Opioids

When Fixing the Problem Makes It Worse

Our best hope is that commercial and cultural change will overcome the tendency to force top-down, one-size-fits-all solutions onto complicated problems.

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In the front of the SUV, a man in a black T-shirt is unconscious, or nearly so, and slumped over the steering wheel. Next to him on the passenger side, a woman's bra strap slides off her thin shoulder as her head lolls. In the back, a 4-year-old is strapped into his car seat, looking oddly placid. The image, published by a local Ohio police department in 2016, is the most striking of the steady drip of such photos and videos, disseminated by well-meaning authorities with the goal of scaring the pants off of Americans and discouraging abuse of heroin, fentanyl, and other opioids.

The opioid crisis—the sharp uptick in opioid-related deaths in recent years—provides endless human fodder for local newscasts. Newspapers and magazines publish story after story about the costs of addiction to families and communities. All of this creates a powerful feeling, even among those generally immune to drug panics, that this time things are different.

A narrative has formed: Many of the people whose lives have been ruined or ended by their drug use were perfectly ordinary until they got a prescription for pain pills. The first bottle might have been legit, offered by a doctor after a wisdom tooth extraction or a broken ankle. But lurking in each pill is a bottomless chasm of physical, financial, and social ruin.

In the face of very real suffering and dysfunction, it is a deeply human response to want to use whatever resources we have at our disposal to end the crisis. But there is another deeply human response as well: the desire for a simple solution.

Luckily, according to the dominant narrative, the solution is simple. Take away the drugs and punish the people who sell them. Ta-da! Depending on your particular blend of prior ideological commitments, the drugs you are most anxious to take away will be the pain pills or the street dope; the sellers to punish first will be Big Pharma or Mexican heroin cartels.

But as Senior Editor Jacob Sullum explains in his cover story (page 18), this powerful, compelling narrative is dangerously wrong. What started as a war on pain meds hasn't come close to reducing drug-related deaths. Instead, the crackdown has escalated the problem, killing addicts and leaving patients in agony.

During the last election cycle, both campaigns treated this issue as a dire crisis that demands decisive and immediate action. When Donald Trump won, he said he'd make the opioid epidemic a priority.

"My take," President Trump declared in February, "is you have to get really, really tough, really mean with the drug pushers and the drug dealers. We can do all the blue ribbon committees we want [but] we have to get a lot tougher than we are."

His disdain is confusing, since he created just such a committee less than a year ago—the President's Commission on Combating Drug Addiction and the Opioid Crisis—and staffed it with key members of his campaign inner circle, including Kellyanne Conway and former New Jersey Gov. Chris Christie. That commission has mostly urged more drug enforcement and doubled down on the idea that a border wall will keep out illegal substances.

It's not at all obvious that the best way to respond to the surge in drug fatalities is harsher interdiction or stricter regulation of prescriptions—so far those policies have driven the number of deaths up, not down. But when you're holding a massive law enforcement hammer, everything looks like a nail.

The opioid crisis is far from the first time seemingly simple solutions have created a new nest of complicated problems.

Go back exactly 200 years, and you'll find that our unfortunate biomedical conservatism springs from an erroneous reaction to a scary story. As Science Correspondent Ronald Bailey explains (page 56), Mary Shelley's Frankenstein was misinterpreted from its very beginnings as a call to put the brakes on scientific progress. Worried about runaway experimentation? Take away new tech and punish the people who sell it.

Cody Wilson's Defense Distributed, a company that disseminates information allowing civilians to make their own unregistered firearms, is a direct response to the calls for gun control that follow every high-profile shooting (page 48). In moments of crisis, Wilson doesn't trust politicians to hold strong against the simple solution, even when that solution is forbidden by our founding documents. Worried about violence? Take away the guns and punish the people who sell them.

Unemployment, lack of civic engagement, insufficient income mobility, and gender inequality are incredibly complex socio-political issues with deep historical roots and multiple causes. But oddly enough, they all apparently have the same simple fix: More college for everybody!

The biggest reason for the appeal of higher education is also the main reason to be skeptical that it is an appropriate answer to all those social ills. As with drug prohibition, it is a solution that has been tried already, at significant expense and trouble. The result has been dramatically inflated prices and unsustainable levels of educational debt. And as economist and provocateur Bryan Caplan describes (page 40), all those social costs have come without the promised social gains. The policies meant to solve deep systemic problems instead created new problems, including the rage that powered the Occupy Wall Street movement.

There are real solutions to the opioid crisis, many of them driven by new and better technologies for dealing with drug dependence and its side effects. Suboxone, a medication that reduces cravings and makes highs less appealing, has gained some ground, though it faces opposition in a rehab culture that seeks to penalize and moralize. Needle exchanges reduce overall risk and help users stay healthy. And Narcan, which can revive opioid poisoning victims, has seen more widespread adoption both by first responders and by the families of people at risk.

