The incredibly unpopular idea that could stem opioid deaths

Friday, December 28th, 2018

Megan McArdle sees two options for dealing with the fentanyl epidemic:

Keep doing what we’re doing and let addicts keep dying as they’re dying, until the opioid epidemic burns itself out. Or start talking about ways to make safe, reliable doses of opiates available to addicts who aren’t ready to stop. That would mean opening more methadone clinics and making it less onerous for doctors to prescribe buprenorphine, a relatively mild opioid that’s difficult to overdose on. But lowering the death toll may well require a more drastic step: legalizing prescriptions of stronger opiates.

Prescription heroin? Remember, I said you might not like the solution. I don’t like it, either — and frankly, neither do the drug policy researchers who told me it may be necessary. But when fentanyl took over the U.S. illicit drug markets, it also got a lot of addicts as hostages. We’ll never be able to rescue them unless we can first keep them alive long enough to be saved.


  1. Bob Sykes says:

    Some time ago, someone (Classical Values?) noted that people take drugs because they are in psychological pain, depression, despair… As far as the White working class is concerned, much of this pain is due to the economic collapse of our industrial economy. When we had factories, unskilled people could get well paying jobs with benefits and could support a family in near middle class comfort. All that is gone, and there is no replacement, not even service jobs.

    So, rather than worrying about dose size, why don’t we forcibly re-industrialize and reserve the jobs for native Americans. That requires slowly closing the borders both to manufactured imports and immigrants, nearly all of whom compete directly for low skilled jobs.

  2. Graham says:

    I’d endorse Bob Sykes’ idea in principle, but it’s never going to work entirely that well in practice. America was never that shut off to trade, even imports, though it did and could again have a different relationship with them than it has now.

    The golden age of the postwar era was not just about American industrial policy, but about the annihilation of industrial competitors through war.

    Even if you made everything else reset to 1955 norms, America wouldn’t be as dominant as it was in the real 1955, because it would have competition. So the living standards and security the working class/lower middle class had then isn’t coming back even under ideal American policies. Not quite.

    Still, that doesn’t mean you have to recite free trade mantras uncritically. Up here in Canada, we benefit from it more than we lose from it, big time, but it imposes its own costs and we have travelled some of the same social and economic road the US has. in terms of class structure and opportunities. We could still do with taking a more pragmatic approach. As long as we still get preferred access to the US…

  3. Graham says:

    On the health policy side, what percentage of opioid addicts genuinely stem from that scenario in which someone gets prescription meds after surgery and then has no help weaning off them and no follow-on pain management? I am willing to believe that is overblown, but it must be some of them.

    That’s the terrifying scenario for me. Because it’s the holy grail of narcotics addiction- the actual, real-world, “It could happen to me!” scenario. I’m not going to try heroin recreationally. I am out of sympathy with anyone who did. But anyone could be in the gaps of health care.

    This isn’t just a Canada-US health care issue shot, either. I suspect it’s easier to fall through that crack [heh] in the states than here, but it’s not that hard here either and we have a fentanyl problem too.

    So that should be part of the strategy- stop making more addicts.

  4. Bruce says:

    Legal heroin would be relatively popular compared to opposing the bipartisan consensus in favor of lower wages through higher immigration, which provides a strong incentive for the people whose wages are lowered to just stay blasted all the time.

  5. Kirk says:

    When you get down to it, addiction is a choice that the addict made, at some point. You can try to treat the symptom, which is the addiction, or you can address the reasons that the addict made and continues to make those choices.

    From what I’ve observed, outside intervention doesn’t work with stopping addictive behavior. You can separate the addict from whatever they’re addicted to, but the minute you turn your back and try to let them live independently again, they’ll go right back to it–Because you never addressed the underlying problems, many of which are essentially insoluble.

    It may be that the only real and truly kind solution is to let these people go, and let nature take its course. Maybe even speed the process up, and make euphoric euthanasia drugs available, spike the supply with fentanyl.

    Plain fact is, they’re not going to stop because you want them to. They’re either going to self-destruct, and take others with them, or they’re going to eventually decide to stop on their own. You can’t help them, and by making it easier on them, you’re really not helping. One of my acquaintances while in the service was a Vietnam-veteran drug abuse counselor, and had been addicted to just about everything at some point. His take on the whole issue was that anything you did to help enable the drug abuser, whether it was passing out needles, having injection stations, or even methadone clinics were basically counterproductive, because they just made it easier for the addict not to face their issues. If you’d have left it up to him, none of that stuff would go on, and you’d just let the addicts drop dead. I guess he’d watched too many people that he’d tried saving relapse, and came to the conclusion that it was kinder to everyone to just let go.

  6. CMOT says:

    Remember how we solved the obesity problem via increasing food stamps, putting fast food franchises on ever corner, and making processed food much cheaper?

  7. CVLR says:

    “Remember how we solved the obesity problem via increasing food stamps, putting fast food franchises on ever corner, and making processed food much cheaper?”

    Cui bono? Answer that question and you will know who fixed the policy.

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