The American Interest
Analysis by Walter Russell Mead & Staff
Killer Pain Pills Dent Case For Ending War on Drugs

Legalizing drugs isn’t making people use them less.  The WSJ reports that about four times as many people die from using prescription painkillers as did ten years ago:

About 14,800 people died in the U.S. from overdoses of painkillers in 2008, up from 4,000 deaths in 1999, while the number of these drugs sold quadrupled, according to the Centers for Disease Control and Prevention, which issued the report.

The costs of social programs and healthcare to treat prescription drug abuse stand at about $72 billion, on par with what the government spends fighting illegal drugs every year.  But it gets worse.  Some members in the medical establishment are abusing their positions to provide easy access to painkillers:

Prescriptions of painkilling drugs are rising as new drugs appear on the market and doctors prescribe them help people manage pain more effectively. The soaring rates of prescription-painkiller abuse and deaths are mostly a reflection of how easy they have become to get, either through “pill mills,” shady storefront operations that dispense painkillers like Vicodin or Oxycontin without conducting medical examinations of buyers, or through “doctor shopping,” multiple prescriptions from a number of physicians, the CDC said.

The market for these barely legal drugs provides a snapshot of what the future might look like if more serious drugs were ever legalized.  So far, the results have been uninspiring: huge costs, a rising death toll and systemic abuse.  If we can’t trust our medical establishment to prescribe legal painkillers, how can we trust it to prescribe methamphetamine or heroin, as some libertarian critics of the War on Drugs would recommend?

This is not to say that we should or even could revoke the FDA approval for painkillers that hit the market in the past decade.  It might even be time to rethink the War on Drugs.  But we will still have to live with the incentives of the policies we make. So far, these incentives have created a system which is far from the predicted libertarian stoner utopia.

The fault is not in our laws but in ourselves — changing our laws won’t make humanity’s crooked timber straight again.

Published on November 3, 2011 8:40 am
  • David Fischer

    Yours is not the strongest argument for a militarized police state to protect us against ourselves.

  • Ken Strumpf

    I don’t understand. How does the abuse of prescription drugs justify the incarceration of hundreds of thousands of otherwise law-abiding Americans? And the ongoing destruction of a country- Mexico-which has done us no harm?

  • Fred

    David, Your assertion (without the slightest argument or evidence) that we have a “militarized police state to protect us against ourselves” or that such a police state is the only alternative to legalization of drugs is not the strongest response to Mead’s argument.

  • http://www.therazor.org Scott Kirwin

    My wife is a primary care physician here in rural North Carolina. She’s on the front lines of prescription drug abuse, and the metaphor is appropriate: it’s a war. But there are numerous differences between the war she deals with on a daily basis and the War on Drugs.

    First, there is tremendous pressure on doctors to dispense pills for any and every complaint. People have this idea that a doctor isn’t doing his job if he’s not prescribing drugs at every visit. If he doesn’t, then he can expect complaints to the staff, his employer (private practices are dying out – most are now owned by private corporations and hospitals), and sometimes even the Board.

    People also think too much about themselves, and have unreasonable expectations about growing older. Only the very young live without pain, and the older you get the more likely you are to have some discomfort. In the past people were too busy working or raising families to worry about every ache and twinge. Now people as young as their mid 20′s expect to pop a pill for every muscle strain or achy joint because they believe a painfree existence is their birthright. Much of these minor aches would disappear if people exercised more and ate better, but they don’t want to hear that. They want to take a pill instead.

    Most people know drinking too much is bad for you, as is smoking – yet when it comes to prescription drugs they act as if they are babes in the woods and show incredible naivety. They feel that a prescription from a doctor is 100% safe even when they don’t take the medicine as it is prescribed. It’s like people just become stupid when they’ve got a pill bottle in their hands. They don’t think of the danger in the pills, whereas they would if you handed them a pack of Marlboros or bottle of scotch. Educating people on the dangers of prescription drugs has only just begun. We have decades of drug education under our belts, so it’s unlikely that were heroin legalized everyone would run out and start shooting up.

  • Dave Boutilier

    If you make doctors and pharmacists the gate-keepers for access to drugs, you create huge financial incentives for them to bend the rules. The solution is to recognize that people should be allowed the make their own choices and bear the responsibility for them. Liberalizing access to prescription medicines would at least have the virtue of relieving doctors and pharmacists of temptation.

