled for the opioid crisisAmerican’s Taste for Cocaine Fuels Powerful Colombian CartelsPowder Cocaine Becomes the Elite’s Drug of ChoiceCrack Cocaine and Its ConsequencesViolent Open Air Crack MarketsDrugs, AIDS, and the ReagansThe Cocaine Overdose of Basketball Star Len Bias Sparks Political EarthquakeThe 100-1 Crack Cocaine Sentencing Disparity FiascoCocaine Myths and LegendsThe Crack Era Ends, But the Policy Infrastructure Built for it RemainsRecommendations3. Prescription for Disaster: Purdue Pharma’s Crime of the CenturyChapter Introduction: Greed is Not GoodHard Lesson: Big Pharma’s reckless marketing of opioids has severely and permanently worsened America’s drug problemThe Spark: Release of OxyContin in 1996The Spread: Purdue’s Pharmaceutical Marketing TornadoThe Accelerant: Industry Funded Patient Advocacy Groups Transform Medical SystemThe Jump: The Transition to Black Market HeroinRecommendations4. Fatal Errors: The Consequences of Pushing Prescription Drug Consumers into the Illicit Drug MarketChapter Introduction: Too Close to HomeHard Lesson: Restrictions on opioid painkillers were recklessly applied and led to many unnecessary drug overdose deaths Prescription Drug Monitoring ProgramsAbuse Resistant Drug Formulations of Opioid MedicationsStrict Limits on Opioid PrescribingShutting Down Pill MillsActions Have Consequences – Accelerating the Transition to Black-Market DrugsRecommendations5. The Real Treatment Gap: Why Most People Who Need Treatment Do Not Seek it and What to Do About itChapter Introduction: Ground TruthHard Lesson: Most chronic drug consumers will only enter treatment via a ‘harm reduction-informed’ approachAmerica’s Two Drug Treatment GapsTreatment Progress and ChallengesThe Costs of StigmaMeeting People Where They Are, But Not Leaving Them ThereReconciling Traditional Treatment and Harm ReductionPutting Lived Experience to WorkThe Best of Both Worlds – A Treatment System That Works for AllOverdose Prevention CentersPsychedelics – Minimizing Risks and Maximizing BenefitsThe Road Ahead – Wrap Around Treatment and the Promise of Artificial IntelligenceRecommendations6. Deep Recovery: Creating a Recovery Friendly AmericaChapter Introduction: Why Are Former Inmates Trying to Get Back to Their Jail?Hard Lesson: Treatment and justice system initiatives are not sufficient to solve crisis, we must also create a nationwide recovery support systemSocial Determinants of Health and Recovery CapitalA New Home, A New LifeGetting Back to WorkBuilding Recovery Friendly WorkplacesTaking on Substance Use on College CampusesRebuilding Lives After Treatment – The Vital Role of Recovery Community OrganizationsRecommendations7. Precision Impact: Controlling Retail Drug Markets without Mass Incarceration or Racial BiasChapter Introduction: When Reality Hits You in the FaceHard Lesson: Mass incarceration damages communities—to combat drugs police must rebuild frayed relationships and adopt a much more targeted approachGrappling with Harsh Racial Realities in the War on DrugsRethinking Drug SentencingThe Tragedy of Re-Entry from Prison During the Opioid EpidemicAddressing the Collateral Consequences Imposed on those with a Substance Use DisorderThinking Through How to Deal with Marijuana in Today’s AmericaA Hard Look at Retail Drug MarketsDismantling Drug Markets without Mass IncarcerationAssessing Results and Prospects for Expansion of Drug Market InterventionsCovert Drug MarketsDeep Partnerships Between Community Groups and PoliceOregon Decriminalization: The Good, Bad, and UglyRecommendations8. True Justice: Reducing Addiction Requires Close Collaboration Between Justice and Health SystemsChapter Introduction: Catching FireHard Lessons: Police, courts and jails will only reduce overdoses and chronic drug use through coordinated initiatives with health agenciesHow to ‘Deflect’ More People Away from Arrest and Into TreatmentFront Loading Life-Saving Treatment at Drug Treatment CourtsHow Drug Enforcement Operations Can Help, Not Harm People Who Use DrugsConcentrated Leadership and Coordination in the Hardest Hit Regions of the CountryRecommendations9. Defense in Depth: Smart Border and Supply Control for Today’s Synthetic Drug EraChapter Introduction: In DeepHard Lesson: Supply control is wickedly difficult—a disciplined focus is needed on the most dangerous trafficking organizationsThe Border Battle - It’s One Thing After AnotherGoing to the Source – International Supply Reduction and ColombiaBreaking Bad – Taking on the Methamphetamine Supply ChainThe Fentanyl FightHard Lessons from the Supply SideA Reality-Based Way Forward on the Supply SideRecommendations10. Costs & Consequences: Scaling Government’s Response to Today’s Vast Drug EpidemicChapter Introduction: Deserve to WinHard Lesson: We have vastly underfunded the drug crisis response and must invest now, or will pay even more laterBolstering Management and Measurement of Drug PoliciesCostly Delays in Utilizing Evidence-Based PoliciesShow Me the MoneyOvercoming the Curse of KnowledgeImplementation Science and the Real Policy CycleClosing the Drug Policy GapsEstablishment of Return-on-Investment Teams at the Federal and State LevelDrug Policy Centers of ExcellenceBuilding Drug Policy Coalitions and Avoiding FragmentationReinforcing Federal and State Leadership of Anti-Drug AgenciesRecommendations11. The Fentanyl Generation: Protecting Youth from Today’s Dangerous Drug ThreatsChapter Introduction: Straight Talk for Dangerous TimesHard Lesson: Youth face a terrifying risk of overdose—new prevention and early intervention programs are needed to protect themProtecting Today’s Adolescents from the Brutal Drug SupplyAdvances in Prevention ScienceThe Failure to Reach Most Kids with Effective Drug Prevention ProgramsGoing Upstream to Help Kids EarlierKids Just Wanna Have Fun – Adapting Iceland’s Drug Prevention Model for the USAIceland’s MiracleUnleash America’s Creative Talent for Next Generation Media CampaignsRecommendations12. ConclusionHard Lesson: There is no easy button – the opioid crisis can only be solved by bringing innovative health and justice interventions to the millions of Americans who need themAppendix: List of Recommendations and BudgetAbout the AuthorBibliographyIndex