Substance Use and Abuse
with Scott Nolen, Director of the Open Society Institute-Baltimore’s Addiction and Health Equity Program
Feb 12, 2019
In 2017, more than 28,000 people died of overdose involving synthetic opioids in the United States.
Scott Nolen, Director of the Open Society Institute-Baltimore’s Addiction and Health Equity Program, joins host Tetiana Anderson for a conversation on his organization’s approach to improving public health.
Anderson: More than 72,000 people in the United States died of drug overdoses in 2017. That´s twice the number of annual overdoses from a decade earlier. According to the CDC, drug overdoses increased among African-Americans more than any other racial or ethnic group. Hello, and welcome to "Comcast Newsmakers." I´m Tetiana Anderson. For details on the impact of this country´s drug problems and policies on communities of color, I´m joined by Scott Nolen. He is the Director of the Open Society Institute Baltimore´s Addiction and Health Equity Program. Scott Nolen, thank you so much for joining us.
Nolen: It´s great to be here.
Anderson: So, drug overdose and abuse isn´t just a health issue, it´s also a criminal justice issue, and we know that this impacts Black Americans more than any other group. What has the criminal- justice aspect of the fight against drug abuse really done to communities of color?
Nolen: So, what we´ve done, actually, is we criminalize drug use, and if you´re familiar with documents from the Nixon administration, we know that there was an intentional effort to deregulate and destabilize African-American communities by having this war on drugs. And so, what has happened over the last 50 or 60 years is that the war on drugs has in fact destabilized African-American communities, and then at the same time, we´ve had, at both the national level and at the state level, conservative governments that have chipped away at our health safety-net, our medicaid programs and other types of safety-net programs. And so, what we ended up with as we entered into this opioid crisis as Fentanyl flooded the market, as Oxycodone came onto the market and people began to misuse it, is that we had a perfect storm of a criminal-justice response that wasn´t going to ever be effective, and a lack of a safety net for people once they did become addicted to drugs and needed the types of services that would help them get their lives stabilized.
Anderson: And when it comes to those types of services, that´s exactly what you do, where your organization excels. And I know you have three main pillars where you´re concentrating. Tick through those for us.
Nolen: Yeah, so, the three elements of sort of the work that we do at Open Society Institute Baltimore is, one, looking at healthcare reform, and that´s not just the Affordable Care Act, that´s all different ways in which we could change and transform the healthcare system to be more responsive to people wherever they are. The second element, which I think is really the key and the reason why this opioid epidemic has expanded in a way that it has is how do we lift the voices of people who are directly impacted? Because very frequently, we have policy makers making decisions about communities that they´re not a part of, and they don´t really understand the issue at the same level that people who are in that community. And third thing -- and I can´t underscore this enough -- is the need for more harm-reduction approaches, right? So, the CDC will tell you that somewhere between 10% and 20% of people who meet the criteria that need actual substance abuse treatment actually are getting it. So, that means somewhere between 80% to 90% of people right now at this very moment aren´t getting access to treatment, and so we´re not going to change that overnight, so what harm-reduction types of policies can we do to help people be as healthy as they can until we can get them to treatment or that they´re ready for treatment?
Anderson: And when it comes to harm-reduction policies, I know that one of the big issues is stigma surrounding people who are drug users and abusers. Why is that such an important thing to tackle?
Nolen: Well, stigma is very important because it creates a situation where people won´t go get help because people know that, for instance, in a situation of an overdose, if I call the police because my buddy who I was using drugs with overdoses, I might be arrested. And so, that stigma, that criminalization of substance use, creates an even more dangerous situation that actually feeds the overdose rate.
Anderson: A lot of your work and results are happening inside of Baltimore, but you guys have a much broader view. Where are you going with this, ultimately?
Nolen: So, OSI Baltimore is often described as a model for the nation, right? So, we try to do pilot projects, we try to do policy reform in Baltimore, which is a fairly typical majority-minority urban city that we think could be exported to Philadelphia, Detroit, New Orleans. There´s lots of places that are very similar to Baltimore in terms of the resources, in terms of the community, in terms of the challenges.
Anderson: So, this is part of a broader sweep in terms of your expansion approach, then.
Nolen: Absolutely. So, for instance, right now we have a project where we´re working with a non-profit organization to provide services to people as they leave out of incarceration, out of the local jail. Because we know that folks are at a 30% to 40% more higher likelihood of a fatal overdose when they walk out of a jail, because they haven´t been using, they may get a hold of something that´s a little bit stronger than what they had been using. And so, that´s the kind of model where we say, "Well, why isn´t this happening everywhere? Why isn´t this happening in, again, Detroit? Why isn´t this happening in Philadelphia?" Because we know we can reduce overdose deaths by transporting this model to different places.
Anderson: And you certainly will. Scott Nolen, thank you so much for joining us.
Nolen: Thank you.
Anderson: And thank you for joining us, as well. For more great conversations with leaders in your community and across the nation, visit comcastnewsmakers.com. I´m Tetiana Anderson.