In Michigan’s opioid crisis, deaths are the problem – not stigma

Why deal with the problem when you can change the conversation?

Michigan has an opioid problem. And it’s getting worse. But to hear Michigan’s public health officials tell it, stigma is a fate worse than death.

In November 2019, the Michigan Department of Health and Human Services announced a $1 million ad campaign designed to “change the conversation” about opioid addiction. I’m sorry — “substance use disorder.”

“With increased medical understanding and the 17-times increase in opioid overdose deaths since 1999, the Michigan Department of Health and Human Services (MDHHS) is working to address the stigmas associated with opioid use so that residents will be better supported and directed to treatment,” read the announcement for the ad campaign.

An eye-popping increase in death tolls – even going from 1 to 17 would be noteworthy, but the actual numbers were 99 deaths in 1999 and 1,788 in 2017 – merits further examination, but the health department’s announcement never shared those numbers.

One could come away thinking the real problem in Michigan is how we talk about drugs, not how many drugs we take, or their human cost.

“Opioid use disorder is not a moral failing. It is a chronic condition just like diabetes and high blood pressure,” said Dr. Joneigh Khaldun, then-chief medical executive and chief deputy for health for the department, in the announcement.

Khaldun added: “It is absolutely imperative that we change the words we use and the way we think when it comes to opioid use disorder in order to truly support our loved ones in accessing treatment and a full recovery.”

Noble sentiment, but a distraction we can hardly afford. Regardless of whether opioids are a moral failing or a chronic condition or both, the plain fact is they’re killing Michiganders in large numbers.

Michigan’s opioid death tolls have only grown in the years. In 2021, more than 2,800 people in this state died of opioid overdoses, according to the Michigan Overdose Data to Action dashboard. That’s 1,000-plus more than the 2017 tally.

In 2019, Michigan had 2,354 opioid deaths – the same year Khaldun was talking about stigma and the health department put out commercials to fix up “the words we use.” Khaldun’s energy would have been better spent striking at the heart of the problem, the deaths. Instead, the press release glides over it, and the commercials never mentioned them.

That mentality carried on this week when Guy Miller, health officer for Berrien County, told his county’s Board of Health that 2022’s opioid deaths were approaching last year’s toll, already. The story was told by The Herald-Palladium out of St. Joseph.

Berrien County, in Southwest Michigan, had 29 opioid deaths in 2021. Through April, it was about 80% of the way there, with eight months left, Miller told the board.

With a literal life-and-death matter playing out in his county, Miller told the board: “It’s something that we need to draw awareness to. We don’t need to draw stigma to it. … We need people to be informed.”

No, Mr. Miller. We need answers. We don’t need you to teach the public how to talk. We need health officers to work to improve public health. Berrien County did not return a request for comment.

Answers will not be easy to find. Michigan has already pulled many policy levers to address the opioid crisis.

Health department data says 53% of Michigan pharmacies carry naloxone — commonly used to counteract the effects of opioids — and will give it to people free of charge.

Opioid prescriptions are down. In the first quarter of 2020, there were 9,440 opioid units prescribed per 1,000 residents. In the first quarter of 2022, the number fell to 6,548, down 30%.

This will help. Naloxone will save lives in real time. Fewer prescriptions, for lesser amounts of drugs, will also help.

Problem is, Michigan’s opioid crisis had already shifted to street drugs and away from prescriptions. Michigan’s opioid crisis may have started in the doctor’s office, but it has moved on from there, to streets that aren’t as easy to regulate. That’s the last war. Street drugs like heroin and fentanyl are the current war.

The focus on stigma is inappropriate, with an actual emergency at hand. And it’s worse than a distraction, it’s not even accurate. If opioid use or addiction has been stigmatized, it sure hasn’t stopped anyone from getting or using drugs, even in fatal amounts.

What are the practical implications of stigma? Nobody ever says. Why focus it? Because that’s easier than fixing the real problem.

In 2020, opioid deaths (2,738) not only outpaced car crash deaths (1,083) and homicides (750), but also their combined total (1,883) by 855 deaths – and driving is an activity 7 million Michiganders are licensed to do.

The next public official to talk about opioids in Michigan needs to offer plans to bring down death tolls. Not ask us to use kinder, gentler words as our friends and family members die.

James David Dickson writes a Sunday column on government issues in Michigan. Email him at

Michigan Capitol Confidential is the news source produced by the Mackinac Center for Public Policy. Michigan Capitol Confidential reports with a free-market news perspective.