Overdose Deaths and the War on Drugs

(I live in Towanda, PA--a small town in Bradford County in the northeast part of the state.  According to the CDC, in 2014 Pennsylvania was ranked 8th in the U.S. for overdose deaths at 219 deaths per million age adjusted population. West Virginia is #1 at 355 per million, and the lowest is North Dakota at 63 per million. The U.S. average in 2014 was 147 deaths per million. I wrote the item below because of the local response to 3 overdose deaths in 3 days in mid-February, 2016. On May 5, 2016, an Addiction Awareness Rally was held in front of the Bradford County courthouse where local residents spoke about friends and family members with drug addictions, with truly heartrending accounts of the deaths of loved ones to addictions. It is tragically ironic that the backdrop for the speeches was the courthouse with the following words at the top of the building: Justice, Law, Mercy. As presented below, the War on Drugs has provided none of these.)


The United States has wasted over a trillion dollars during the last four decades for its war on drugs. Not only has that vast sum been wasted, it has exacerbated the problem. Add several hundred billion dollars to this amount for the purchase of illegal addictive substances and for the loss to society from drug related crime, illness, and death. [1]

Purdue Pharma compounded the problem in 1996 when it introduced OxyContin and lied about its addictiveness and effectiveness. The drug is highly addictive, and it is effective for much less than the 12 hours claimed by Purdue, requiring increased or more frequent dosage. [2] Doctors believed Purdue's false claims and began prescribing OxyContin for patients with chronic pain. Lax oversight in some states resulted in "pill mills", where unscrupulous doctors prescribed OxyContin for anyone without requiring an examination but requiring a cash payment for the visit. [3] Purdue ultimately reaped $31 billion in revenue, and people became addicted. When the addiction problems surfaced, state and federal regulators cracked down on OxyContin use, and some people with chronic pain were unable to get needed medications.

This created a market for illicit drugs, which were readily available and cheaper, although usually adulterated and of unknown concentration. With the previous flood of OxyContin and the always-available illicit supply, pain patients and others experimenting with drugs, typically teens or young adults, had few barriers, thus setting the stage for the expanding catastrophe.

The CDC reported drug-related overdose deaths of 41,340 in 2012, 43,982 in 2013 [4], and in 2014, over 47,000 -- 1.5 times those killed in car crashes [5]. Almost 500,000 Americans died from drug overdoses from 2000 to 2014. [6] Extrapolated worldwide, the lost lives and wasted money are truly staggering.

The National Institute on Drug Abuse (NIDA) recommendations for treatment include: "no single treatment is appropriate for everyone; treatment needs to be readily available; effective treatment attends to multiple needs of the individual, not just his or her drug abuse; remaining in treatment for an adequate period of time is critical, at least 3 months, the best outcomes occur with longer durations and frequently requires multiple episodes of treatment, and as with other chronic illnesses, relapses to drug abuse can occur and should signal a need for treatment to be reinstated or adjusted." [7]

The NIDA treatment recommendations show that drug addictions are a chronic illness and relapses are common because non-drug treatment isn't effective for everyone. Some require drug maintenance to eliminate or minimize deviant behavior (returning to illicit drugs and crime to support their addiction.) Maintenance treatments include methadone, buprenorphine, and diamorphine (heroin.) [8] None are magic bullets, and their use is based on harm-reduction -- basically to keep the addict alive, productive, away from illicit drugs and crime, and in frequent contact with medical professionals until treatment works, which may take many years. There is no defined recovery time. Forcing one increases the probability of failure.

Portugal decriminalized all drugs in 2001, including cocaine and heroin. Personal drug use is still prohibited but it is treated as an administrative offence, not criminal. Offenders may receive a small fine, or referral to a treatment program -- but no jail. The main effect has been that offenders are more likely to seek treatment because the stigma of illegal activity has been removed. Resources that were previously wasted on prosecuting and imprisoning addicts are now available for treatment. [9] The overdose death rate per million between ages 15 and 64 in Portugal is 3. In the U.S., it is 147. [10]

To reduce drug addiction and overdose deaths, the U.S. must change its laws to treat addiction as a chronic illness. We can't arrest our way out this problem, we can't wish or pray our way out, and 28-day rehabs only delay the problem. Until it is treated realistically, the overdoses and deaths will continue.

John L Ferri

Links:
- Washington Post: A Policy Conversation About Addiction in America
- A New Divide in American Death
- Consumer Union's Licit and Illicit Drugs