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Death by Dope
Prescription Drugs’ License to Kill

Americans’ abuse of painkillers has reached “epidemic” levels, according to the CDC. USA Today reports:

Use of narcotic painkillers, such as Vicodin and OxyContin, has also grown. In 1999, 5% of adults 20 and older reported using a narcotic painkiller. Four years later, that number grew to 7%, where it has remained, Sales of the drugs quadrupled between 1999 and 2010, the report said. […]

In 2012, 16,007 people died from overdoses involving opioid painkillers, triple the number who died in 1999, a 5% decrease from 2011 when 16,917 people died, the CDC reported last year.

Of course, some of this use may be legitimate, involving people who are seriously injured or otherwise need painkillers. But when you look at these numbers in light of general data about prescription drug use, they look less benign. For example, according to the White House, “nearly one-third of people aged 12 and over who used drugs for the first time in 2009 began by using a prescription drug non-medically” and “over 70 percent of people who abused prescription pain relievers got them from friends or relatives.”

Painkillers aren’t the only drug devastating the country, as a recent NYT story on heroin use in Vermont shows. After announcing that the state was experiencing a “‘full-blown heroin crisis,” Governor Peter Shumlin launched an aggressive campaign to help treat addicts. The NYT argues that the campaign has been successful in some ways, but deaths due to heroin in the state are still climbing, with 66 percent more people dying in 2014 from heroin use than in 2013.

The country is currently caught up in a debate about marijuana legalization, but these stories show how complex and multifaceted the drug problem in America is. Painkillers are legal—but their legal status hasn’t reversed the abuse outlined in USA Today. As WRM pointed out in a classic essay on the drug war, “Some of the most widely abused addictive drugs in the US today are available by prescription; that system has stimulated the black market in drugs like Oxycontin rather than closing it down.” (This seems to be happening with marijuana, as well.) And then there is heroin—should that be legal? It’s hardly clear how that would save the Vermonters dying from it. It’s necessary to end the drug war in its current form, but things are likely to get worse for Americans in some ways—or, at the least, no better—when we do.

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  • Jacksonian_Libertarian

    It is stupid to think legalization would make things worse, half the people in prison are there because of drug offenses, drugs are the major source of organized crime income, and if legalized and taxed not only would it fill government coffers but savings on drug enforcement would be billions every year. It would also allow society to treat drug abuse in a responsible way like smoking and the campaign against smoking which has reduced per capita use of tobacco from 12 lbs to 4 lbs in the US.

    • Corlyss

      “It is stupid to think legalization would make things worse,”

      As the marijuana legalization has shown, legalization makes things different, not necessarily better or worse, depending on what got your dander up before legalization. I believe it’s Washington state or Colorado that has discovered the income didn’t match projections, AND they now have different social problems they didn’t have before. I’d like to try legalizing all drugs just to see if I like those problems better than the ones the “war on drugs” has produced.

      • Kevin

        Legalization will never bring in the revenues that are hyped. At best it will be a very modest amount. It might reduce law enforcement (both police and prison) costs more substantially. But ultimately it is non-budgetary considerations which should drive this policy – can prohibition save enough lives to offset the costs in foregone liberties?

      • jeburke

        Of course legal pot will make things worse. More people will ingest more pot to get or stay high. Unless you contend that more people intoxicated more of the time is a desirable outcome, you must acknowledge that legalization will make things worse. Liquor is bad, too, but more pot highs will not reduce alcohol abuse or Rx drug abuse. Legalize all drugs? Great, and condemn unborn millions to addiction, degradation and despair.

        • Corlyss

          I dunno. Neither do you, unless you have some studies by unbiased sources. That’s one of the problems with trying to make public policy about an unknown condition: there are no unbiased studies and most places haven’t had legalized drugs long enough to tabulate the results.

          We can only speculate, usually based on our moral or religious backgrounds. I suspect that a lot of the charm of drugs is their illegality. We could find out by legalizing it. I’d like some data, particularly uncontested data from a longitudinal study on the long-term effect of drug usage on the brain. What has been clear is prohibition don’t work. Let’s try something else and get some evidence.
          I don’t use and I have no interest in the subject except as a public policy issue.

          • jeburke

            Who says “prohibition don’t (sic) work?” An important part of that missing data is the amount of increased dope consumption if it’s legal, compared to when it’s illegal but law enforcement is lax or illegal with strict, aggressive enforcement.

            It is commonly said that “Prohibition (of alcohol) didn’t work,” but that is a totally data-free conclusion based mostly on movies and suppositions. Actually, it did “work,” if work means lower consumption and abuse of alcoholic beverages. Overall consumption dropped by more than half, and alcohol-related deaths and illnesses like cyrhossis dropped like a rock.

          • Corlyss

            “It is commonly said that “Prohibition (of alcohol) didn’t work,” but that is a totally data-free conclusion based mostly on movies and suppositions.”

