6

Final Reflections

To conclude the day’s events, each roundtable member was asked by the moderator of the previous session, Francisco Garcia, to share their final thoughts in 2 minutes or less. Several roundtable members first noted that current drug policies, laws, and sentencing practices do not take into account the social determinants of health. Adverse childhood experiences also play an important role in the development of substance use disorders.

The “center of the storm” regarding drug use has been in the most impoverished communities in the United States, particularly communities of color. As a culture, “We have a very conflicted relationship with substances,” which has led to the creation of hierarchies that are based on social constructs. Until the culture can be changed, and the stigma associated with drug use stops, the nation will remain at an impasse in its treatment of substance use disorders, especially for communities of color, noted Garcia. One roundtable member noted, “There is no doubt that the war on drugs is a war on people of color.”

In terms of promising programs, innovative and hyperlocal strategies offer some hope for addressing substance use. In the United States, the tendency is to create crisis-oriented programs rather than considering the root causes of the crisis. Additionally, there are currently significant challenges in getting Medicaid reimbursements at adequate levels for peer-oriented services, explained Martinez. It is important to remember that substance use disorder is not a crime; rather, it should be

treated as a health care concern. Overdose is a disease of disconnection, not a crime, said Julie Baldwin, a roundtable member. Resources need to be redirected from the criminal justice system to local communities, explained Villarruel. This is particularly true for programs targeting youth. Harm reduction strategies also show promise in treating substance use disorders.