“We can’t arrest our way out of this epidemic”

“We can’t arrest our way out of this epidemic” is a recurring challenge to the idea that enforcement alone can resolve the opioid crisis. The phrase links the costly work of dismantling heroin networks to the harder questions of who is arrested, who can obtain care, and whether people leaving crisis or incarceration have a viable route into treatment and ordinary life.

From Medical Promotion to Enforcement

The expression appears against a history in which opioid risk was also minimized within medicine. Purdue Pharma promoted OxyContin for a wide range of chronic pain, and its representative David Haddox cited an addiction risk below one percent. At the same time, hospitals and accreditation boards were adopting pain as “the fifth vital sign.” New patient surveys and reimbursement pressures encouraged more liberal pain treatment, and the Joint Commission approved mandatory pain-assessment and treatment standards in 1999.

Purdue saw those standards as a commercial opening. Its budget plan described an opportunity to present itself as a leader in helping hospitals comply, while the company planned hundreds of thousands of dollars in branded pens, binders, wall charts, and clipboards. This context does not make enforcement irrelevant; it complicates the idea that the epidemic can be addressed by pursuing street-level activity alone. The book places aggressive opioid marketing and expanding medical use alongside the later effort to arrest dealers and users.

The Limits and Cost of Arrest

The phrase is voiced as police chiefs and sheriffs confront the limits of the War on Drugs. In Shenandoah County, Sergeant Brent Lutz’s investigation of a heroin ring opened a view into a large operation and the people working within it. Yet the book sets that investigative work against the broader imbalance of a system in which drug users were arrested four times as often as people selling drugs. It also notes that opioid-related crime enforcement cost $7.6 billion nationwide in 2013, while treatment for the people driving demand offered a different kind of intervention.

In Roanoke, heroin had long been treated as a largely hidden problem associated with a small, mostly African American group. Don Wolthuis described its users as isolated and less visible to police than people involved with crack or meth. By the mid-2000s, however, the drug’s growing strength could increase users’ desire for it. The expression therefore marks a shift in the book’s account: heroin enforcement was not simply a matter of locating a fixed criminal population, but part of a changing crisis whose roots and consequences extended beyond police work.

Unequal Application

The book also asks whose arrests are included when officials say that arrest cannot solve the epidemic. It contrasts the generally white opioid users who might deal drugs or commit property crimes to stave off withdrawal with people such as Ronnie Jones, imprisoned for armed heroin distribution. The narrator observes that the call to move beyond arrest seemed more readily applied to the former group than to Black and Latino people arrested for selling drugs. Three-quarters of federal drug offenders were Black or Hispanic, while people of color made up 57 percent of those imprisoned for drug offenses in state prisons.

The book connects this disparity to unequal medical exposure as well as unequal policing. Centers for Disease Control and Prevention data from 2014 addressed why Black Americans had been less caught up in opioid addiction: doctors, distrustful of people of color as potential abusers, prescribed them painkillers at much lower rates than they prescribed them to white patients. By that year, overdose deaths among young white people had risen to three times their 2002 rate, while the death rate for people of color had changed relatively little. The contrast does not treat unequal prescribing as a simple protection; it shows how racialized medical judgment and criminal enforcement shaped different paths through the crisis.

Treatment Requires a Handoff

The expression’s alternative to arrest is not a slogan in place of practical help. In Roanoke, Chief Chris Perkins sought to adapt the Police Assisted Addiction and Recovery Initiative into the Hope Initiative. The proposed partnership would use trained volunteers, called angels, to guide people toward treatment and help them navigate housing, mental-health, and employment resources. Based at the Bradley Free Clinic, the program aimed to accompany people through a difficult, often relapsing process rather than leave them to manage it alone.

The barriers were immediate. A project to create a smoother transfer from emergency care to outpatient medication-assisted treatment and counseling faced bureaucratic, financial, and legal obstacles, a shortage of providers, and too few detox and treatment beds. Hospital social workers referred revived overdose patients to Hope, including people who had passed out while driving, but the system for moving them into care remained disjointed. In the initiative’s first month, twenty-two people came in; none entered residential treatment, and only a handful accessed outpatient medication-assisted treatment. Janine Underwood became so exhausted that colleagues called emergency services after she passed out at work.

The labor of transfer could fall on volunteers and families. In one case, Janine helped keep a patient in detox for an additional day while arranging the next step in treatment as the brief opportunity to accept help was closing. That episode gives the expression its practical force: avoiding arrest is not enough if the next available service cannot be reached, coordinated, or entered in time.

The book extends the argument to reentry. It considers how workers from Bryan Stevenson’s Equal Justice Initiative might have helped Ronnie Jones return to a city with more employment and harm-reduction resources, while low-level drug and prostitution offenders could be diverted from prosecution and connected to housing, case management, and jobs. Stevenson linked reducing the prison population to potential savings that could be invested in treatment. In this account, “We can’t arrest our way out of this epidemic” is both a criticism of enforcement as a stand-alone response and a demand for the resources, coordination, and fairer treatment that an alternative requires.