Drug War

A Record Number of Drug-Related Deaths Illustrates the Lethal Consequences of Prohibition

The war on drugs is not just ineffective; it exacerbates the problems it is supposed to alleviate.

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The United States saw a record number of drug-related deaths in 2020. The total exceeded 93,000, which was up 29 percent from 2019, according to the latest estimates from the Centers for Disease Control and Prevention (CDC). The 2020 spike—the largest ever recorded—was largely attributable to the COVID-19 pandemic and the legal restrictions it provoked. But drug-related deaths already were rising before anyone had heard of the coronavirus, not just despite but also because of the government's efforts to prevent people from using psychoactive substances.

The new CDC numbers confirm the folly of relying on supply control measures to reduce drug fatalities. Those policies are based on the premise that drug availability by itself causes drug-related deaths, which is clearly not true in light of the social, economic, and psychological factors that plausibly explain last year's surge. In any case, attacking production and distribution through legal restrictions, interdiction, seizures, and arrests rarely has a significant or lasting impact on prices or availability. Worse, those interventions drive substitutions that make drug use deadlier, as illustrated by the rise of illicit fentanyl and the crackdown on prescription pain medication, which accelerated the upward trend in opioid-related deaths.

Three-quarters of the drug-related deaths that the CDC is projecting for 2020 involved opioids, and the vast majority of those (about 83 percent) involved "synthetic opioids other than methadone," the category that includes fentanyl and its analogs. The total number of opioid-related deaths has more than tripled since 2010, while the share involving synthetic opioids has nearly sextupled. Those two developments are clearly related, because fentanyl is much more potent than heroin, which means that using it as a heroin booster or substitute makes the composition of black-market opioids more variable and unpredictable, increasing the chances of lethal errors.

Nowadays fentanyl is showing up in black-market pills sold as hydrocodone or oxycodone and even in stimulants such as cocaine and methamphetamine. Its proliferation is a response to the very supply control measures that were supposed to reduce drug-related deaths. To the extent that the government succeeds in exerting pressure on the supply of illegal intoxicants, it encourages traffickers to distribute more-potent drugs, which are easier to conceal and smuggle.

Since fentanyl is far more potent than heroin, a package weighing less than an ounce can replace one that weighs a couple of pounds. Synthesizing opioids is also a less vulnerable and much cheaper process than production that relies on poppy crops. Researchers at the RAND Corporation estimate that heroin is at least 100 times as expensive to produce as fentanyl, adjusting for potency.

Black-market drugs were already iffy because of prohibition; the prohibition-driven rise of fentanyl has made them even more of a crap shoot. And these are the substitutes nonmedical opioid users resorted to after drug warriors succeeded in driving down prescriptions of analgesics such as hydrocodone and oxycodone. That shift replaced legally produced, reliably dosed pharmaceuticals with illegal drugs of unknown provenance and composition. The result was predictable (and was in fact predicted): As opioid prescriptions fell, opioid-related deaths rose.

The New York Times story about the surge in drug-related deaths glides over this perverse policy. The paper acknowledges that social distancing requirements and recommendations may have backfired during the pandemic, making people not just more inclined to use drugs but also more likely to do so on their own, meaning that no one was around to help if they ran into trouble. But when it comes to restrictions on pain pills, the Times merely notes that Congress passed legislation "meant to reduce the death toll by limiting overuse of prescription drugs." How did that work out? Not so well, as you can surmise from the numbers the Times is discussing.

"The combined pressures of the COVID-19 pandemic, an increasingly toxic illicit drug supply, and an overwhelmed and under-resourced public health system have driven the overdose epidemic to catastrophic levels," Daliah Heller, director of drug use initiatives at Vital Strategies, says in a press release. "These data are an urgent call to action for federal, state, and local governments: we need to mount a massive public health response to overdose that emphasizes harm reduction and support instead of punishment for people who use drugs. We need to prioritize a community-based response that includes syringe service programs, naloxone distribution, medications for opioid use disorder, and mobile outreach. It is time we stop investing in strategies that stigmatize and punish people for using drugs."

I question the medicalization of human behavior implicit in the term epidemic, and I am skeptical about the cost-effectiveness of whatever "massive public health response" politicians might settle on. But I agree with the general proposition that harm reduction is preferable to the current approach, which is more like harm maximization.

Harm reduction recognizes that drug-related deaths are not a simple function of drug use or addiction. Between 2002 and 2019, according to the federal government's survey data, the number of Americans who had a "substance use disorder" involving heroin roughly doubled. During that same period, according to the CDC's data, the annual number of heroin-related deaths septupled, while the total number of opioid-related deaths quadrupled. The war on drugs helps account for that disparity, since it has made opioid use more dangerous in the ways I've just described, which suggests that repealing prohibition would be the single most effective harm reduction strategy.

