In case you haven’t heard, there’s an opioid crisis in America.
With majorities of Americans now clearly supportive of marijuana legalization, opioids, a class of drugs used for thousands of years to treat pain and other ailments, have become the latest target of drug warriors and do-gooders alike.
“Our nation is in the throes of a heroin and opioid epidemic,” Attorney General Jeff Sessions said Wednesday. “Overdose deaths more than tripled between 2010 and 2014. According to the CDC, about 140 Americans on average now die from a drug overdose each day. That means every three weeks, we are losing as many American lives to drug overdoses as we lost in the 9/11 attacks.”
Indeed, according to the Centers for Disease Control and Prevention, more than 33,000 Americans lost their lives in 2015 due to opioid-related overdoses, including 12,989 deaths associated specifically with heroin.
Candidate Donald Trump suggested, of course, a border wall would help solve the problem, while President Trump has complained America is a “drug-infested” country where “drugs are becoming cheaper than candy bars.”
On the other side of the aisle, Democratic Senator Joe Manchin of West Virginia has gone so far as to call for a new war on drugs to combat apparent problem of opioid use, abuse and overdoses.
With so many Americans dying, it’s important to clarify a few things about opioids, the folly of knee-jerk government reaction and the need for harm reduction.
The exaggerated danger of opioids
Despite their reputation, opioids are neither especially addictive nor dangerous on their own.
Research has consistently shown that few individuals who are prescribed opioids ever actually develop a problem with them. A 2016 study by Castlight Health, Inc. suggested only about 4.5 percent of individuals who receive opioid prescriptions are abusers. A 2010 Cochrane review of 26 studies found reports of opioid addiction in only 0.27 percent of patients.
Meanwhile, guidelines issued by the CDC in 2016 for prescribing opioids for chonic pain cited another study which followed chronic pain patients who received opioid prescriptions for 13 years. The study found that “one in 550 patients died from opioid-related overdose” over the 13 years, which upon reflection is a remarkably low rate considering the demographic involved.
As for the dangerousness of opioids, one variable often left out in discussions of opioid overdose is the fact that opioid overdoses tend to involve multiple drugs.
A 2014 report from the CDC based on nationwide emergency room data noted that alcohol was involved in 22.1 percent of deaths related to opioid pain relievers, but conceded the figure could be higher, given wide varieties in how states and localities collect and report toxicology data.
Other, more focused studies have found incredibly high rates of drug mixing at play in opioid overdoses. A 2015 paper looking into opioid overdoses in San Francisco from 2010-2012 found that 74.9 percent of opioid overdose deaths involved other drugs, including cocaine (35.3 percent), benzodiazepines (27.5 percent) and alcohol (19.6 percent). Likewise, data from the New York City Department of Health and Mental Hygiene noted that “nearly all (97 percent) overdose deaths involved more than one substance.”
With respect to heroin specifically, as a 2003 article published in the Journal of Urban Health explained, “The overwhelming majority of overdoses, both fatal and nonfatal, involved the concomitant consumption of heroin with other drugs. The extensiveness of polydrug use among ‘heroin’ over-doses suggests that ‘polydrug toxicity’ is a better description of the toxicology of overdose.”
Rarely do mainstream media reports of the opioid crisis mention the prevalence of polydrug toxicity – except for the occasional surge in excitement over fentanyl, a highly potent opioid which unscrupulous drug dealers sometimes put into heroin to strengthen its effects. (Naturally, the mixture of fentanyl with heroin is more an unintended consequence of prohibitionist drug policies and a resistance to harm reduction approaches than anything else.)
Of course, it is much more politically lucrative to exaggerate the risk and danger of opioids than to acknowledge the relatively low risk of addiction and the likelihood that harm reduction efforts (like warnings against mixing opioids with other drugs) might save lives.
Government policies turned people to heroin
As the prescription and use of opioids surged in the first decade of the 2000s, so too did the number of people seeking addiction treatment and experiencing overdoses. Rather than take a measured approach, government officials instead pursued policies aimed at restricting access to prescription painkillers, criminalizing and arresting doctors and patients in the process.
The continued rise in overdose deaths only indicates these approaches haven’t worked to curtail abuse or death from opioid use and misuse.
Instead, individuals who previously used pharmaceutical opioids have increasingly been pushed towards heroin use, with heroin use in the United States the highest its been in 20 years. According to the Drug Policy Alliance, “Ninety-four percent of opioid-addicted individuals who switched from prescription opioids to heroin reported doing so because prescription opioids ‘were far more expensive and harder to obtain.’”
Of course, for people who have switched from pharmaceuticals to heroin due to lack of access to legal pain medication, or those who abuse either pharmaceuticals or heroin for whatever reason, government policy has only made them less safe.
And there’s plenty of reason to believe government policies have only made opioid and heroin use less safe than before. The increased number of deaths reported in 2016 happened despite decreases in the number of opioid prescriptions and the number of heroin users.
Despite the well-documented role of polydrug use opioid overdoses, it’s unlikely we’ll see proclamations from Jeff Sessions or Trump or any other prominent politicians warning people to engage in harm reduction when using opioids by foregoing alcohol, benzodiazepines or any other contraindicated drug that could heighten the risk of harm or death from opioid use.
Other ideas include getting allowing individuals with chronic pain to access the medication they need without criminalizing their ailment or threatening their doctors with prosecution. Or allowing the operation of safe injection sites and expanding access to medication-assisted treatment and access to syringe exchange programs and naloxone, which can effectively reverse opioid overdoses.
Of course, a border wall won’t solve the problems associated with opioid use and abuse, nor will an expansion or perpetuation of prohibitionist policies. Yet, Trump’s budget proposal includes $175 million in increased expenditures for the Department of Justice “to target the worst of the worst criminal organizations and drug traffickers in order to address violent crime, gun-related deaths, and the opioid epidemic.” It also, of course, includes calls for billions of dollars for his beloved wall. Furthermore, Jeff Sessions’ public proclamations have overemphasized the role of enforcement and drug abuse prevention ideas from the ’80s and ’90s.
Alas, the nation’s massive anti-drug bureaucracies and agencies need some way to stay afloat, even though their entire mission is predicated on the fraudulent idea that drug prohibition and enforcement will keep Americans safe and drug-free. Anti-drug crusades predicated on saving people from themselves or sinister chemicals may be dressed up in good intentions, but as history has shown, they are little more than ruses to further expand government intervention in our lives and bloat the budgets of government agencies.