            Studies by the National Bureau of Economic Research, the Cato Institute, and the Shaffer Library of Drug Policy ( You’ll want to be sure and contact these establishments to inform them of their errors.

            “We find that alcohol consumption fell sharply at the beginning of Prohibition, to approximately 30 percent of its pre-Prohibition level. During the next several years, however, alcohol consumption increased sharply, to about 60-70 percent of its pre-Prohibition level. The level of consumption remained virtually the same immediately after prohibition during the latter part of Prohibition, although consumption increased to approximately its pro-Prohibition level during the subsequent decade.


            “By the mid-1920’s, it was apparent that at best limited success had been achieved in prohibiting alcohol consumption. Initially Congress respeonded with increased enforcement. Money approriated for enforcing Prohibition increased from $6.3 million in 1921 (the first year of large scale enforcement) to $9.2 million in 1925 and to $13.4 million in 1930 (U.S. Department of Treasury (1930), p.2.). However, the inability to restrict illegal trade and the inevitable accompanying corruption eventually led ot widespread public disenchantment with Prohibition.”

            – Alcohol Consumption During Prohibition, National Bureau of Economic Research, 1991


            “The fourth qualification may actually be the most important: a decrease in the quantity of alcohol consumed did not make Prohibition a success. Even if we agree that society would be better off if less alcohol were consumed, it does not follow that lessening consumption through Prohibition made society better off. We must consider the overall socialconsequences of Prohibition, not just reduced alcohol consumption. Prohibition had pervasive (and perverse) effects on every aspect of alcohol production, distribution, and consumption. Changing the rules from those of the free marketto those of Prohibition broke the link that prohibitionists had assumed between consumption and social evil. The rule changes also caused unintended consequences to enter the equation.

            An examination of death rates does reveal a dramatic drop in deaths due to alcoholism and cirrhosis, but the dropoccurred during World War I, before enforcement of Prohibition.[28] The death rate from alcoholism bottomed out justbefore the enforcement of Prohibition and then returned to pre-World War I levels.[29] That was probably the result ofincreased consumption during Prohibition and the consumption of more potent and poisonous alcoholic beverages. Thedeath rate from alcoholism and cirrhosis also declined rather dramatically in Denmark, Ireland, and Great Britainduring World War I, but rates in those countries continued to fall during the 1920s (in the absence of prohibition)when rates in the United States were either rising or stable.[30]

            Prohibitionists such as Irving Fisher lamented that the drunkards must be forgotten in order to concentrate the benefitsof Prohibition on the young. Prevent the young from drinking and let the older alcoholic generations die out. However,if that had happened, we could expect the average age of people dying from alcoholism and cirrhosis to haveincreased. But the average age of people dying from alcoholism fell by six months between 1916 and 1923, a period ofotherwise

            “Conclusion: Lessons for Today

            “Prohibition, which failed to improve health and virtue in America, can afford some invaluable lessons. First, it canprovide some perspective on the current crisis in drug prohibition–a 75-year effort that is increasingly viewed as afailure.

            “Repeal of Prohibition dramatically reduced crime, including organized crime, and corruption. Jobs were created, andnew voluntary efforts, such as Alcoholics Anonymous, which was begun in 1934, succeeded in helping alcoholics.Those lessons can be applied to the current crisis in drug prohibition and the problems of drug abuse. Second, thelessons of Prohibition should be used to curb the urge to prohibit. Neoprohibition of alcohol and prohibition oftobacco would result in more crime, corruption, and dangerous products and increased government control over theaverage citizen’s life. Finally, Prohibition provides a general lesson that society can no more be successfullyengineered in the United States than in the Soviet Union.

            “Prohibition was supposed to be an economic and moral bonanza. Prisons and poorhouses were to be emptied, taxescut, and social problems eliminated. Productivity was to skyrocket and absenteeism disappear. The economy was toenter a never-ending boom. That utopian outlook was shattered by the stock market crash of 1929. Prohibition did notimprove productivity or reduce absenteeism.[55] In contrast, private regulation of employees’ drinking improvedproductivity, reduced absenteeism, and reduced industrial accidents wherever it was tried before, during, and afterProhibition.[56]

            “In summary, Prohibition did not achieve its goals. Instead, it added to the problems it was intended to solve and supplanted other ways of addressing problems. The only beneficiaries of Prohibition were bootleggers, crime bosses,and the forces of big government.”

            – Alcohol Prohibition Was a Failure, Cato Institute, 1991

          • jeburke

            To have cut total national alcohol consumption by 30-40 % was hardly a failure, considering two things:

            — In some states, overall consumption dropped by considerably more and in some communities, the decline was twice that.

            — The Halstead Act never prohibited all alcoholic beverages. Far from it, the following continued to be perfectly legal:

            -Liquor, wine and beer in private stocks obtained prior to the Act’s effective date. With long notice, many people laid in multi-year supplies, especially of spirits.