But it also seems likely that drug mixtures, which account for the vast majority of so-called overdoses, have become more common, more reckless, or both. To understand why that might be, you have to consider the conditions that encourage people to seek oblivion even at the potential cost of their lives. Someone who dies after consuming a dangerous combination of drugs may not be deliberately killing himself, but the fact that he accepts the possibility of that outcome suggests that his life lacks the rewards that would deter most people from taking such a chance. The factors that can lead people to that dark place include unemployment, financial insecurity, emotional stress, social isolation, and disengagement from meaningful activities.

The pandemic amplified those problems, but it did not create them. A 2019 Joint Economic Committee report on "deaths of despair" noted that "drug-related deaths have been rising since the late 1950s." Reversing that trend is no simple matter, since it depends on public policies and private initiatives that replace despair with hope. But one thing should be clear by now: Attacking drug-related deaths of despair by attacking drugs only makes a bad situation worse.

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  1. Fentanyl imported by Chicoms though Mex cartels, didn’t see that reported. Consequence of open borders. They would still do it even if drugs were legalized because causing problems on our southern border is a Chicom trick. Biden admin has no stomach to confront the issue, so he was a bad pick. Congrats.

    1. “Biden admin has no stomach to confront the issue, so he was a bad pick. Congrats.”

      LOL

      I cannot believe so many people comment on Reason.com without understanding the fundamental point of this website. So here it is again:

      Koch / Reason libertarianism seeks to make billionaires even richer.
      Billionaires didn’t do well enough under Drumpf.
      Koch-funded libertarians concluded billionaires would be better off under Biden.

      With me so far? Good! Because here’s the most important part…

      Koch-funded libertarians are getting exactly what they wanted from the Biden Administration.

      1. what’s the Kraut word for when the satire is reality?

        1. https://en.wiktionary.org/wiki/Realsatire

          Not as pleasantly german-sounding as it probably could be but there it is.

          1. sounds alright w/an accent I guess, but yes disappointing

    2. I suffer from chronic pain and have had multiple surgeries. Over the last 3 years, with federal restrictions and guidelines, I have been reduced to a very small amount of opioid drugs. Now people are oding in greater numbers due to uncontrolled fentanyl and it’s just poring over the border. People that need medication seem to be suffering to me because the government should have no right in making a decision that should be between me and my doctors! Idiocy!!!

    3. Most overdoses are accidental, from street drugs. But legalization solves nothing, as evidenced by $100 million bailout of weed industry in California where it’s all legal and the black market thrives from over-regulation. And California still has tons overdosing every day, because drug laws aren’t enforced and most homeless are drug addicts.

      The only solution is to feed them all into a hog enclosure.

  2. Although we do not want to believe it, we are often presented with the choice between two bad alternatives. Most, if not all, schedule drugs are addictive. The war on drugs kills rights, funds gangs and their turf wars, and supplies the market with poor quality and adulterated drugs. Legal drugs would eliminate those negatives but will almost surely create a rise in drug use.
    Some of those users will probably be like occasional drinkers. Many will probably end up like functioning alcoholics. A smaller group will die. A lot of overdoses are not due to bad drugs, but rather because of the desire for ever greater doses.
    Can we sit around and watch the carnage? As a libertarian I believe in personal choice and personal responsibility. If you choose to make bad choices, then live or die with the consequences.

    1. A lot of overdoses are not due to bad drugs, but rather because of the desire for ever greater doses.

      Which could sometimes be described as… remarkably good quality heroin. Ie, the addict was used to the watered down shit, then some “really good shit” entered the market and killed him.

      1. I don’t see how a reliable, known supply of drugs wouldn’t reduce the rate of accidental overdoses, at least. And for opioids at least there is a highly effective antidote.
        Dinkle is right, I’m sure that there would be more users of drugs if everything were legalized. And many people would freak out about that. Which is why I have zero expectation of seeing anything other than weed and possibly some psychedelics legalized even in a limited way.

        1. Who would manufacture the drugs? Nobody sane would produce unregulated potentially lethal addictive drugs. The families of dead overdosees would sue the manufacturers into oblivion. If you don’t think so, ask the Sackler family what happened when people died ODing on their FDA approved, prescription-only painkiller medication.
          Production would default to the cartels, just like today.

          1. Legalize the drugs, illegalize lawsuits for things like overdoses unless it can be proven the packaging was mislabeled or something. like a PLCAA for drug makers

            then, let god sort em out.

    2. Dinkle conflates “fascinating” with “addictive.” Opiatesand their synthetics, and imitations such as barbiturates are addictive. Hemp, nail-biting, older women, alcohol, stimulants are NOT addictive inasmuch as they produce no withdrawal sickness. Scheduling serves only to tarbrush by association and make any experiments liable to expose the lies illegal. Robert H DeRopp’s correction of Louis Levin’s Phantastica disclosed objective facts.

