Archive for May, 2019

The answer to the opioid crisis

May 3, 2019

Drugs now kill around 70,000 Americans annually. More than AIDS at the height of the epidemic; more than the entire Vietnam war. Most are opioid deaths.

More specifically, most are overdose deaths. They can be largely prevented by making safe doses available. Not doing so is insane public health policy.

Blame is heaped on pharmaceutical companies. But let’s remember that opioid drugs like oxycontin are not evil; to the contrary, they relieve pain experienced by millions. However, many who start taking them for pain get addicted. And doctors are allowed to prescribe opioids for pain only—not for addiction. So when people get addicted, their legal supply ends, and they turn to unregulated illegal supplies. Mostly not prescription pills like oxycontin, but drugs like heroin and fentanyl. Whose street prices are much lower. But their doses can’t be properly calibrated, and users commonly overdose. Naloxone can save them, but because people usually shoot up in hiding, they often can’t receive it in time.

The “war on drugs” logic is that we’d be better off if nobody abused drugs. True enough; yet the main harm, overdose deaths, is not prevented by, but actually caused by, drugs’ illegality. This is a holdover from the misguided mentality that gave us alcohol prohibition. In that case we soon realized the harm from prohibition was worse than what it aimed to stop, which, in fact, it didn’t stop anyway. People still drank, while the alcohol supply got worse and more dangerous, and criminality exploded. Thankfully, we ended that folly. Opioids present the same situation—only worse, given the death rate.

As with alcohol prohibition, there’s also a moralistic element in drug prohibition. I prefer the libertarian principle of barring only behavior that harms others. But if you want to talk morality, most drug users are more victims than villains. The real immorality is society letting them die from overdoses.

The drastic policy reversal suggested here is not utopian. Several other countries, notably Portugal and Switzerland, follow such a harm-reduction plan, enabling users to get their fixes safely under government supervision, avoiding overdose deaths.

Some fear that legalizing drugs would increase their use. Yet illegality stops hardly anyone from using; and few people not tempted now would become tempted if drugs were legal. Even if drug prices plummeted, which legalization would cause. But meantime that price decrease would eliminate most crime by addicts to finance their costly habits. Indeed, the entire societal cost of waging the “war on drugs” — crime, mass incarceration, corruption, destruction of neighborhoods and families, the costs for the criminal justice system, police forces, etc., is beyond colossal. Meantime too, with programs like Switzerland’s, giving addicts other kinds of helpful support, most eventually wean themselves off drugs and get their lives back on track.

But any American locality wanting to provide a safe injection facility like that would be violating federal law.

However, there are other ways to reduce harm. A recent article in The Economist says the “gold standard” for combating opioid addiction is medication-assisted treatment. The major medicine is buprenorphine, which reduces drug cravings. But the government restricts doctors from prescribing it even more stringently than it restricts opioid prescriptions!

Buprenorphine is not even commonly used in U.S. hospitals to treat addicts who come in due to a crisis. Mostly they’re sent on their way with no treatment at all.

The government has estimated the cost of the opioid disaster at around $500 billion annually, or around 3% of GDP (equivalent to the entirety of our economy’s growth, or more). Bipartisan legislation enacted last year allocates to this problem just $1 billion over two years. While Trump has declared the border to be a “national emergency” supposedly requiring a $5.7 billion expenditure on a wall.

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