  • Luke Lea

    Killer Pain Pills Dent Case For Ending War on Drugs?

    I’d say they make it. How many lives have been lost and/or ruined — both here and abroad — compared to these individuals, all of whom at least did it under their own volition? To say nothing of the public moneys spent.

  • Robert Morris

    This whole post strikes me as an excellent argument for marijuana legalization. It killed pain and absolutely no people in 2008.

    These sorts of maximalist arguments for the status quo are dumb and dangerous. A saner drug policy does not mean a crack rock in every school lunch. The first step is some sort of marijuana de-criminalization or legalization. Once we see how that goes we can start talking about actual lessons learned, rather than ridiculous apples to oranges comparisons like this one.

    Is Mead on the payroll of the corrections officers unions or something? I don’t see how a guy who is so sensible on so much can be so rooted in 20th century thinking on this issue.

  • Rick

    I may be reading this wrong, but prescriptions have become easier to obtain at a four-fold pace, but overdoses have increased around 3.75x. So, despite increased access, there is a decrease in proportional access. That isn’t very informative on whether or not legalizing drugs will be a problem or not.

    In the WSJ article itself, two other problems arise, the first, mentioned in the blog post, is that many prescriptions are illicit, therfore illegal, making them not very different from other drugs, and showing that existing regulation is poor, that can be changed, especially if resources used in the war on drugs were shifted towards policing legal drugs. The second is that there is no account of intentional overdoses in the article, or reference to overdoses in people with a history of drug abuse…the former may be increasing because of ease of access to painkillers, but if a person is suicidal, the pain killers are not the underlying cause of death, the latter can run on a similar theory, an addict is an addict is an addict, that is exactly the type of person who needs to get help and if all drugs were legal, it would be easier to keep track of those heading towards the constant use path, and help allow for an intervention.

  • http://whenfallsthecoliseum.com/author/kwatson/ megapotamus

    It doesn’t matter how beneficial or detrimental prescription drugs or indeed ANY drugs are, the government has no standing to interpose itself between competent adults and the conduct of their own lives which absolutely includes their own psychochemistry. The insipid denial of this simple, eternal truth costs lives, money and most disastrously, Liberty of all sorts.

  • WigWag

    Professor Mead’s post oversimplifies the matter; while it is true that over use of prescription pain killers is a serious problem, conversely, so is the problem of under use of pain killers. Many physcians are so gun-shy about prescribing pain killers and anti-anxiety medications because of all of the scrutiny they receive when they prescribe these medications, that seriously ill patients often deal with far more pain than they need to. Even terminally ill patients have been denied the pain killers that they need because physicians worry that if they prescribe pain killers too often they will be the subject of investigations.

    There are no easy answers here but the best approach would be to leave these issue to patients and their physicans; the government should stick its nose out. This solution certainly doesn’t provide a panacea but in the world of medicine, where issues are complex, panaceas rarely exist. The under use of pain killers is every bit as much of a problem as the over use of pain killers; it’s just that the over use of pain killers gets most of the attention from a credulous press.

  • Jacksonian Libertarian

    You talk about prescription drugs as if they were legal, and then say that their abuse is proof that legalization doesn’t work. You talk about Doctors becoming pushers, and still don’t recognize that it’s impossible to be a drug dealer if the drug is legal. If all drugs were legal, and simply taxed to pay for rehab programs, and education programs, the costs to our society would be much reduced. The costs of imprisonment, gang turf wars, black markets, police, courts, and to families, that comes from the nanny state FDA are more like a $1 Trillion or more, not the minuscule $72 Billion you are quoting. Isn’t it time we were all treated like adults, with the Right to decide what we will put into our own bodies, like with tobacco and alcohol?
    Imagine a world without Drug Cartels, no more Taliban opium money, no more cocaine submarines, no more piles of heads in Mexico. Imagine our prison populations reduced by at least half, our poor neighborhoods filled with working people instead of gangsters, and the police looking for real violent criminals when they have to work at all.
    Drug abuse is with us for the foreseeable future, but treated responsibly it will decline just as tobacco and alcohol abuse have continued to do.