This laundry list of smarter responses to the crisis—elaborated upon in Sullum's feature—doesn't satisfy the craving for big blue-ribbon solutions. Piecemeal fixes do not offer the rush of satisfaction a silver bullet provides. They are the sort of remedy a thoughtful working group might recommend and a crusading politician will almost certainly ignore.

Our best hope is that commercial and cultural change will overcome the tendency to force top-down, one-size-fits-all solutions onto complicated, multifaceted problems. Taking away all the drugs and locking up the people who sell them won't rescue that kid from his car seat—any more than taking away the guns will end violence or shoving everyone into college will eliminate inequality. Instead, the simple solution makes it more likely that he'll grow up without parents at all.

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14 responses to “When Fixing the Problem Makes It Worse

  1. “Our best hope is that commercial and cultural change will overcome the tendency to force top-down, one-size-fits-all solutions onto complicated, multifaceted problems.” hope in one hand and shit in the other, see which one fills up first!

  2. Taking away all the drugs and locking up the people who sell them won’t rescue that kid from his car seat?any more than taking away the guns will end violence or shoving everyone into college will eliminate inequality. Instead, the simple solution makes it more likely that he’ll grow up without parents at all.

    “There are no solutions. Only trade offs.” Thomas Sowell

    There will always be drug use. There will always be violence. There will always be inequality.

    Any attempt at a solution is still a trade off. But people intent on fixing things don’t see it that way. They trade a little good for a lot of bad, but don’t realize that the lots of bad is the trade off for the little good that they are accomplishing. It becomes a cycle that gets worse and worse.

    1. “The lots of bad is the trade off for the little good that they are accomplishing”. Are they accomplishing any good? Except for getting reelected and a longer ride on the gravy train, no.

      1. I think they do accomplish some good. I know people who were addicts who got busted, and cleaned up their act as a result. They may have never quit, may have even died, had they not been arrested. So some good is accomplished. But at what cost?

        1. Or not fearing jail they would have gotten treatment to get off the drugs.

    2. There will always be inequality.

      Not if we wish it away!

  3. The author’s ostensible skepticism with respect to education has already collided awkwardly with her Yale degree; I expect it to be battered further when she advises (and, likely, funds) her children with respect to higher education.

    The most likely explanation is that her weak jabs at education (and the degreed “elite”) are a half-hearted attempt to flatter her right-wing friends.

    1. her weak jabs at education

      Jabs at education? What are you talking about?

      Helping people get a college education has some benefits, but the costs are skyrocketing tuition costs and huge debt.

      Is the trade off worth it?

  4. “Narcan, which can revive opioid poisoning victims, has seen more widespread adoption both by first responders and by the families of people at risk.”

    A study came out yesterday indicating that Narcan is adding to the problem, creating more overdoses because users often have someone with them that can administer the Narcan. When they want to get that high again, but do not have the Narcan, they die. A similar study came out and said Narcan may lower overdose deaths but does lead to more overdoes. More studies will be done.

    1. Tell me why I need to provide a solution to protect people from themselves? Stop short circuiting the negative feedback loop and the problem will solve itself. You’re free to do whatever drugs you want and I’m free to let you live with the consequences.

  5. …photos and videos, disseminated by well-meaning authorities…

    Do any of these authorities act to prolong and increase their authority?

  6. But oddly enough, they all apparently have the same simple fix:

    There is a simple fix – keep the government away and let people come up with their own diverse solutions.

  7. I’ve had several surgeries of various sorts (70+ years old). Most of these were followed by opioid prescriptions. And I took the opioids when I was in significant pain, then tapered off and stopped as the wounds healed.

    This isn’t some great virtue on my part. It’s just how I’m put together: opioids make me feel sleepy. I don’t like feeling sleepy. The only time I want to feel sleepy is when it’s time to go to bed, and then I don’t (usually) need opioids to get to sleep.

    Obviously, there are going to be some people who like the way opiods make them feel. Those people are at risk of addiction. And that’s a shame. But it’s also a shame (not to mention bad policy) to deny opioids to those who _do_ need them. If I couldn’t have Norco at home, I’d have had to stay in the hospital much longer, basically not moving except when absolutely necessary, because the post-op pain was, frankly, pretty awful.(*)

    But at least those were short-term. I know somebody with a wrecked back. Without opioids, he won’t be able to get out of bed. The new regulations just force him to see a doctor _every month_, even though his condition will not change for the rest of his life.

    Just plain stupid.

  8. Those people are at risk of addiction. And that’s a shame. But it’s also a shame (not to mention bad policy) to deny opioids to those who _do_ need them. If I couldn’t have Norco at home, I’d have had to stay in the hospital much longer, basically not moving except when absolutely necessary, because the post-op pain was, frankly http://australiaposttracking.me/
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