The Outbreak of Fentanyl Shows How Broken the War on Drugs Is

And how safe injection sites might decrease overdoses

Photo courtesy of Twenty20/@Nana_Boliyani

It’s a menacing nightmare that killed more than 64,000 people in 2016 and has taken the lives of at least 4,000 Californians, with 130 deaths in the Bay Area since 2015. It’s the substance that’s behind most of the surging overdose deaths, and evidence suggests that the pandemic has continued to worsen in 2017. As well as the human toll, it costs the US economy $78.5 billion in the form of lost earnings and criminal-justice and health-care costs. It’s the culprit that lurks in the backdrop of the addiction stories that inflict damage on the fabric of families and communities.

More Americans die from opioid drugs than gun fatalities or vehicle-related deaths. A staggering new report shows that opioids killed more Americans in 2016 than the entire 19-year Vietnam War and the AIDS crisis.

This drug, of course, is fentanyl, an illicitly synthetic opioid far more potent than heroin. Back in the ’90s, bolstered by big pharma’s deceitful campaign of opioid painkillers, doctors were persuaded to treat America’s chronic pain problem with products like OxyContin and Percocet. Today the overdose epidemic rages in the streets with a proliferation of opioid misusers following the emergence of fentanyl, which underlines the perverse failure of the war on drugs and our response to addiction. As Ethan Nadelmann, one of the leading drug reformers in United Sates, puts it, “People overdose because [under prohibition] they don’t know if the heroin is 1 percent or 40 percent.…Just imagine if every time you picked up a bottle of wine, you didn’t know whether it was 8 percent alcohol or 80 percent alcohol [or] if every time you took an aspirin, you didn’t know if it was 5 milligrams or 500 milligrams.”

Latest figures by the Centers for Disease Control and Prevention show that deaths from synthetic opioids such as fentanyl rose by over 72 percent since last year.

Consider the facts. More Americans die from opioid drugs than gun fatalities or vehicle-related deaths. A staggering new report shows that opioids killed more Americans in 2016 than the entire 19-year Vietnam War and the AIDS crisis. Latest figures by the Centers for Disease Control and Prevention show that deaths from synthetic opioids such as fentanyl rose by over 72 percent since last year.

The figures are shocking, indeed. But for those who are familiar with the history of drug policy, there is no mystery as to why fentanyl’s death grip is taking over. It’s a concept known as the Iron Law of Prohibition. Under the Iron Law of Prohibition, as crackdowns intensify to suppress the illicit drug supply, they simultaneously produce economic incentive favoring evermore-potent substitutes.

For evidence, you only need to look at the alcohol prohibition in the 1920s. During the years of Prohibition, bootleggers preferred to saturate the market with strands of hard spirits, such as whiskey, gin and moonshine, effectively driving down the consumption of relatively weaker beer and wine.

In the United States, 90 percent of the money spent on drug policy goes to policing and punishment, with currently 10 percent going to prevention and harm reduction.

The reason is simple. In his acclaimed book, Drug Crazy, Mike Gray explains how when you’re in the business of smuggling, “you have to put the maximum bang in the smallest possible package.” The big winners from Prohibition were, of course, the nation’s most notorious gangsters. The same pattern was in full display in the 1980s, when eradication efforts targeting marijuana led to the rise of cocaine — a more compact and lucrative drug — and the subsequent ascendance of drug cartels in Latin American countries such as Colombia. Today, the same forces are driving the growth of fentanyl-producing labs in clandestine networks in China and Mexico. As it so happens, Mexico is a country accustomed to terrible waves of violence and vast political corruption encouraged by American drug policy. In a tragic irony, a century spent fighting the war on drugs has produced political instability and impure drugs that are more powerful.

For decades, the United States has had the same drug-policy approach: police, guns and incarceration.

In the United States, 90 percent of the money spent on drug policy goes to policing and punishment, with currently 10 percent going to prevention and harm reduction. Conversely, only 1 in 10 of those in need of addiction treatment receives it. For decades, the United States has had the same drug-policy approach: police, guns and incarceration.

But in truth, the cultural tide is shifting in favor of new harm-reduction strategies. “Practical ideas like supervised, safe injection sites are an evidence-based harm-reduction strategy that works,” says Dr. Vitka Eisen, CEO of HealthRIGHT 360, which operates nonprofit clinics in San Francisco. “The current situation lacks flexibility and is clearly not working for everyone. You can see that with a high rate of injection drug use in our communities, we need a fresh approach.” For Eisen, that means offering addicts the viable option of a new life instead of shame, blame and despair.

According to the Center on Budget and Policy Priorities, over the next decade the latest GOP budget envisions $1.3 trillion in cuts to the public-health system that is in deep crisis.

Similar innovative ideas, like supervised self-injection sites, are steadily catching on with city officials. Rachael Kagan — director of communications at the San Francisco Department of Public Health, which set up the Safe Injection Services (SIS) Task Force — tells me, “The Task Force recommended [safe injection facilities] to the board of supervisors, and that is being considered now. A legal analysis is the first step.” The Task Force report shows that enhanced access to supervised injection programs in the cities where they exist “has not increased drug use, drug trafficking or crime in the surrounding area.” What’s more, the report suggests that practical approaches to fight the overdose epidemic, such as the availability of anti-overdose medication to the public — in particular Naloxone—has drastically reduced the number of overdose deaths from injection drug use, and 2016 saw 877 reported reversals of overdoses.

This all-too-silent scourge needs to be addressed differently, and that means dealing with the lack of funding for harm-reduction programs and redefining drug addiction as primarily a health issue.

Yet in an age of hollow politics and ideological cuts, these sorts of crucial public services face attacks. According to the Center on Budget and Policy Priorities, over the next decade the latest GOP budget envisions $1.3 trillion in cuts to the public-health system that is in deep crisis. Attorney General Jeff Sessions’s “moral and just” drug policy is in fact a repeat of the old drug-wars retribution that devastated communities and set millions, especially minorities, on a vicious cycle of mass incarceration. Meanwhile, Sessions’s policy comes at a time when the punitive notion of the war on drugs is floundering internationally.

Childhood trauma, alienation, economic pain and poverty are among the driving forces behind addiction, and all require a different approach for treatment.

This all-too-silent scourge needs to be addressed differently, and that means dealing with the lack of funding for harm-reduction programs and redefining drug addiction as primarily a health issue. It means sentencing people to rehab and care rather than imprisonment. It means focusing on evidence-based policies rather than those riddled with contradiction and inconsistency. Childhood trauma, alienation, economic pain and poverty are among the driving forces behind addiction, and all require a different approach for treatment. If the reasons behind drug abuse vary wildly, so must the treatment methods.

The opioid epidemic needs to be treated as the national calamity that it is. Having an evidence-based strategy that responds to addiction as a public-health issue is a good start. There are already addiction-treatment hubs modeled after the health-care systems in nine countries, including the United States. A growing number of countries are experimenting further with decriminalizing drugs, especially cannabis. Portugal, which decriminalized all drug use 16 years ago, has seen a significant reduction in drug-related deaths and injection-linked HIV transmissions. Similar principles can lead us out of this crisis if applied nationally.

The end to the global drug war seems so distant that it resembles some kind of science-fiction fantasy. In reality, the first steps to unravelling the very concept of it have already been taken, and they are real. The fears about ending it will melt away as more people see the alternative put into practice.