  • Stephen Houghton

    It is true that “changing our laws won’t make humanity’s crooked timber straight again.” We have a drug problem now, we will have one what ever we do. Thus I hold our choices are a drug problem with orginized crime profits or a drug problem without. I chose a drug problem without.

  • Gerald Owens

    Professor Mead’s point is quite obvious: if currently legal, socially acceptable, and medically necessary drugs like pain killers are being abused to the point of causing massive costs equal to the current expenditures fighting the war on drugs, then the “cost savings” argument for legalizing drugs has been gutted. Thus, the appeals to “patient/doctor” privacy (despite the fact that probably all sales of newly legalized drugs will *NOT* be made under the controls of a prescription written by a doctor, just as the vast majority of abortions (despite the hype of “personal physicians”) are performed by physicians that never saw their “patients” before).

    Here’s another fact spun in a different way for people to ignore: Most models of libertarian freedom and liberty require that the players be rational. This (implicit) requirement is stood on its head when it comes to the more popular drugs, due to their having a psycho-active component or side-effect that quite literally distorts the taker’s view of reality. Most libertarian fantasies have such people being inactive and inert from their drug taking, but the accident statistics on the road and at work indicate otherwise. Not every interaction between people is structured as a market transaction that libertarians seem to believe comprise the whole of societal life: many interactions within the various “commons” require a great deal of cooperation that can only happen smoothly when every party is “rational”.

    Legalize currently illegal drugs? I would suggest resurrecting the opium dens with a turnstile that is keyed to a drug analyzer.

  • Mogden

    You misstate the libertarian position. No doctor should stand in the way of an adult citizen and whatever medicine or drug they wish to partake of.

  • Robert Morris

    @Gerald Owens. Your point is no doubt profound, but I don’t understand it at all. Why don’t we focus on actual examples rather than ones that require require in-depth analyses of Libertarian philosophy? Like Portugal for example. Their 10 year experiment with de-criminalization has been a complete success. Why don’t we talk about what has actually happened in lieu of retreating to our respective soap-boxes and hobby-horses: http://www.newyorker.com/reporting/2011/10/17/111017fa_fact_specter

  • megapotamus

    Mr Owens I don’t understand your criterion for entry through your “turnstile”, for which I doubt the technology exists, but you are admitting people who already have opium in their bloodstreams or only the clean? Or is it to those who have opium in their hands. Or on their minds. If not the latter it doesn’t make much sense. Seeing your dismissal of “libertarian fantasy” seems to imply what the rest of your post disputes. Or am I already on opium[amnn ep[lbae ggushe pu74hhf774 74grtfboob f f

  • Glen

    The conclusion from the source material – that “prescription painkillers” actually killed 14,800 people in 2008 – is fundamentally flawed.

    If this conclusion were valid, then it would also be true that cardiac arrest (or pneumonia) was the leading cause of death in the United States, killing tens of millions of people every year. But we understand that these so-called causes of death are merely the final acts of much more complex diseases processes. And so, too, are the vast majority of deaths that are attributed solely to drug abuse.

    This is an area where Professor Mead has repeatedly demonstrated his ignorance. Moralizing about “humanity’s crooked timber” brings nothing to the discussion of disease prevention or government overreach or individual liberty. So stop it.

  • Cato the Youngest

    @Robert Morris: The abstract (I refuse to pay for the privilege of reading the whole thing) to the New Yorker article to which you sent us has this: “Yet there is much to debate about the Portuguese approach to drug addiction. Does it help people to quit, or does it transform them into more docile drug addicts, wards of an indulgent state, with little genuine incentive to alter their behavior? By removing the fear of prosecution, does the government actually encourage addicts to seek treatment? Unfortunately, nothing about substance abuse is simple.” Is that what you meant when you wrote that their experiment “has been a complete success”? The worse case suggested above doesn’t sound like the sort of end result the libertarians would endorse.

  • Robert Morris

    @Cato Wish they would un-block it. I only read the article in the hard copy. The article comes down emphatically on the side of “the drug war is a failure”.

  • christian Mathew

    I was recently prescribed this medication and it has worked wonders for my pain. The only drawback is that many pharmacy’s in my area aren’t carrying it because of its negative press, and I felt like I was being treated like I was a drug addict at each pharmacy I went too.
    christian Mathew
    Antianxiety-drugs.com