Jeffery A. Singer

The opioid crisis that gets the most attention is the growing rate of opioid-related overdose deaths in non-medical users. This conflagration consumes growing numbers of men and women, young and old, across diverse demographic categories. In 1972 President Nixon declared a “war on drugs,” and these people are drug prohibition’s civilian casualties.

The lure of easy money from selling drugs in the black market attracted drug dealers — including unscrupulous doctors and pharmacists — to supply non-medical users with substances of abuse. According to the National Survey on Drug Use and Health, less than 25 percent of non-medical users of prescription opioids ever get them from a doctor — they get them from a friend, relative, or drug dealer.

Study after study show a “misuse” rate of less than 1 percent in patients prescribed opioids for acute pain or chronic pain. And numerous large studies show an even lower overdose rate from opioids used in the medical setting. Despite these facts, the crisis managers’ solution is yet another prohibition: prescription prohibition.

States have enacted laws that limit the dosage and number of pain pills doctors can prescribe to their patients. If doctors are thought to prescribe more than regulators believe appropriate, they might get a visit from the Drug Enforcement Administration and be escorted out of their office in handcuffs.

The Food and Drug Administration has encouraged drug companies to replace their prescription drugs with “abuse-deterrent formulations” that cannot be crushed and snorted or dissolved and injected. But abuse-deterrent opioids have been shown to drive thousands of opioid abusers to deadly heroin and fentanyl. And the DEA ratchets down the amount of opioids drug makers are permitted to produce. This has caused severe shortages of injectable opioids in hospitals, making hospitalized patients suffer in pain and causing some hospitals to cancel elective surgeries.

But the black market caused by drug prohibition is very efficient. A look at the CDC mortality numbers shows as prescription opioids diverted to the black market became abuse-deterrent or less easy to obtain drug dealers filled the void with heroin and fentanyl.

Prescription prohibition is behind the other opioid crisis: the pain crisis. Each day more and more patients suffer needlessly because their doctors are under-treating their pain or cutting them off from pain medicine that has allowed them to function. Many become invalids and shut-ins, unable to lead a meaningful existence, as their unbearable pain returns.

Fear of opioids propels drug prohibition, the black market, and rising overdoses from heroin and fentanyl. It also drives the misguided prohibition on prescribing pain medication, causing patients to suffer and destroying lives.

Jeffrey A. Singer practices general surgery in Phoenix, Arizona, and is a senior fellow at the Cato Institute.