“It is impossible to understand addiction without asking what relief the addict finds, or hopes to find, in the drug…Far more than a quest for pleasure, chronic substance use is the addict’s attempt to escape distress. [They] are self-medicating conditions like depression, anxiety, PTSD, and ADHD. Addictions always originate in pain…they are emotional anesthetics.” - Dr. Gabor Mate
The banner label of “opioids” refers to a large collection of painkilling codeine-based substances that fall across the entire Controlled Substances Act in the U.S. (Schedule I-IV) and are categorized as a Schedule I Controlled Substance here in Canada. We are in the midst of what is often described as an “epidemic” or “crisis” and policymakers are conflicted between a hard-line approach and a harm-reduction model. All the while, we are seeing nearly 4,000 people in Canada and 17,000 people in the U.S. die annually due to opioid abuse and overdose, with no end in sight.
The underlying political issues in regards to opioids revolve around the law (and its application), the production of opiates, their procurement, their regulation, and the human cost as a result thereof. It is my assertion that the opioid epidemic has been exacerbated and intensified by government regulation and a narrow societal view of addiction. The most beneficial method to help alleviate (but not completely resolve) this tragedy is to take a libertarian/human centric approach that includes: Decriminalizing all drugs, encouraging private charities in the field, allowing social space for harm-reduction techniques, and abandoning the idea of a “demand reduction” approach (i.e. the “war on drugs.”)
If we are to make meaningful inroads into the opioid epidemic (and help the 11 million Americans currently abusing them), we need to realize how we got here, what the options are, and how to move forward with evidence-based decision making.
Tectonic Shifts and Big Pharma
The root cause of the “opioid epidemic” is the hopelessness and despair of an increasingly hollowed-out middle and lower class, coupled with the shadow society of the abused and sexually exploited. Their decimation has come in the form of rapid socio-economic change nested within an increasingly nihilistic and cynical Western culture.
This is especially prescient when considering that the same districts that voted to “Make America Great Again” in 2016 are also the same ones suffering the worst effects of widespread opioid abuse. As Dr. James Goodwin posits, “It very well may be that if you’re in a county that is dissolving because of opioids, you’re looking around and you’re seeing ruin [and despair]…You want something different. You want radical change.”
It is not hard to imagine an impoverished, desperate, and anxious segment of the population that while living in existential darkness turn to painkilling drugs and bombastic politicians for solace. This is happening while the shadow of a corporate service industry blankets working class locales and imposes an information economy over the top of a traditionally blue-collar reality. Creative destruction is obviously a natural and desirable part of dynamic capitalism, but within the last 25 years it has also been exacerbated by offshoring, heavier tax burdens, hedonistic influences over pop culture, rapid technological development, and a ruthless corporate-governmental axis that seeks to maximize influence and destroy competition. One of the worst offenders in this arena are the colossal pharmaceutical companies.
As it currently stands, 5 U.S. states are in the process of suing one such entity—Purdue Pharma—in relation to their production and sale of a signature drug called OxyContin. Stemming from the drug’s initial release, the lawsuits accuse Purdue of “deceptively pushing powerful painkillers” and “misrepresenting the drug’s safety as the pills sparked the opioid crisis.” Patrick Morrisey, West Virginia’s Attorney General, went further by claiming that Purdue was criminally negligent because “even when it became apparent that thousands of people were dying of opioid abuse, Purdue doubled down by continuing its relentless and deceptive campaign.” Allegedly, Purdue was enticing doctors to write prescriptions for OxyContin while suppressing information about its highly addictive nature.
