Voice-over: You're with The Takeaway and Melissa Harris-Perry.

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President Richard Nixon: America's public enemy number one in the United States is drug abuse. In order to fight and defeat this enemy, it is necessary to wage a new all-out offensive.

Melissa Harris-Perry: President Richard Nixon back in 1971, declaring a war on drugs. More than 50 years later, it's clear that what was a war on drugs in principle or at least in rhetoric turned into an assault on marginalized communities in practice. In 1994, Nixon's former adviser, John Ehrlichman, even told Harper's Magazine, "We knew we couldn't make it illegal to be either against the war or Black, but by getting the public to associate the hippies with marijuana, and Blacks with heroin, and then criminalizing both heavily, we could disrupt those communities."

Now, that's a tone quite different from what we heard from President Biden earlier this year during the State of the Union address.

President Biden: There's so much we can do, increased funding for prevention, treatment, harm reduction, and recovery, get rid of outdated rules that stop doctors prescribing treatments, stop the flow of illicit drugs by working with state and local law enforcement to go after the traffickers. If you're suffering from addiction, you should know you're not alone. I believe in recovery, and I celebrate the 23 million, 23 million Americans in recovery.

Melissa Harris-Perry: It's not just President Biden, even conservative politicians like Arkansas Senator Tom Cotton have advocated for treatment rather than punishment to address opioid addiction. It's a drug epidemic where white Americans largely have been the public face, but to be clear, opioid use is a crisis. In 2019, over 70% of overdose deaths in the US involved opioids.

According to research published in the American Journal of Epidemiology, overdose deaths between 2009 and 2019 actually hit Black communities hardest. Even as the crisis has been discussed in ways quite different from previous drug epidemics, there's still a lot of stigma for those recovering from opioid use disorder, also known as OUD.

This month, the Department of Justice sent out an important message with hopes of addressing that stigma. The DOJ issued guidance explaining that people who are recovering from opioid use disorder are in fact protected under the Americans with Disabilities Act. This includes anyone taking prescription medications as part of their treatment.

For more on this, we have Ryan Hampton, advocate and author of the book Unsettled: How the Purdue Pharma Bankruptcy Failed the Victims of the American Overdose Crisis. Ryan is also a person in recovery from opioid addiction. Welcome back to the show, Ryan.

Ryan: Thanks for having me, Melissa.

Melissa Harris-Perry: Also with us is Kassandra Frederique, who's executive director at Drug Policy Alliance, a nonprofit working to end the war on drugs. Welcome back to The Takeaway, Kassandra.

Kassandra: Thanks for having me.

Melissa Harris-Perry: Kassandra, let me start with you. Does this new DOJ guidance actually change federal drug policy?

Kassandra: No, I think more of it is really highlighting something that we've known. Addiction is something that people should be supported in. I think it's important that the Department of Justice put out this edict and guidance, but I think what we really need them to do is to diverse from policing in order for this to actually matter for people.

Melissa Harris-Perry: Ryan, I want you to walk me through why this guidance from DOJ on people recovering from opioid use disorder is important, and then I do want to talk about the limitations of it.

Ryan: The guidance is welcomed from the DOJ but it's long overdue. Discrimination against people seeking recovery from substance use disorder has been ranted for some time now, discrimination in employment, health care settings, access to inpatient and outpatient treatment, drug courts, most importantly to me, and personal to me housing access.

As Kassandra said, this guidance doesn't change existing law. It just erases some ambiguity that's existed, whether or not people with substance use disorder actually fall under the protections of the ADA. It's the DOJ weighing in saying, "Hey, we're going to begin enforcement specific to these violations."

Every single day in the United States of America, people who are on medication for opioid use disorder are discriminated against. We've seen problems solve in courts, drug courts, which are government-funded programs, deny access to services to individuals on buprenorphine or methadone. We've seen people turned away from outpatient care because they're on these medications and they're told they're not "clean", to come back when they're ready to practice full abstinence, nurses being shut out of OUD services covered by their employer.

It's just unconscionable that this discrimination is so widespread, and this is a welcome move by the DOJ. However, I do want to mention there was one glaring omission because it was not called out in the DOJ guidance, and that's housing. This new DOJ guidance, if it's going to hold any weight, it has got to cover housing for people in or seeking recovery from OUD. People seeking recovery housing, they're some of the most discriminated against if they're on medication. I was one of those people.

Melissa Harris-Perry: Ryan, I want you to take one more beat for me. I think many people will understand precisely what you're talking about here about being on medication, but I know there are other folks listening who will be like, "Wait, what? On what? Do me a favor and give me that explanation of why for opioid use disorder, why would the courts even, for example, know or why would a landlord know that you are on a medication? Help people to understand.

Ryan: When someone enters the drug court system or is going to start an outpatient program or get into recovery housing or other social services, they're oftentimes asked to take a drug test. I was. In that drug test, it may show that someone is on buprenorphine or on methadone. Many times these services have had the ability to deny access to care for people based on them being on these types of medications because they do have an opioid in them, although it has an antagonist, methadone, for example, buprenorphine. These are addiction treatment medications that actually save lives.

I was denied access to them for years. In 2015, I had to beg to get on to buprenorphine. It actually saved my life, but I was denied housing when I tried to find safe, stable recovery housing because I was on that medication. I actually wasn't "clean" and I was substituting one drug for another. It is blatant flat-out discrimination.

