“Amid the news that the U.S. had reached 1 million deaths from COVID-19, this week saw another grim milestone. The Centers for Disease Control and Prevention (CDC) announced that the U.S. recorded more than 107,000 deaths from drug overdoses last year, a record high. This is a 15 percent increase from 2020, which held the previous record of around 93,000 deaths. While there has been plenty of talk about how many COVID deaths were preventable, it’s also worth considering how many overdose deaths were the result of needlessly draconian government policies.
According to The New York Times, an increasing share of the number of total overdose deaths came from users of synthetic opioids and methamphetamine. The number of deaths from synthetic opioids increased from 58,000 to 71,000; most of these involved fentanyl, which is considerably stronger than morphine or heroin, and its analogs, which are even more potent. It is often mixed with heroin or stamped into counterfeit prescription drugs. Deaths associated with meth also rose from 25,000 to 33,000.
Each increase follows a longer-term trend: A decade ago, meth-related deaths numbered fewer than 2,000, but by 2017, the number had risen to 10,000. Similarly, deaths from fentanyl numbered around 1,600 in 2011 but increased more than tenfold by 2016.
Obviously, there are a number of reasons why people may abuse drugs. But the role of drug prohibition in exacerbating the crisis cannot be overstated.
During the same years that fentanyl use increased, the prescription rates of opioids like OxyContin plummeted. This was no accident: In 2018, then-Attorney General Jeff Sessions bragged about how successful the government’s efforts had been at lowering the rates at which doctors prescribed opioids for pain. And yet, the overdose rate continued to climb, as both addicts and chronic pain patients alike were forced to seek out black-market alternatives.
A few years earlier, in an attempt to combat the spread of meth, Congress restricted the availability of the decongestant Sudafed, while the Drug Enforcement Administration cracked down on homegrown meth labs that used it as an ingredient. As a result, cheap, low-quality meth from Mexico with suspect ingredients filled the gap in supply.
Each case provides a perfect example of what Dr. Jeffrey Singer, a senior fellow at the libertarian Cato Institute, refers to as “like playing a game of ‘Whack-a-Mole,'” in which the government cracks down on a drug, only for its users to seek alternatives, typically in a more dangerous form. Prescription opioids, in particular, certainly do have the potential for abuse, though not to the extent often portrayed in popular media. But for those who genuinely need pain relief and who are suddenly unable to get it, the alternatives are much worse.”
“Three years ago, President Donald Trump bragged that “we are making progress” in reducing drug-related deaths, citing a 4 percent drop between 2017 and 2018. That progress, a dubious accomplishment even then, proved fleeting. The upward trend in drug-related deaths, which began decades ago, resumed that very year, and 2020 saw both the largest increase and the largest number ever. That record was broken last year, according to preliminary data that the Centers for Disease Control and Prevention (CDC) published this week.
The CDC projects that the total for 2021 will be nearly 108,000 when the numbers are finalized, up 15 percent from 2020, when the number of deaths jumped by 30 percent. Two-thirds of last year’s cases involved “synthetic opioids other than methadone,” the category that includes fentanyl and its analogs. Those drugs showed up in nearly three-quarters of the cases involving opioids.
Illicit fentanyl, which has become increasingly common as a heroin booster or substitute during the last decade, is now showing up in cocaine, methamphetamine, and counterfeit pills passed off as prescription analgesics or anti-anxiety drugs like Xanax. That phenomenon vividly illustrates the hazards of the black market created by the war on drugs that Trump thought the government was finally winning.
Joe Biden, a supposedly reformed drug warrior, is still keen on “going after drug trafficking and illicit drug profits,” a strategy that has failed for a century but, he figures, might just work this time around. At the same time, Biden talks a lot about drug treatment and other forms of “harm reduction,” including “key tools like naloxone and syringe services programs.” He proudly proclaims that his drug control plan is “the first-ever to champion harm reduction to meet people where they are and engage them in care and services.””
…
“If we focus on substance rather than words, the real breakthrough will come when politicians understand and acknowledge the nature of the harm that needs to be reduced. It is not just the harm caused by drug abuse but also the harm caused by misguided and counterproductive efforts to address that problem. Prohibition itself is the most obvious example.
