In high-income cities recently there were billboards filled with young, attractive, smiling people. The caption read “Drink with friends,” explaining if you drink & drive, ask a friend to go with you to help steer, watch for oncoming traffic and tell you when you’re swerving out of your lane. If that sounds utterly ridiculous that’s because it is. Except, drinking wasn’t the topic of the billboards, fentanyl use was.
Attractive young people laughing and smiling as they shared a carefree high. But the intoxicant being celebrated was fentanyl, not beer. “Do it with friends,” the billboard advised, so as to reduce the risks of overdose.
The advertising campaign was part of an ongoing national effort by activists and health officials to destigmatize hard-drug use on the theory that doing so would lessen its harms. Particularly in blue cities and states, that idea is having a moment. The general message carried by the San Francisco billboard appeared as well in the New York City health department’s “Let’s Talk Fentanyl” campaign, which last year told subway riders, “Don’t be ashamed you are using, be empowered that you are using safely,” and further counseled them to “start with a small dose and go slowly.”
Public health advocates believe that removing the stigma of hard drug abuse would make it easier to advocate for them. However, professors, Keith Humphreys and Jonathan Caulkins explain why it was a huge mistake. Not only that, some of the destigmatize hard drug use logic is beyond absurd.
The nationally influential Drug Policy Alliance goes further: It lauds many fentanyl dealers as “harm reductionists” who should be respected and left alone by authorities (because the arrest of a trusted dealer might cause users to seek the drug from an unfamiliar source). A prominent subset of academics provides intellectual support for these initiatives, theorizing that stigma against drug use is ethically wrong and also worsens public health.
That so many influential people are working hard to promote a positive image of a drug that is killing 200 Americans a day is stunning, though the peculiar logic behind their efforts is not hard to understand. Many believe that policy changes have next to no ability to affect the prevalence of drug use. Some think that the government shouldn’t try to reduce use, even if it could. If the amount of drug use is beyond control, the theory goes, it is better to bring that use out of dark corners so that at least some of its dangers can be contained.
Nancy Reagan was ahead of her time. When she came out with her “Just say no” [to drugs] campaign it was dismissed as naïve, laughable, simplistic, outdated and at best ineffective. According to Wikipedia:
Critics also think that ‘Just Say No’ contributed towards the well seasoned stigma about people who use drugs being labelled as ‘bad’, and the stigma toward those people who are addicted to drugs being labelled as making a cognizant immoral choice to engage in drug use.
Perhaps I’m mistaken, but the passage of time and the current fentanyl crises has probably rehabilitated Reagan’s image to some degree. Nobody samples fentanyl with the intention of becoming addicted or dying. When the difference between an enjoyable recreational dose of fentanyl and a deadly dose is very small, “just say no” has more relevance. Also, when drugs are considered a hobby of losers, drug use loses its glamour. This from The Atlantic:
Taboos exist, in part, because they are effective. Avoiding temptations of all kinds can be easier if one thinks about those choices as being virtuous and automatic—I am not the kind of person who does this—rather than reevaluating them case by case or day by day.
Ironically, one of the best demonstrations of the power of stigma to change behavior was produced within the same public-health community that is now trying to destigmatize drug use. Cigarette smoking went from being banal and ubiquitous in the 1950s to uncommon today, one of the greatest achievements of public health. Crucial to this success was deglamorizing smoking through anti-smoking advertising campaigns (including some featuring graphic portrayals of the health effects of cigarettes), relentless recitation of the deaths smoking had caused, and a clear message that not smoking was a smarter, better choice.
The authors make some additional points that are valuable: The legal system can help prevent an activity from becoming normalized. Addiction drives petty crimes that are too often considered a nuisance rather than something to expend law enforcement resources on. Decriminalizing hard drug use also removes a tool to make drug use less glamorous.
The article is worth reading Destigmatizing Drug Use Has Been a Profound Mistake