We are seeing the familiar trajectory of how the US views social problems played out in the case of the opioid overuse epidemic. When a social problem like drug use is seen as primarily affecting the black community, it is treated as a crime and dealt with harshly, with police crackdowns on users and the handing out of long criminal sentences. The racial disparity in sentencing was most visible in the way that use of crack cocaine (used primarily in the black community) was treated far more harshly than powdered cocaine, a form of the drug that was favored by the affluent white community.

But when the problem is seen as affecting the white community as well, we shift to the second stage of trying prevention and treatment rather than punitive measures. When the extent of the ravages of opioid addition (estimated to be killing 91 people per day and costing $78.5billion annually due to health care, lost productivity, and criminal activity) became realized and that it was affecting the white community as well, the drug problem started transforming from a crime issue to a health issue and we saw calls for treatment and prevention rather than punishment. There has also been a shift from viewing drug usage as being due to personal moral failures to having more systemic causes, with even the chair of the Federal Reserve Janet Yellin suggesting that despair due to lack of jobs and hope may be a factor in the rise, citing the puzzling decline in workforce rates among working age men.

The analysis of causes also follows a standard pattern.

Society’s response has been understandably desperate but generally wrongheaded. We start by blaming addicts. Then we blame the pharmaceutical companies for developing and marketing painkillers. We blame doctors, for overprescribing opiates, which pressures them to underprescribe, which drives patients to street drugs – cheaper, home delivery via the internet, and zero quality control.
…

There has been some progress: There are pockets of activity here and there where prescribed opiates – like methadone and Suboxone – are made more easily available to addicts. That’s a good thing, because increasingly desperate addicts are often driven to the street, where they’re most likely die. The availability of naloxone, which works as an antidote, is slowly wending its way through the drug policy jungle, providing a simple resource to deal with an overdose on the spot. But in most segments of most communities in the US and elsewhere, it is still too difficult to obtain.

But now we have reached the third stage where the cost of treatment becomes a factor as the cost of the life-saving drugs get jacked up.

Often, the only thing separating whether an overdose victim goes to the hospital instead of the morgue is a dose of naloxone, also known by the brand name Narcan, a medication that can reverse the effects of opioid overdoses.

Two doses of an injectable form of naloxone, Evzio, cost $4,500, up from $690 in 2014. The price of other forms of the drug, including the nasally administered Narcan, typically range from $70 to $150 per dose, officials say.

Compounding the costs, the potency of the newest batches of opioids often means first responders must administer multiple doses of naloxone to revive patients. Health officials say powerful additives to the illicit market — such as fentanyl and carfentanil, an elephant tranquilizer — are to blame.

Poor white people who overdose are seen as perhaps less deserving of the cost of saving their lives, and lines are being drawn as to who is worth saving and who is not. Ohio is one of the states badly affected.

With 96 fatal overdoses in just the first four months of this year, Mannix said the opioid epidemic ravaging western Ohio and scores of other communities along the Appalachian Mountains and the rivers that flow from it continues to worsen. Hospitals are overwhelmed with overdoses, small-town morgues are running out of space for the bodies, and local officials from Kentucky to Maine are struggling to pay for attempting to revive, rehabilitate or bury the victims.

As their budgets strain, communities have begun questioning how much money and effort they should be spending to deal with overdoses, especially in cases involving people who have taken near-fatal overdoses multiple times. State and local officials say it might be time for “tough love”: pushing soaring medical costs onto drug abusers or even limiting how many times first responders can save an individual’s life.

“It’s not that I don’t want to treat overdose victims, it’s that the city cannot afford to treat overdose victims,” said Middletown Council Member Daniel Picard, noting this industrial town in northern Butler County might have to raise taxes in response to the crisis.

Once again we see what happens when national problems are left to local communities to deal with. Communities that are well off can treat people while those that are poor see themselves as being faced with the awful choice of whom to save and whom to let die. While poor white drug users are not yet being thrown into prison yet like black people, we have reached the stage where their lives are starting to be viewed as not worth saving.