Consider one of the harm reduction measures that the Times mentions: the distribution of test strips that can alert drug users to the presence of fentanyl in a substance sold as something else. Those test strips don’t tell you how much fentanyl a bag of powder or a pill contains; they just tell you whether there is a detectable amount. But even that much knowledge is an improvement in a black market where people routinely buy drugs of unknown provenance, composition, and potency.
The danger that fentanyl poses to drug users is not inherent in the drug itself, which can be used safely when you know the dose, as demonstrated by its various medical applications. I was recently given fentanyl, along with midazolam, as a sedative during dental surgery, and I was not at all worried that it would kill me. Patients who receive fentanyl injections in the hospital or use fentanyl patches, lozenges, or nasal spray to relieve severe chronic pain likewise are not dropping dead left and right.
In the black market, by contrast, drug users may not even realize they are buying fentanyl; hence the test strips. Even if they do realize that, they still don’t know the concentration. That potentially lethal ignorance is entirely a product of prohibition. While the proliferation of illicit fentanyl has made drug use more dangerous by increasing variability and uncertainty, those problems are not new. They are inevitable when the government tries to prevent the use of psychoactive substances by banning them.”
…
“Biden thinks that “going after drug trafficking” will help prevent drug-related deaths. But the pressure from enforcement drives drug traffickers toward more-potent products, which facilitate smuggling by allowing them to pack more doses into the same volume. Alcohol prohibition shifted consumption from beer and wine toward distilled spirits. Drug prohibition gave us heroin instead of opium, fentanyl instead of heroin, and sometimes even-more-potent fentanyl analogs instead of fentanyl.
Given the economics of the black market, interdiction has always been a hopeless proposition. That should be clearer than ever today as the government vainly tries to intercept little packages of fentanyl, each of which contains thousands of doses. But while “going after drug traffickers” has never been a cost-effective way to reduce drug consumption, that does not mean it has not accomplished anything. It has been remarkably effective at making drug use deadlier.”
I used to support legalizing all drugs. Then the opioid epidemic happened. German Lopez. 2017 9 12. Vox. https://www.vox.com/policy-and-politics/2017/4/20/15328384/opioid-epidemic-drug-legalization Dopesick Reinforces These Pernicious Misconceptions About Opioids, Addiction, and Pain Treatment Jacob Sullum. 2021 11 17. Reason. Two Courts Debunk Widely Accepted Opioid
Substance Use and Intimate Partner Violence: A Meta-Analytic Review 2016. Bryan M. Cafferky, Marcos Mendez, Jared R. Anderson, and Sandra M. Stith. Psychology of Violence. https://d1wqtxts1xzle7.cloudfront.net/59511278/Cafferky_201820190604-60960-qtu1qv-with-cover-page-v2.pdf?Expires=1643220750&Signature=JmFWS~QkCg86Icul9oqw-3Sz9j5uO~LzKP~HsVRSKQtNbZcNthwDy3nCgpG9yKXqPN2J2hs4tBs5pXVaD7cqLr9OXk9MDuEs37O1A0-c1-ZxX7EWjD16pZdSF3uKci5vDn4Geu2DhSduZ-Jqd~qkfmjK~NJybrESL7vvuiyszzVMhd~XjwQUQKw-PDdYiOY8qMD4oA~ecbZKCSVF~Rmxm5aFaYmnHAtWJb6Xc221n2SG5db3vXeECkCW3Ym09t7YAkY2b-Sg~sjKhHe3vGbUVcPkSj3aMKjsjBuA~mGK6xynPEQkGlmRJ0Htg22yJsh02QBtbqf51KqlGMKsk0L4uA__&Key-Pair-Id=APKAJLOHF5GGSLRBV4ZA ALCOHOL USE IN FAMILY AND DOMESTIC VIOLENCE Ashlee Curtis et al. https://onlinelibrary.wiley.com/doi/am-pdf/10.1111/dar.12925 The Role of Illicit
Comparative risk assessment of alcohol, tobacco, cannabis and other illicit drugs using the margin of exposure approach Dirk W. Lachenmeier and Jurgen Rehm. 2015. Scientific Reports. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4311234/ Margin of exposure European Food Safety Authority. https://www.efsa.europa.eu/en/topics/topic/margin-exposure What Are Margin of Exposure (MOE) and
“Jonathan Wall, a 26-year-old cannabis entrepreneur, has been confined at a federal supermax facility in Maryland for nearly 20 months, awaiting a May 2 trial that could send him to prison for life. Wall is accused of transporting more than 1,000 kilograms of marijuana from California, where cannabis is legal for recreational use, to Maryland, which allows only medical use.
