Trump's Opioid Emergency Response

He can continue pursuing lethal supply-side policies, or he can focus on saving lives through harm reduction.


Last week Donald Trump promised to "spend a lot of time, a lot of effort, and a lot of money on the opioid crisis," which he declared a "national emergency." Judging from the president's campaign rhetoric and his comments since taking office, which have focused on building a border wall to "stop the drugs," much of that time, effort, and money will be devoted to erecting barriers between Americans and the intoxicants they want.

That supply-side approach has been failing for more than a century, and it seems doubtful that Trump will be the man to finally make it work. But he may very well succeed in exacerbating the problem he is trying to solve.

To understand how, consider recent trends in opioid use. Since 2010 or so, heroin use has been rising while nonmedical use of narcotic painkillers has been falling.

Many of those new heroin users are former prescription opioid users driven to a black-market alternative by the government's crackdown on painkiller prescriptions. That switch exposed them to much higher risks.

The U.S. Centers for Disease Control and Prevention (CDC) attributed 18,893 deaths to opioid analgesics in 2014. It attributed 10,574 to heroin, which was used by less than a tenth as many people. By that measure, heroin was more than five time as dangerous.

"I used to take just the pills, and then I started doing dope, the heroin, only when I could get it, when it was cheaper," said an opioid user interviewed for a study recently reported in the International Journal of Drug Policy. "But I don't prefer it because you never know what you're getting. It's scary."

In recent years the unpredictable potency of heroin has been magnified by increased adulteration with fentanyl, a synthetic narcotic that is roughly 40 times as potent. "Heroin fluctuation in purity is a known overdose risk," notes another study in the same journal, "and the presence of illicit synthetic opioids contaminating the heroin supply has led to a particularly erratic 'street dope' market that multiplies this risk."

These two developments—novice heroin users accustomed to the reliable doses of prescription opioids, plus greater variability in potency thanks to more use of fentanyl and its analogues—may help explain the strikingly disproportionate increase in heroin-related deaths during the last decade. Between 2007 and 2015, the number of heroin users (as measured by the National Survey on Drug Use and Health) more than doubled, while heroin-related deaths more than quintupled, from about 2,400 to nearly 13,000.

The government has contributed to these deaths in several ways. It created a black market in which drug users do not know what they are getting, encouraged traffickers to move toward increasingly compact and potent products (such as fentanyl), and reduced access to less dangerous alternatives (such as prescription painkillers).

Carrie DeLone, Pennsylvania's former physician general, recently confessed that "we knew that this was going to be an issue, that we were going to push addicts in a direction that was going to be more deadly." Her justification: "You have to start somewhere."

Why not start with policies that might save lives instead of killing people? In addition to lifting restrictions on buprenorphine-based treatment and increasing access to the overdose-reversing opioid antagonist naloxone, the government can shield bystanders from criminal charges when they call for help in response to an overdose, provide honest information about ways to reduce the hazards of drug use (such as not taking opioids in combination with other depressants), promote drug testing services that can alert heroin users to the presence of adulterants such as fentanyl, and tolerate safe injection facilities where people can use drugs in a sanitary environment under medical supervision.

Trump can try to "stop the drugs," which will increase the dangers faced by people who manage to use them anyway. Or he can try to reduce the harm associated with opioid use, including the harm caused by prohibition.

© Copyright 2017 by Creators Syndicate Inc.

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  1. “Lethal supply-side policies”

    And Reason’s descent into cocktail-party Fake Libertarianism is complete.

    1. Yet you choose to stay here, as if you’re owed something from the author.

      1. Nothing goes over your head, huh? Your reflexes are too fast- you would catch it!

  2. Carrie DeLone, Pennsylvania’s former physician general, recently confessed that “we knew that this was going to be an issue, that we were going to push addicts in a direction that was going to be more deadly.” Her justification: “You have to start somewhere.”

    Hey, you gotta break some eggs to get that tasty criminal justice omelette that voters seem to crave.

    1. It’s all rooted in a hatred of success and succesful people.

  3. My mother died from opioid abuse at the young age of 52. She was addicted for 34 years. I can honestly tell you that nothing anyone did would make her quit. It would have had to be her decision and it never was.
    I also was addicted to a different drug. Nothing anyone did made me quit. I had to get to a place where I could no longer stand myself.
    The best case scenario for any drug addiction is to make all drugs legal, take some of the money spent in the war on drugs and make treatment free for those that want it, but otherwise cut off ALL other forms of public assistance.
    You have to help someone bottom out if they are ever going to change. The sad reality is most won’t regardless of what you do. That means that as a society, we need to quit wasting our resources on those that are not ready and fighting a war we can never win.

    1. Please explain which years of a 34 year addiction were the ones that killed her? And what is your definition of “opioid” and was it actually “opiates” that she was using? Did she use alcohol? Did she eat junk food? Exercise? The addiction probably had little to do with her death at 52.
      I did see not any titles or degrees next the author’s name Jacob Sullum. The DEA are not trained in medicine either. No President was an M.D. Police are not medics or doctors either.
      Vast majority of drug users can live life and function as well and better than non-users. Those who fall into addiction and then are “shamed” or chastised suffer more from their guilt than anything.

      Opiates are very beneficial but now we have synthetic opioids which are deadly. Codeine is a very good pain reliever but government has manufacturers combine it with acetaminophen which taken in a large dose causes liver failure and death. Codeine by itself will not.
      During Prohibition alcohol was still made for industrial purposes but sometimes it would be stolen by employees. So government added poisons to it and when it did not kill effectively enough they added more poison. This was called “denatured” alcohol. Caused death, blindness and other maladies all in the name of “Public Health and Safety”.
      Lastly, one should immediately dismiss any article that cites “facts” from the CDC. Period.

      1. Look into Dr Carl Hart’s talks and studies. He is a professor and neuroscientist at Columbia University. He will educate anyone about drugs, his first lesson being that politicians all lie about drugs and second he says we must stop abusing drug users. Nobody ever died from heroin for example. What is deadly is drinking alcohol while using an opiate. Media will report a heroin overdose death but they leave out the part that the death was actually combining alcohol with the drug.

        1. That guy’s pretty great. He’s the archetypal american success story, and the area he’s succeeding in is refuting all the lies we’ve been told about drugs.

  4. The so-called war on drugs has been a total failure for many decades, yet the government continues, probably because people in our corrupt government are making a big profit by making sure a controlled amount crosses the border. Controlling the supply ensures the price will be high.

  5. the more pressing issue here is where are today’s Lou reeds and bill burroughses(?)? Make opioid addiction great again!

  6. This sudden focus on opiates just coincidentally tracks the legalization of marijuana. Nothing to see here folks. Move along.

    But what else are the feds supposed to do with all those DEA people? There has to be some drug we can make war on, and what better than the drug used by aging boomers? Heck, they don’t move fast and they’re easy to find when they congregate at bingo halls and chili cookoffs. What’s not to like?

    Last week my insurance company denied my MS Contin scrip, saying they wouldn’t allow me to have more than a 7 day supply on hand. For the past 8 years I’ve never been able to be away from a pharmacy for more than a month, now under Trump’s new “war” they want to keep me on a 7 day leash. My doctor said they were doing it to everyone, not just me.

    Of course they’re going to drive people to street drugs. That’s the whole idea.

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