We will see how the cases turn out, but I do not think it is unreasonable to assert that Purdue is morally and financially culpable for the effects of their products on the marketplace, especially if they hid research or information about the reality of OxyContin. That being said, users are not totally absolved of their actions, but in the absence of proper information the consumer has nothing to trust except the authority of drug companies and regulatory bodies like the FDA. As the Canadian Federation of Medical Statements has published:
“Much of the current opioid crisis originated from the development and malicious marketing of slow release OxyContin…[they were] marketed as a non-addictive opioid with little potential for abuse; however, it was soon discovered that the slow release properties were diminished when the pills were crushed...Oxycodone was then reformulated to OxyNeo, which was less accessible than its predecessor…however, the liberal prescribing of oxycodone had resulted in many people becoming opioid dependent iatrogenically [and a] second subset of the opioid dependent population—those using non-prescribed opioids—were also affected by its removal from the market, as oxycodone was often being diverted and misused. The major unintended consequence of the transition from oxycodone to OxyNeo was a skyrocket in opioid use, as the removal of oxycodone drove opioid users—non-prescribed and prescribed alike—to seek illicit alternatives, such as heroin.”
This supports the Cato Institute’s view that excessive government regulation and defacto supply management created the opioid epidemic. Because so many users could not obtain the strength and quality of oxycodone that they desired (because of medical regulations surrounding prescriptions), they were then forced to the black market, where quality control is nonexistent, and either overdose or become highly addicted to extremely concentrated drugs, i.e., Fentanyl. From this perspective, a decriminalization of drug possession and a liberalization of their availability seems to be a reasonably compassionate approach. This would allow individuals to medicate their unique needs, remove the stigma around drug use, and leave the user in a better position to seek help for their problems.
The Portuguese Experience
North Americans are not alone in their struggle against rampant substance abuse. International examples may highlight the necessity for strategies and policies that may seem counter-intuitive and destructive at first glance but have proven beneficial. These ideas revolve around ending the social shaming of addiction (shifting it to a health issue as opposed to criminal matter), decriminalizing “drugs,” and having private charities implement harm-reduction programs and techniques.
In this respect, Portugal serves as a great source of information and guidance for this methodology. At a national level, the Portuguese predicate their anti-drug and pro-health strategy on three foundational pillars:
There is no such thing as a soft or hard drug, only healthy and unhealthy relationships with drugs.
An individual’s unhealthy relationship with drugs often conceals frayed relationships with loved ones, with the world around them, with their past, and with themselves.
The eradication of all drugs is an impossible goal.
This is diametrically opposed to the popular view of drug use being “destructive,” of addicts being “weak,” and of extensive and destructive law enforcement power being used to eradicate supply. Nearly 50 years of the drug war is ample proof that if people want a product or service, regardless of its legality, they will procure it, often in a dangerous fashion. This is why North America should adopt the Portuguese model of decriminalizing all drugs, as the U.N. has praised.
Portugal has seen no increase in national drug use, has fewer people incarcerated for drug crimes and has seen more people receiving treatment and rehabilitation. It has also experienced a major reduction in HIV/AIDS deaths, in teen drug use, and in drug-induced deaths. This also has the spillover effects of reducing overall government expenditures (penal, legal, and enforcement), redirecting those wasted funds to something more beneficial, and treating users as people as opposed to criminals.
“The questions raised about the Iraq War are equally relevant to the War on Drugs: Are the declared aims valid and attainable? Are the means employed likely to achieve their desired goals? And what are the human and economic costs of carrying it out?” — Dr, Gabor Mate
The bottom line is that the opioid issue will not be solved by government dictate, by slandering and suing pharmaceutical companies, or by punishing users through the criminal justice system. It is going to take a concerted effort that requires government step back from its legalistic and punitive stance, requires private citizens actually get involved in providing charity and volunteer assistance and requires Western society view addiction through a compassionate lens. We cannot arrest, virtue signal, or regulate our way out of this mess.
The shadow society of opioid addicts needs help, meaning and optimism in their lives. None of these are being served by our current policies and practices. As Dr. Gabor Mate points out, “Every 3 weeks there is a 9/11 casualty rate happening from the opioid crisis.” Each community situation will be different; each addict has unique needs and problems, and every neighbourhood afflicted will require different resources. This is a human problem, not a drug problem. And the only significant way to alleviate the suffering of this crisis is for the government to get out of the way, and for individual citizens to wilfully dedicate their time, effort, and resources in aiding their fellow human beings in finding a meaningful existence.
If people genuinely care about this problem, they will act.