Wall’s case illustrates the draconian penalties that can still be imposed on people for selling pot at a time when most states have legalized marijuana businesses. As far as the federal government is concerned, all of those businesses are criminal enterprises. But depending on how federal prosecutors choose to exercise their discretion, selling pot can make you millions of dollars as a state-licensed supplier, or it can send you to prison for decades.”
“In 2018, the Trump administration issued an emergency order that would make it easier to prosecute people for selling so-called fentanyl analogues, drugs that share the same chemical structure of the powerful synthetic painkiller that has helped to fuel the nation’s opioid epidemic. Even as the Trump administration began embracing criminal justice reforms and opioid treatment elsewhere, the temporary order was part of a wider law-and-order crack down on new variations of the substance that had been flourishing in illegal drug markets.
The move was small, but significant. With little fanfare and debate, it gave federal prosecutors across the country sweeping new authority to charge people for federal drug crimes, triggering onerous mandatory minimums without the usual scientific process to determine whether the novel new drugs people peddled were even dangerous.
Yet, it wasn’t just a Trump phenomenon: On Thursday, Congress reauthorized the fentanyl copycat order for the sixth time — and the fifth time since Joe Biden’s inauguration — with broad bipartisan support, extending it to the end of this year. Instead of opposing the stricter enforcement, Biden favors making the order permanent — a move civil rights groups, public health researchers, criminal justice reform experts and other critics argue would further embolden federal law enforcement authorities and disproportionately affect low-income defendants of color. Opponents say it would usher in a remarkable change in drug law, one that criminalizes thousands of substances, some that haven’t even yet been developed, and set a precedent that could eventually extend to other drug categories.”
…
“Federal authorities usually go through a multistep checklist to classify, or schedule, an individual drug into a certain category, which then determines how easily it can be researched and whether it merits criminal penalties. Some fentanyl analogues have already been individually tested and scheduled. But the 2018 order puts fentanyl copycats, which can include thousands of substances, into the government’s strictest drug control category — Schedule I, which also includes heroin, marijuana, LSD and ecstasy — without that scientific review. This represents the first time an entire category of drugs has been scheduled based on chemical structure alone.
In some cases, those fentanyl analogues can be more powerful than fentanyl, which is in the slightly less restrictive Schedule II category. But in other cases, analogues can be harmless or even potentially therapeutic. The FDA has testified that at least one new, potential overdose-reversal agent has fallen victim to the class-wide scheduling order.
Prosecutions for fentanyl-related substances soared during the Trump administration as the substance became more ubiquitous. The number of people prosecuted for and convicted of fentanyl-analogue crimes was nearly non-existent in 2016, but grew to 233 in 2019, according to data from the U.S. Sentencing Commission. Nearly 70 percent of those prosecutions targeted Black and Hispanic people, many of them street dealers rather than major drug kingpins, according to the government data.”
…
“some defense lawyers worry the impact might be bigger than the data show. Based on her conversations with defense lawyers and independent research, Patricia Richman — national sentencing resource counsel at the Federal Public and Community Defenders, which represents indigent clients in federal cases — argues that many more people are likely being charged under the emergency order. Federal authorities have yet to release updated data on how the law has been used since 2020.”
…
“Meanwhile, the opioid crisis has worsened: Drug overdose deaths have reached record levels, topping more than 100,000 in the 12 months ending in September 2021 with death rates among Black people catching up to rates among white people. By June of last year, synthetic opioids, which include fentanyl and related substances, accounted for 65 percent of all drug overdose deaths, representing a massive increase from just a few years earlier.”