Mises Wire

A Heartless “Solution” to the Heroin Epidemic

The National Institute for Health and the National Institute on Drug Abuse recently released a disturbing report on drug overdose deaths. The number of drug overdoses from both legal and illegal drugs increased from approximately 22,000 in 2002 to over 52,000 in 2016, making it a leading cause of accidental death.

Even more disturbing is the increase in the number of overdose deaths from heroin. As recently as 10 years ago the number of heroin overdose deaths was stable at around 2,000 per year. After four years of increases, the number of such deaths has increased from approximately 3,000 in 2010 to 13,000 in 2015, or a 328% increase!

No, I am not a medical doctor, but it should seem obvious that the overall increase in drug overdoses is in part attributable to the increase in the number of prescriptions of dangerous drugs. My guess is that in the vast majority of cases the cost of a prescription (total price paid, plus all the complications, interactions, side effects, risks, etc.) far outweigh the benefits vs. simple lifestyle changes. The number of prescription overdoses increased from 7,523 in 1999 to 29,728 in 2015. That is a nearly 300% increase, and a 15% increase last year alone. In 2015, there were 4.4 billion prescriptions or nearly 13.6 for every woman, man, and child in America.1

The Connection Between Heroin and Prescription Drugs 

One class of prescription drugs is directly related to the heroin epidemic, on which I have recently reported. To recap, drug companies that make opiate pain killers have influenced the American Academy of Pain Medicine to change their guidelines for prescribing pain killers. The changes in the guidelines have made it much more likely for doctors to prescribe pain killing opiate drugs such as Oxycontin and Vicodin for things like ordinary injuries and surgeries. The DEA, FDA, and the AMA monitor prescribing behavior of doctors, so they are more likely to follow such guidelines to avoid risk of sanction.

These drugs are highly effective for pain, but can be addictive and deadly themselves (16,000 deaths in 2015 alone). When the injuries heal, addicted patients can no longer get refills for the drugs. For those who have become addicted their choices are going cold turkey, enter an addiction treatment program, or obtain the drugs on the black market. In other words, they have no good choices.

For those who choose the black market alternative, the costs can be very high; as much as $25 a pill as well as being exposed to black market drug dealers, and even being arrested. The next choice is heroin, which can be purchased on the black market (from the same dealers they have recently met) for as little as $4 per dose if purchased in large quantities. The main reason why there are so many deaths is that black market heroin comes in an unknown potency and is often adulterated with highly dangerous ingredients and other powerful drugs.

The American Enterprise Institute (AEI) recently published an article, “How to treat an opioid epidemic,” by psychiatrist and addiction treatment specialist, Sally Satel. The article first appeared in the January 13 edition of the Wall Street Journal.

According to Satel:

I endorse treatment over punishment. But the medicalized rhetoric of the public-health establishment — namely, that addiction is a brain disease in which neural circuits are “hijacked” by drugs — oversimplifies the problem.

She goes on to explain the multiple reasons for the high failure rate of addiction treatment programs and alternative public health options and the truly daunting challenges of overcoming addiction to opiates like heroin. In particular, the high dropout rate from treatment programs is the big reason for failure because many of the addict’s challenges are not overcome in time.

Satel’s “Enlightened” Paternalism: Throw Addicts in Jail 

Less time in treatment means that addicts have less time to learn recovery strategies, like identifying the specific circumstances in which they are most vulnerable to craving the drug. Rushed treatment in the office of a primary-care doctor also means less attention to fixing the often broken lives of addicts. Healing family rifts, reintegrating into the workforce, creating healthy social networks, finding new modes of fulfillment — all are imperative, but they take time and focused therapeutic care.

She then tenderly presents her “enlightened systems of care” to better resolve the problem of addiction:

I speak from long experience when I say that few heavy users can simply take a medication and embark on a path to recovery. It often requires a healthy dose of benign paternalism and, in some cases, involuntary care through civil commitment.

In clearer words, throw the addicts in jail. Paternalism is the Orwellian idea that the state should limit some person’s liberty for what is presumed to be that person’s best interest. She even suggests that some people “voluntarily” agree to such incarceration.

I agree that in the current context some addicts are a danger to themselves and to others. However, if we are talking about such fundamental reforms, then let us think outside of the methadone clinic box of Sally Satal’s heartless recommendations.

Legalizing heroin would go a long way to eliminate black market heroin and the overdose deaths it causes. In exchange for a consoling session on how to use and not use legal heroin, the addict could purchase pure low-dose heroin. They could subsequently decide to increase or decrease their dose. This is called the maintenance approach. Clinics would open that would maintain and wean addicts off of heroin while simultaneously addressing physical, emotional, and other issues.

I know that some reader will revolt at such a suggestion. However, let us take a look at what would likely result: (1) a huge decrease in heroin overdose deaths; (2) an indefinite period of time for the addict to adjust to stress conditions, solve family problems, overcome economic problems, and to become resigned to beat their addiction; and (3) an alleviation of the anxiety the addict suffers from having to worry about finding a reliable supply, and having to spend a vast amount of time and money acquiring a supply.

Medical marijuana, i.e., cannabis, could also play a role. Cannabis might act as a substitute for addicts trying to wean themselves off of heroin. Cannabis can act to relieve many of the symptoms of withdrawal such as nausea, pain, agitation and restlessness, fatigue, anxiety, insomnia, and drug cravings.

Of course it should go without saying that doctors should stop prescribing opiate drugs unless absolutely necessary and return to the use of non-opiate pain killers of the past.

I have been told that wealthy addicts can appear to lead normal and productive lives and that many addicts simply grow out of their addictions. Let’s give them that chance.

Mark Thornton is a Senior Fellow at the Mises Institute and the book review editor of the Quarterly Journal of Austrian Economics. He has authored seven books and is a frequent guest on national radio shows. Contact: email, Facebook, twitter.

  • 1If you want to try to reduce the number of prescriptions you are taking I would recommend the Dr. Doug McGuff and Professor Robert Murphy book The Primal Prescription.
Image Source: Dimitris Kalogeropoylos www.flickr.com/photos/dkalo/
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