Time for pragmatism to tackle North America’s opioid crisis

Not too long ago, I wrote about the devastating opioid crisis that is holding much of North America in its grip. The numbers are staggering. In 2016, about 64,000 people died from drug overdoses in the United States. 

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In the hardest hit county, McDowell County in West Virginia, the overdose death rate was 93 per 100,000. That’s very close to the murder rate in cities like Acapulco, Mexico. If you struggle, as I do, with these numbers, imagine that the opioid crisis now kills more Americans per year than car accidents and even by far surpasses the number of US soldiers killed in the deadliest year of the Vietnam War (16,899 in 1968). It’s now affecting families and victims come from all levels of society, all ethnic groups, in both urban and rural areas. It is a crisis of such magnitude that it is now even impacting productivity and life expectancy in the United States.

Today, the Global Commission on Drug Policy, of which I’m a member, is launching a position paper titled The Opioid Crisis in North America. Much has already been written about the causes of this crisis, including the unethical methods of big pharma in expanding prescriptions of medical opioids. Some important factors are often overlooked, however, such as the role of economic upheaval, unemployment, and inequality. We know that they increase the risk for addiction and decrease the odds of recovery in this “crisis of despair”. We also know that once someone is dependent, simply cutting off the supply, as the US government is trying now by restricting medical opioids, is not the solution. 

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The government’s efforts to limit prescription opioids have driven many people with addiction to less expensive and more accessible street heroin – which has increasingly been mixed with fentanyl. Fentanyl is a very concentrated synthetic opioid. It is cheaper to make, about 50 times more potent than morphine per gram and therefore also easier to hide and transport. It is also much harder to get the right dosage, and deaths linked to fentanyl are up 540 per cent over the past three years. These enormous fatality increases once again tragically underscore the “iron law of prohibition”: illegal substances become more concentrated and more dangerous under repressive policies.

So, what should be done? Well, people using these drugs first need to have options: treatment must be widely available and include opioid substitution therapy – which in the US only eight to 10 per cent of treatment centres currently offer. And everyone needs to have better chances of staying alive. Experience in different countries has shown that harm reduction interventions do just that and are cost-efficient at the same time. It’s a crisis that we cannot afford to ignore.  Its economic impacts are staggering: in the US, the cost of lost earnings and employment alone amounts to $25.6 billion, in addition to $25 billion in healthcare costs. 

It is great that naloxone, which can reverse an opioid overdose, is made more widely available in both the United States and Canada now. But other services, especially needle and syringe programs, supervised injection facilities and drug checking, are urgently needed on a much greater scale. Canada has shown its willingness to embrace these measures, but it needs to move much faster. The United States needs to overcome its widespread suspicion towards harm reduction and treatment, reverse misguided policies and openly embrace these life-saving measures.

It is also striking that in states that allow regulated use of medical marijuana, overdose death rates are lower. It confirms what my fellow Commissioners and I have been saying for years: that the most effective way to reduce the extensive harms of prohibition and advance the goals of public health and safety is to get drugs under control through responsible legal regulation.

Government and wider society in both the United States and Canada need to start an urgent conversation on what can be done to prevent yet another family from receiving the news that their loved one has died. It is time for pragmatism, not ideology.

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