By Dr. Roger Stark, director of the Center for Health Care Reform, Washington Policy Center
Over the past few years, the number of deaths in the United States related to opioid abuse has increased dramatically. Yet for decades the government has been ineffective at solving the illegal drug problem.
In 1969, President Richard Nixon declared that drug abuse was “a serious national threat.” He followed this in 1971 with the statement that drug abuse was “public enemy No. 1” and announced a “war on drugs.” This has been an ongoing battle for 50 years. In spite of the billions of taxpayer dollars spent over the years, the current opioid crisis is a direct result of the failure of this effort.
Any market transaction depends on the supply of a product or service and the demand for that product or service. The illegal drug trade is no different. For a war on drugs to be successful, it must reduce both the supply and the demand for drugs.
The emphasis for the past 50 years in the U.S. has been to combat the supply of drugs and punish those who use drugs illegally. This has cost American taxpayers billions of dollars; however, the current opioid crisis shows the limitations of this approach. As one supply chain is stopped, another takes its place. As one drug becomes less accessible, another takes it place.
According to the federal Center for Disease Control and Prevention (CDC), from 2006 to 2010 the opioid overdose rate tracked closely with the overdose rate of prescription opioid drug users, one per 13,000 prescriptions. From 2010 to 2016, however, the prescription drug death rate dropped while non-medical drug users turned to the use of fentanyl and heroin in the illicit market.
This data strongly suggests that the current opioid crisis is not caused by legal prescription drugs, by medical manufacturers and distributors, or by doctors. Instead, the crisis is caused primarily by abuse of illegal fentanyl, heroin, and to a lesser extent, cocaine. From the CDC’s 2016 data, prescription drugs were the cause of just 23 percent of drug-related deaths. While a problem in itself, this is a clear minority compared to illicit drug deaths. Legal prescription drugs are not the cause of today’s opioid crisis.
Many who view drug abuse as a disease would like to see the decriminalization of the drug user and more emphasis on prosecuting major suppliers and manufacturers of illegal drugs. This is not to be confused with the legalization of all drugs. Incarceration of the user is extremely expensive for taxpayers and provides no real treatment or long-term solution. Shifting resources to prosecuting suppliers while providing effective treatment for users is not an argument for legalization.
An unintended consequence of the current opioid crisis is that patients who are truly in pain are often denied or limited in the amount of prescription pain-relieving medication they can actually receive. This limitation is obviously a disservice to thousands of patients in pain who could benefit from opioid medications and whose prescribed use of pain medication is not contributing at all to the broader opioid crisis.
It is difficult to show a correlation between legally written prescription drugs and opioid deaths. While the number of opioid overdose deaths has risen over the past ten years, according to the American Medical Association 2018 Task Force, the number of legal drug prescriptions written by doctors decreased 22 percent from 2013 to 2017. From 2016 to 2017 alone, the number of written prescriptions decreased by nine percent.
Elected officials have been unable to close the market for illegal drugs and slow or stop the overdose death rate. Perhaps it is time for a new approach to the drug abuse problem – one that views the drug user as an individual with a preventable and treatable disease, while making every effort to fully prosecute illicit drug manufactures and smugglers.
Dr. Roger Stark is director of the Center for Health Care Reform, Washington Policy Center.