Drug Overdoses And King Canute - A Dialogue
How exactly is this supposed to work?
Drug overdoses are clearly very terrible--on this we can all agree. But how to have less of this terrible thing? . . .
"Well, that is easy", many claim. "Just make what is causing the overdoses illegal."
“And what is causing them?” I ask
Many Claiming: “Drug use--specifically, opioid drug abuse. Therefore, use of these drugs should be illegal.”
Me: “But don't they have medical benefits?”
MC: “Oh, yes. So amend that to 'Highly regulate but allow some drug use; make the rest illegal totally.’”
Me: “Obviously, we have already done this. So I have to ask how well this is going.”
MC: “That is complicated. Drug overdoses are the harmful byproduct of a world riddled by drug abuse.”
Me: “Is drug use the cause of the overdosing or a symptom of an underlying cause?”
MC: “Well, it is both.”
Me: “So, could we just make the underlying cause illegal?”
MC: “No, obviously not. The underlying causes are vast and varied. They include poverty, feelings of despair and lack of belonging, desire to find benefits from quick fixes (aka, drug highs), chronic and acute pain, etc. Since we cannot fight these directly or even as we try, we still cannot let the false refuge of drug abuse run rampant.”
Me: “Is opioid drug use not rampant today?”
MC: “It is, but it would be so much worse if we didn’t do all we are doing.”
Me: “Are you sure about that? How many more people would start taking heroin or other opioids if it were completely legal?
MC: “Plenty!
Me: “Really? Would you start?
MC: “No, but not everyone is like me.
Me: “How different are they?
MC: “Well, many people suffer from chronic or acute pain. For them, prescription opioid pain medicine is a very important part of their lives. However, if not kept in check, these people could become addicted and start abusing it. Others lack my good judgement.
Me: “There have been millions of Americans who have been given prescription opioids. Yet the abuse rate among this immense population is less than 1%.1 Perhaps you do have exceptional judgement. Fortunately, that doesn’t appear to be a decisive attribute to avoid falling victim to substance abuse as 70-90% of users of the most stigmatized drugs like opioids and methamphetamines do not suffer this fate.”2
MC: “Would you just turn your backs on the ones who do fall victim? I cannot morally consider such an act.”
Me: “Absolutely not. I completely agree. I think we should do a lot to help the many, varied people who do not share your great judgement or have become unwitting victims otherwise. For example, I support harm reduction methods such as overdose prevention centers (OPC).”3
MC: “You would encourage and enable the use of heroin?!? That seems pretty irresponsible and a far cry from caring about drug users. I am all for treatment, but only to help users stop using and abusing. Not to help them ‘safely’ do it—whatever that means.”
Me: “I thought you wanted to reduce overdose deaths. Given your worries about the power and prevalence of opioid drugs, wouldn’t OPCs help this effort?”
MC: “Well, perhaps, but I don’t like the idea of my tax dollars funding drug use. You yourself said that most opioid users do not become abusers. So why should we pay for people to indulge in this behavior?”
Me: “Should we deny medical treatment for uninsured motorcyclists injured in accidents?”
MC: “No, but we shouldn’t buy them motorcycles either.”
Me: “Where you see a pure subsidy I see mitigation of the very thing you are more convinced of than me—namely, that drug use leads to dangerous drug abuse. The more right you are in that fear, the more you should be looking for mitigating efforts to reduce the ultimate risk—overdose death.”
MC: “Be that as it may, we should tread lightly down that road. And if you are right about only a small share of users becoming self-dangerous abusers, these folks in the small share must be especially vulnerable given the horrible volume of overdose deaths.”
Me: “Not to be macabre, but is your implication that this not really a long-run problem? That those susceptible to drug overdose simply kill themselves off and then we would be left with those very unlikely to have overdoses? Survival of the fittest, if you will.”
MC: “How dare you!?! That is a disgusting premise! I am simply saying that, as we agree, there is a tragic level of overdose deaths year after year. Something must be behind it. A safe space for use of drugs hardly seems like a solution. Besides, illegal drugs are made and distributed in unsafe and unregulated black markets.”
Me: “Perhaps you have stumbled upon the true solution.”
MC: “How so?”
Me: “The source of the very real dangers in currently-illegal drugs is that they are made and sold in black markets—existing outside of regulation and the light of open-market transparency. Prohibition itself is the problem rather than the solution.”
MC: “There you go again, trying to encourage drug use.”
Me: “I am doing no such thing. I am simply acknowledging the fact that many people choose to use drugs and/or many people become addicted to drugs. At the same time we create an environment where the drugs people use are made and distributed in extremely dangerous ways where the worst of the worst control the market—at great profit I might add.”
MC: “So if you can’t beat ‘em, join ‘em?”
Me: “On the contrary, use the best force the planet has ever known to beat out the worst problems encountered when people try to meet their needs and wants—the competitive free market.”
MC: “You are woefully naïve. Making these drugs legal would just lead to more overdoses and greater degeneracy everywhere.”
Me: “Do the tens of thousands of people suffering overdoses willfully chose to overdose?”
MC: “No, just a small fraction. The rest are appropriately counted as unintentional overdoses.”
Me: “So what makes it unintentional?”
MC: “You really should watch the news occasionally. Overwhelmingly it is fentanyl that ends up being in the drugs they take where the user didn’t know it was there or what the potency was.”
Me: “And the drug cartel or drug dealer didn’t disclose this upon sale?”
MC: [blank stare]
Me: “It seems people using drugs need more information and safer environments. They need better assurance about what they are taking and how to take it. Perhaps then they could make better choices to at least minimize if not avoid overdose risk. It would be good if we could ferret out and eliminate bad actors making and selling drugs more dangerous than understood by the buyer. It would be nice if victims of addiction could find treatment without the risk of being labeled a criminal with all the harsh trouble that entails. If only there were a known and proven way to get all of this. But we would not want to encourage drug use, of course. That would lead to many overdose deaths and great harms otherwise.”
MC: [another blank stare]
. . . If only we all could have the wisdom of a great king.
https://www.bmj.com/content/360/bmj.j5790
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7328574/
https://www.cato.org/briefing-paper/overdose-prevention-centers-successful-strategy-preventing-death-disease
Excellent. A+. Nailed it. Everyone should understand this.