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Digital Subscriptions > Boston Review > Left Elsewhere > What Activists Know About Fighting the Opioid Crisis

What Activists Know About Fighting the Opioid Crisis

IN 2017, for the second time in recent years, U.S. life expectancy decreased. Headlines blamed the decline on suicides and opioids, and cast impoverished rural whites as the primary victims. A great deal of attention has been focused on Appalachia, whose population is (erroneously) portrayed as uniformly white, poor, and ravaged by drug addiction. White sickness has thus come to stand for what is supposedly wrong with health, health care, and culture in the United States.

The truth is not so simple. Black mortality rates continue to dwarf those of whites—another tragic indication of how our society has normalized racial inequality. In West Virginia, the state with the highest overdose death rate, the rate of overdose among blacks is slightly higher than among whites. In Tennessee, whites fare worse than blacks, but maybe not for long: from 2008 to 2016, the overdose mortality rate more than quadrupled among blacks compared to about a doubling among whites. Moreover, mortality rates increased for seven of the ten leading causes of death, with the highest percentage increase seen in influenza and pneumonia. Drug addiction, then, is not the easy explanation we have made it out to be. Income inequality, loss of social safety net services, and state violence against communities of color are also massive problems, a conclusion borne out by a large body of research. But by only focusing on class—those poor white Appalachians—most media reports ignore the racism, xenophobia, and LGBTQ discrimination found in every aspect of the U.S. health care system, from medical research to bedside care.

There is hope in this story, however. Because these marginalized communities have been hung out to dry for so long, they have developed the tools that are now proving most successful in combatting the opioid overdose crisis. “Harm reduction,” as this approach is called, is a social justice movement that supports the dignity and rights of people who use drugs. Many harm reduction programs have roots in 1980s activism around HIV, and most of the organizations I have worked with exist thanks to the unrelenting labor of queer activists. Some view the approach as controversial because it bucks the dominant neoliberal attitude toward drug use, exemplified by the War on Drugs’s focus on punishment. Instead of trying to enforce abstinence—viewing individuals as the site of punitive state intervention—these initiatives try to reduce the harms, both medical and social, associated with drug use. With social services and medical support increasingly out of reach for many Americans, harm reduction takes seriously the intersecting inequalities that push people into the fringes and drive down life expectancy.

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“Rural spaces,” writes Elizabeth Catte, author of What You Are Getting Wrong About Appalachia, “are often thought of as places absent of things, from people of color to modern amenities to radical politics. The truth, as usual, is more complicated.” With activists, historians, and political scientists as guides, Left Elsewhere explores the radical politics of rural America—its past, its priorities, and its moral commitments—that mainstream progressives overlook. This volume shows how these communities are fighting, and winning, some of the left’s biggest battles. From novel health care initiatives in the face of the opioid crisis to living wages for teachers, these struggles do not fall neatly into the “puny language,” as Rev. William Barber says, of Democrat or Republican. Instead they help us rethink the rural–urban opposition at the heart of U.S. politics. The future of the left, this collection argues, could be found elsewhere. With contributions from William J. Barber II, Lesly-Marie Buer, Elizabeth Catte, Ash-Lee Woodard Henderson, Nancy Isenberg, Elaine C. Kamarck, Michael Kazin, Toussaint Losier, Robin McDowell, Bob Moser, Hugh Ryan, Matt Stoller, Ruy Teixeira, Makani Themba, and Jessica Wilkerson.