            – Spirits (mostly whiskey) prescribed by a physician, which were dispensed in half pints by drugstores! Thus, the old joke about “medicinal use.” It was felt that docs had few tricks to deal with many ailments and a bit of booze was one of them.

            – Beer you made yourself. Many people pooled their alotments and designated one brewer — kind of like a microbrewery.

            – Wine you made yourself — up to about a gallon per household per month. Americans had not previously drunk much wine, but during Prohibition, vineyards boomed due to demand for grapes used in private production.

            — Wine used in religious rituals, both Catholic (and other) communion and Jewish sabbath observance. Clergy were licensed to buy the stuff. Mogen David was flush.

            Add all this legal alcohol up and it comes to a fair amount of the pre-Halstead level, which sheds a brighter light on that 30-40% decline.

  • iconoclast

    Evolution in action

  • Fat_Man

    Let Darwin do his job. Make all drugs legal.

  • jeburke

    This is not an easy problem to solve because opioid pain killers have many legitimate uses, including for chronic pain from cancer, arthritis, etc. as well as to manage post-surgical pain and injuries. Millions of people are prescribed such drugs because millions of people have these ailments. Remember, the supposed rationale for legalizing “medical pot” is that it helps manage pain, so it would be crazy to over-regulate drugs produced expressly for pain management. And we may have reached a point of maximum regulation since the law now effectively bars a prescription for more than a month’s supply of hydrocodone or oxycontin, so a doc must write a new prescription every 30 days, which is a pretty tough hoop to jump through.

    It’s also worth noting that the 16,000 deaths in one year were from overdoses involving or related to opioids. Most of these also “involved” other drugs, conspicuously alcohol and tranquilizers, but no doubt illegal drugs in some cases. It would be important to know how many, and also what proportion of the deaths involved illegally obtained pills, not those prescribed.

  • Kevin

    Any policy here will involve trading off misery between different groups. I would probably strike the balance as of these trade offs in favor of much looser regulation – I would favor greater personal liberty even knowing this will allow many people will make horrible choices that will ruin their lives, greater access to needed pain medication to patients suffering even knowing this will allow addicts greater access and lead to more ODs, and reduced violations if civil liberties by law enforcement even if it allows greater scope for those who profit by trading on human weakness by drug dealers – whether in white lab coats or standing on street corners. The cost of the state trying to save people from their own mistakes is simply too high in dollars for enforcement and foregone liberties.

  • FriendlyGoat

    Except for those opioids stolen from manufacturers or distributors, all of those drugs used “non-medically” (abused) had their normal profit margins going to makers, distributors and doctors who prescribed them. Medical patients and/or their employers/insurers paid for them. Those are embarrassing problems.

    As for marijuana, some believe that the large tobacco companies are waiting in the wings to capture the market for a lot of whatever legalized weed we actually legalize—-because of their innovation on “heat, not burn” technology. Most people believe that governments can’t wait to tax the stuff to make all citizens “complicit beneficiaries” of weed use as it grows. Those are problems too.

    • Corlyss

      “Except for those opioids stolen from manufacturers or distributors, all of those drugs used “non-medically” (abused) had their normal profit margins going to makers, distributors and doctors who prescribed them. Medical patients and/or their employers/insurers paid for them.”

      LOL So?

      Friend, you’re so predictable.

      • FriendlyGoat

        What’s funny about people getting addicted or dying while employers pay for it and incorporated business people profit from it?

        • Corlyss

          Assuming your shockingly simple characterization of the issue is correct, it’s funny that what seems to bother you more is that, quelle horror, someone somewhere makes a profit from the determined self-destructiveness of some people. I’m with Fat Man, let Darwin work. Save society a lot of wasted money. That sure ’nuff would stop the profiteering.

          • FriendlyGoat

            I really do try to distill thinking to the “shockingly simple”. I’m well aware that I’m not smarter than others or necessarily right in any particular comment. But expressing things as simple as possible is what I strive for in this hobby.

            There is something questionable about doctors, pharmacies, distributors and manufacturers making “normal” margins on tons of extra pills peddled because some people are stealing them from others.

            You and Fat Man have a point that making all drugs legal, such as cheap heroin, for instance, would cut those margins way down. I’m not sure I understand yet what other “shockingly simple” consequences might follow. Will let you know if I figure that out.

  • ljgude

    There is a deeper level to this problem and that is the notion baked into our culture that there is usually a pill for just about any ailment. We have these things called drug stores on every corner and in every mall and spend twice the OECD average on medical care even before we got the ACA. When I was a wee lad I took it for grated that was a powder to fix everything too as I watched recently returned WW2 aviators dust my uncle’s tomatoes and themselves with DDT. Magic dust. It kills bugs. And pilots too – even the ones Germans couldn’t kill. You have a headache. You take an aspirin, right? No, wrong. Walk a mile. It your headache persists, meditate. We are the descendants of people who had zero pills. Be glad for modern medicine and use it when necessary, but after, not before you try diet and exercise.

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