Melissa Harris-Perry: Kassandra, let me come back to you here because your point that on the one hand, this guidance is important. It does not however change federal law, and that it leaves open policing. Say more about that.

Kassandra: I think one of the things that are super important to recognize about this overdose crisis is that a lot of the reasons that we're experiencing this is because criminalization is driving so much of this crisis and making it almost impossible to save lives when overdose is largely preventable. What Ryan was talking about before about the level of surveillance and the barriers that are put in place for people who are trying to access support, it is a part of a culture of policing, surveillance, stigma, and punishment.

What we're seeing is that oftentimes, law enforcement are going to places like methadone clinics and trying to find confidential informants, they're harassing people that are going to these places, oftentimes people are just trying to get some help and resources and are subject to the harassment of law enforcement.

We know the role that folks are often playing, where it's kind of like, "We want to help you, but we also want to punish you at the same time." Even when you heard President Biden speaking at the State of the Union, he talks about all the help and then automatically went, "We are going to root drugs out and we're going to fight the traffickers."

I think what we're trying to push is like if we know that this is a health issue that people are struggling with, then let's use it as a health issue. For example, we don't think people should be involved in the court systems at all to get access to support. We actually think drug courts send the wrong message that if we know that this is a health issue that a lot of people are navigating, that it's inappropriate for it to be in the confines of a criminal legal system.

The thing that I also want to pull back here is that it's really, really important for us to recognize that this is a drug poisoning crisis. Yes, the data is showing that 70% of these overdose deaths involve opioids, but it's important to recognize that people that use any kind of drug need support and that we actually really need to be investing in the research and supports for people that are dealing with other drugs.

When we talk about the overdose crisis, it's dramatically increasing among Black Americans, and dramatically increasing among indigenous communities. Those overdose deaths are also pushed by things like cocaine and methamphetamine. Oftentimes when we're talking about the overdose crisis, we focus on opioids and stimulants are also being contaminated with fentanyl, but also people are still using stimulants and passing away from it, and that those people also need support.

As we talk about this overdose crisis, and we continue to show the different layers, we have to recognize that it's all drugs that need our support. It's all drugs that need the investment of resources. It's the fact that the criminal legal system should have no contact with people that are navigating drugs, and that the systems of care like hospitals, schools, housing, public benefits should not carry through the cultural punitive surveilling stigmatizing culture that comes from a criminal legal system that make it impossible for someone like Ryan to get housing which we know is one of the most stabilizing forces to people managing chaotic use.

Melissa Harris-Perry: Ryan, I want to come back to you on the issue of housing and employment, and the language you used was the language of flat-out discrimination. If I'm a listener and maybe I'm thinking, "Wait a minute, that's not discrimination. That's relevant information that an employer or a landlord would want to have because it is indicative of a higher risk." Respond to that for me.

Ryan: I mean I would just say that is a hogwash. It isn't higher risk. The data is absolutely clear that when people use opioid use disorder medications, that they have a better chance at maintaining and sustaining their recovery. I believe also that these protections should extend to people who use drugs that need those types of supportive services.

Listen, the facts are the facts. 106,000 people died for the 12-month period ending in November of 2021. This is an astounding number that only continues to climb, and as Kassandra mentioned, it's now driven primarily by illicit fentanyl. It's a public health problem that demands public health solutions. Stigma is just another kind of kind buzzword for systemic discrimination bias against people who use drugs, people in recovery, and those seeking recovery, and it remains the top barrier today if we are going to help save lives.

I want to dovetail to what Kassandra was mentioning though about policing and about the criminalization of this issue. We talk about it in the context of being a public health crisis, but we're starting to see this really troubling trend in states and in the federal government. Some policymakers both Democrats and Republicans, it seems that there's some unity on this, have had this knee-jerk reaction to gravitate towards previously failed policies almost an emergence of what I like to call a war on drugs 2.0.

We've seen these knee-jerk responses with drug-induced homicide laws and more criminalization because of Fentanyl. Specifically, it is not the answer. It's a public health crisis that needs a matched public health response, so what does that look like? Obviously, it looks like lowering the barriers to care for people. Getting rid of that discrimination and that old thinking that has kept people from staying alive and seeking help and getting access to these medications.

It also looks like investing more in things like harm reduction on the state and federal level. It means we've got to look at all options. Fentanyl test strips, expanding access to clean syringes and safe smoking supplies, really getting the promising data coming out of New York's first overdose prevention site, it's due attention, exploring that as an option in other states, vast expansion of naloxone access, including making naloxone more available via over the counter.

The data's been out since 2017 from the surgeon general's report about what we need to be doing to combat these overdoses. It shows that if we get someone past year five in their prescribed recovery pathway, that they have an 85% chance of maintaining their recovery for the rest of their lives.

Melissa Harris-Perry: Ryan Hampton is advocate and author of the book Unsettled: How the Purdue Pharma Bankruptcy Failed the Victims of the American Overdose Crisis. He's also a person recovering from opioid addiction. Kassandra Frederique is the executive director of the Drug Policy Alliance, a nonprofit working to end the war on drugs. Thank you both for talking this through with us.

Ryan: Thanks for having us on.

Kassandra: Thank you for having us.

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