12 years ago I witness what I thought was an unusual trend in higher education. Middle and upper-class Euro American students presenting with a need for treatment related to heroin use at the college counseling center. Little did I know that this is not a blip on the screen like I thought it to be, but the beginning of a nationwide trend. Opioid dependence has been an issue for communities of color since the 1800s. Whether it was the china trade (also known as the Opium War) of the 1800’s, the Vietnam era influx or heroin from the golden triangle, or the war on drugs and the emergence of the golden crescent in the 1980’s and 1990’s communities of color have experienced the dark side of capitalisms cannibalistic nature of praying on the pain of the poor to build wealth through the sale of Opioids. Whether it be families such as the Astor’s, Forbes, Delano (as in Franklin Delano Roosevelt’s), or Friedrich Bayer (founder of Bayer Pharmaceuticals), an empire of wealth has been accumulated by peddling opium and opioid based products to poor communities of color. The social and personal ills that result from opioid use is well chronicled in the United States as early as the 1800’s. Yet it wasn’t until the demographic of the “opioid user” reflected the power structure in the USA, that our leaders have taken action to destigmatize substance use, fund prevention and treatment. Now there is a movement to legitimize Substance Use Disorder, changing our understanding of “addiction” as an illness rather than a moral failing. Today the Sacklers of Purdue Pharma (producers of OxyContin) are getting rich off of opioid sales to middle and upper class Euro-Americans, the daughters and sons of teachers, judges, doctors and other upstanding middle class folk. Sincere the demographic of the opioid user has changed incarceration is no longer an acceptable first line public policy for dealing with this social ill. Addiction becomes Substance Use Disorder, a moral failing becomes a medical condition, and criminals become people in need of treatment. It is important that policies change as we learn more, but with knowledge comes responsibility. What happens to those who are in jail for substance use disorder for non-violent offenses or “3 strikes your in” policies? Where is the compassion, justice, and reparations for the damage done to generations of people of color and their families related to harsh public policy? Until legislators and the criminal justice system (who are overwhelmingly older Euro-American men) begin to write and enact policy that addresses the systemic harm done to those who have been incarcerated related to substance use disorder, it will remain difficult to believe that this kinder, gentler approach to treating people substance use disorder is anything more than privilege in action. It is time that we come together as a community, and demand that public policy addresses Substance Use Disorder as a medical condition. Until we realize that Substance Use Disorder is a social justice issue, there will not be liberty and justice for all.