A Fresh Look at an Old Problem

Opioid overdose (mainly heroin) is now the leading cause of death for Americans under the age of 50. Despite all efforts at stopping this, the trend is only getting worse. Federal and state governments have taken action to regulate pain management clinics, as well as push for tighter criminal laws. It sounds excellent as the debate rages on, but it’s hard not to get emotionally charged as children are literally dying in the streets, and trying to assign blame during such tragedy is only natural. But what if this approach is only hurting those we are trying to help?

Let’s take a look at the regulation of pain management drugs for example. In the US, opioid prescriptions are closely monitored. Doctors are limited in the amount of prescriptions they can write for opioid painkillers, which is supposed to combat addiction. Is this effective? No.

By restricting the supply of painkillers, it pushes people into getting supplies from the black market, which creates an increase in price on black markets (which is where most addicts get their drugs anyway). For example, in Pennsylvania, the average price of an Oxycodone (Branded Percocet and Oxycontin) on the street was about 50 cents per milligram in 2008. By 2011, that price was about 1 dollar per milligram.

As a result of this, less and less users of narcotic painkillers can afford their habits. They are forced to seek a cheaper alternative, and since they are already buying drugs on the black market, heroin is alluring. During that same time period of rising street prices for narcotic pills, the price of heroin was slashed in half. In 2008, an addict was lucky to find heroin in NEPA for less than 20 dollars for a single “bag.” This was already far cheaper per dose for a typical opiate tolerant person than buying pain pills on the street. By 2013 it was commonly under 10 dollars.

But this price decrease in heroin is not just due to increased amounts of dealers. There is something far more nefarious at play. Do you remember in DARE class, when they told you that street drugs are often cut with poison? They made it sound like cyanide or ricin. In reality, it’s the added fentanyl (and its analogs) that’s killing people at such a high rate. Fentanyl is so potent that an amount as small as a period in this article will kill a person with no opiate tolerance. Some of its analogs are even more potent.

Fentanyl also is less “euphoric” in terms of its effects compared to heroin, and has a shorter duration leading to compulsive redosing.

So why is fentanyl turning up in heroin? For starters, it is cheap. Certain fentanyl analogs sell for about 75 dollars per gram (less when buying wholesale) and is easily imported from overseas. Black markets have no quality control, and making heroin seem more potent by adding a tiny amount of fentanyl can increase sales and allow dealers to use more fillers (any similar colored and water-soluble powder) to cut the drugs and further increase their profits. But, considering typical dealers do not have the type of equipment to properly measure these drugs, combined with lack of knowledge in how dangerous they really are, the result oftentimes is death.

In addition to this, the variable purity rates are also an issue. From dealer to dealer (even bag to bag from the same dealer) drug purity can vary wildly. An addict who normally uses a certain amount, can use the same amount from another batch and die. There is no “standard” and while test kits are available online (at least to detect fentanyl and other more dangerous adulterants), most users do not even know they exist.

So, what can we do? Well, for starters it’s clear that our attempts to stop the supply of drugs through regulation is an absolute failure. Pushing the market deeper underground has never worked to solve a problem, so maybe we try the opposite. Allowing regulations to be lifted on the way drugs are prescribed does not sound helpful, but it would cut down the street prices for these drugs and stop pushing as many people into heroin use.

Secondly, as crazy as it sounds, we need to decriminalize the sale and use of heroin. Allow quality control methods to spring up and allow it to be sold by reputable companies who can be held accountable for tainted drugs. Our focus needs to be on reducing demand. It is easy to think if we cut drug supplies that we will save lives. The reality is that we can’t cut the supply without adverse effects that make matters worse. Increasing education and treatment is also key. We can work on making treatment available by reducing the licensing requirements to serve as an addiction counselor, which would not only lead to lower treatment costs, but also provide a job or business opportunity for those in recovery.

Decriminalization would also stop slapping criminal records on those convicted of nonviolent drug crimes; potentially breaking the cycle by making it easier to find work in recovery. While many may argue decriminalization and deregulation would cause a spike in use, Portugal has proven otherwise. Since decriminalization of drugs, overdose rates and HIV have fallen dramatically. While for a period of time surveys showed an increase in drug use after their decriminalization, this is because people are more likely to be honest in a survey if there is no stigma attached. Since then, drug use in Portugal has fallen.

I think it is about time we look at helping in a new light. Almost everyone in the U.S. has a friend or family member who has directly been affected by this issue. How long can we continue down this road, allowing people to die due mainly to our reactionary and emotion based policy that only serves to worsen the problem?

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