Looking at the Facts Even when it Hurts

The news this week includes the possibility that the Sackler family (owners of Purdue Pharmaceutical which promoted prescriptions of synthetic opioid drugs) will receive immunity from future opioid abuse prosecution in exchange for their donation of about $5 Billion to a fund for victims. Since victims alive today are in the 100,000s range, the “settlement” at most give $10,000 to $50,000 per victim while the Sackler family enjoys the remaining billions they have stashed away in foreign bank accounts. Ill-gotten gains to be sure.

I oppose this immunity deal because it represents a pathetic capitulation to the power of wealth over justice. But there is more. Our policy makers need to face the facts too.

While we were counting deaths from COVID19 approaching 500,000 in 2020, over 100,000 died of synthetic opioid abuse in the same year. Even though physicians have greatly curtailed their prescribing Oxycontin and related opioids, deaths from abuse have continued to climb. In 2011, a group of physicians responded to the crisis by promoting cutting back physician-written prescriptions. It was a well-intentioned policy that missed the mark by a mile because of a well-known phenomenon.

Enter “the iron law of prohibition.” The phrase was coined by researchers and activists in 1986 referring to the effect of reducing drug supplies while not managing demand at the same time. A recent article in Scientific American states that “Almost always, it results in the rise of a more harmful drug because of a simple physical fact: hiding smaller things is easier than hiding bigger ones. So, because illegal drugs need to be concealed, prohibition favors more potent and therefore more potentially deadly substances.”

The same effect was observed during alcohol prohibition in the 1920s where much more powerful whiskey could be distilled in the woods and smuggled inside one’s boot, hence the term “bootleggers.” Because they are less potent, wine and beer cannot be easily smuggled.

The well-intentioned but ill-informed policy established by the doctor group in 2011 had the immediate effect of creating enormous demand for street opioids. This was first met by much less expensive heroin which was later cut with illicit Fentanyl making the new street drugs hundreds of times more potent and addictive.

Did the policy makers among the physicians and government believe that lessening prescription opioids would cure addictions? We don’t know. Broadly, this failed policy is part of “supply side economics” which rarely produces the intended results.

A demand-side policy would involve making the two overdose treatment drugs easily available. These medications are proven to reduce overdose deaths by 50% or more. It is true that some physicians profited handsomely by setting up illegal “pill mills” prescribing “oxy” for anyone who asked for it. But if the goal of the physician group policy in 2011 was to help addicted patients and improve pain management, those patients could have been contacted and given immediate access to treatment for their medical conditions when their pill mill doctors were shut down. This was not done and thousands of addicts became easy prey for drug dealers.

Recent research has demonstrated that reduction in prescription supply makes matters much worse. One study of millions of medical records found that reduction in opioid prescriptions actually led directly to increased disability, decrease productivity, rising medical costs, and increased pain. Other studies found that reduction in medically prescribed opioids led to increase in suicides and tripled the overdose rate.

We should seek some kind of justice and settlement with the pharmaceutical companies who profited from misrepresenting their products. But if we want to use that settlement money to help people, we must first acknowledge that the supply-side policies put forward by physician groups and the government have worsened the problem. Negative emotions towards big pharma run high. But policies that reduce medical prescriptions for opioids for all patients do nothing but push addicted patients into the arms of drug dealers. Policies that do not address the demand-side have been shown to cause more harm than good. On top of that supply-side policies cause us to grow our police force to “get tough on drugs” and create a host of social-political problems along with it. J

A better world for everyone would involve setting policies based upon hard, cold evidence and not on emotion.

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