      1. You’ve got strange taste in women.

  3. The factors that can lead people to that dark place include unemployment, financial insecurity, emotional stress, social isolation, and disengagement from meaningful activities.

    And other things. Remember, there are financially secure people who decimate their lives via the desire to use drugs. Ie, financial insecurity without question can be the result of drug use, leading to emotional stress, social isolation and disengagement from meaningful activities.

    That is if former drug addicts are to be believed.

    1. Some people are just highly prone to addiction. Such people are probably the ones who ruin a perfectly good life with drugs. But for most people I think that having a decent life is a pretty good incentive against getting too carried away with drugs.

      1. This is absolutely the case. I personally know of a couple of highly successful people that were in the 1% earning-wise and that died from an overdose. You don’t know what is going on in someone’s head. Some people have a chemical predisposition for depression and seek to alleviate it through drugs. Some people have a chemical predisposition for becoming addicted. Some people have both.

  4. No mention of the “possible” link between lockdowns and deaths of despair, huh?

    Interesting.

    1. The factors that can lead people to that dark place include unemployment, financial insecurity, emotional stress, social isolation, and disengagement from meaningful activities.

      The pandemic amplified those problems, but it did not create them. A 2019 Joint Economic Committee report on “deaths of despair” noted that “drug-related deaths have been rising since the late 1950s.”

      1. Good catch. It’s about halfway there. I would argue that chalking the increase up to “the pandemic” in general, or conflating a slow, fairly modest trend with the results of 2020 are at least mildly disingenuous.

    2. Reminding people of what the IRS did to McAfee? Thoughtcrime!

  5. The total exceeded 93,000, which was up 29 percent from 2019,

    So, rough guess, 21,000 excess deaths year over year attributed to that cause. A ton of folks could have used that info along with other info about excess deaths to make an argument re the total impact of the lockdowns etc

    Course you can’t make that argument if you are denying the existence of excess deaths because just the fucking flu.

  6. Gee. I wonder what happened in 2020 that might have caused so many people to take so many drugs. Oh right, it was drug prohibition. Wew! Good thing nothing else happened in that year that might have otherwise influenced the number.

  7. See. things like this are why we need to stop the spread of misinformation on the web.
    I have it on good authority, from a source close to the window, that NO ONE died of overdose last year.
    EVERYONE who died last year died of the Communist Chinese Virus.

  8. The primary cause of the sharp increase in OD deaths last year was the carefully coordinated unwarranted totalitarian lockdowns by left wing Democrat Governors, Tony Fauci and lefty deep staters at CDC (that employs very few Republicans and no libertarians).

    But Democrat loving Sullum failed to mention that key fact, which many of us repeatedly predicted would occur during the past 16 months.

    At least Sullum didn’t falsely blame Trump for the increase in drug OD deaths after lying about and demonizing Trump (who was the most libertarian President since Cal Coolidge) in hundreds of articles during the past 5 years.

  9. Freedom is hard.
    Thin the herd by weeding out the weak and the stupid.

  10. In “This Was My Life,” Robert St. John describes how 200-proof ethanol became the popular, transportable form of alcohol during Prohibition. As that, barbiturates and narcotics replaced bulky, smelly gin in the 1920s, so they replaced bulky, smelly, harmless marijuana and relatively harmless mescalin, LSD, DMT and mushroom derivatives under Biden laws. Sullum thinks the Kleptocracy values life. What repeals prohibition laws is understanding that looter prohibitionism wrecks a fractional-reserve banking system and makes rich cronies poor.

  11. Sullum always gets this right.

  12. I am always suspicious of ‘deaths of despair’, when someone suggests the despair is caused by ‘unemployment, financial insecurity, emotional stress, social isolation, and disengagement from meaningful activities’, since it seems this requires a little more mind reading than I am comfortable with.

    Let me suggest a more direct cause of despair.

    I have become addicted to opioids. I can’t get them legally. I can’t get them cheaply. I can’t get them guaranteed to be safe and effective. I must constantly be on the hustle for my daily opioid supply, while watching my back for law enforcement, who wants to put me in a cage for many years if I make a wrong step.

    Because of this my daily life is so miserable I don’t really care so much if I live or die.

    Note: I am not describing myself.

    1. I suffer from chronic pain and have had multiple surgeries. Over the last 3 years, with federal restrictions and guidelines, I have been reduced to a very small amount of opioid drugs. Now people are oding in greater numbers due to uncontrolled fentanyl and it’s just poring over the border. People that need medication seem to be suffering to me because the government should have no right in making a decision that should be between me and my doctors! Idiocy!!!

  13. I’m sure if we legalized highly addictive drugs we’d get fewer overdoses. That’s a rational position. I’m sure along with legalizing all these dangerous drugs we will be repealing the health insurance we’re all shelling out to support these losers? No? We aren’t interested in that reduction in government? Because then who would treat and house your junky friends? Right.

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