Our collective failure on opioids

President Trump's nominee to be "drug czar," Tom Marino, withdrew his name from consideration on Tuesday. The reason, as explained by a joint 60 Minutes/Washington Post investigation, was that Marino had connived with the pharmaceutical industry and Sen. Orrin Hatch (R-Utah) to pass a bill making it easier for them to flood American communities with opioid pills.

Effectively, Marino is one of the biggest drug pushers in the entire world — his nomination was something akin to nominating Pablo Escobar to run the ONDCP. Whoops! But that is only the start of Washington's failure to address the crisis — both through its economic failures and its abysmal addiction policies.

The harvest of death reaped by Big Pharma's greed is many tens of thousands of Americans yearly, and as my colleague Matthew Walther writes, Washington has been doing little or nothing about the problem for nearly two decades now — aside from actively enabling it.

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But Washington's failure to address the crisis runs even deeper than its coddling of Big Pharma. These opioid pushers have preyed on economically left-behind communities, particularly in Appalachia and New England, because desperate, hopeless people are more likely to get addicted. (There was a similar spike in alcoholism and death in Russia after the economic devastation wrought by post-communist crash privatization.) Tiny towns in these states were flooded with millions of pills — 780 million in six years into West Virginia alone, according to one investigation — making addiction factories out of the human flotsam left behind by Washington's embrace of neoliberalism.

All this has made American opioid intake staggeringly out of line with the rest of the developed world. Here Stanford's Keith Humphreys compares U.S. opioid use to Japan:

And while Japan's opioid use is low by world standards, America is still far out ahead in first place — with roughly a third greater per-person use than second place Canada, and twice that of Germany.

Secondly, there has been a near-total failure to adopt the kind of treatment and harm reduction policies that could easily cut the death toll. As Tim Dickinson at Rolling Stone points out, the addiction-fighting record of the Drug Enforcement Administration is not good at all. While that agency did work against the Marino-Hatch bill, they have had little if any concern for the people already hooked.

Specifically, there has not been a strong public relations campaign trying to educate against the mixing of opioids with other drugs, especially alcohol. As the vast majority of "opioid overdoses" are actually multi-drug interactions, this could conceivably help quite a lot — but it's too rhetorically close to countenancing drug use for most elites to endorse. Perhaps more important, there has not yet been universal, widespread deployment of naloxone and other overdose treatments. It usually takes quite a while to die of an overdose, and these treatments are quick and easy to administer. (These are at least starting to become widely available, but it's not gone nearly far enough yet.)

But those are just two obvious steps. If America really wanted to ameliorate the harm caused by addiction, it would completely overhaul its entire approach to the problem. Instead of stigmatizing and punishing addicts, it would treat addiction as a medical problem, and only employ the criminal justice system insofar as it can help people stop using. The record of decriminalization in other countries like Portugal, for example, is far superior to the traditional hyper-punitive American approach.

The opioid epidemic is notably different from the crack epidemic of the 1980s, which inspired a heavily racialized moral panic and a raft of brutally repressive laws. Obviously, this difference is because most opioid users are white. But the inattention shown to opioid addicts in Washington — and especially outright collusion with drug pushers — is not much better than stuffing them into prisons.

If we wish to prevent the next 200,000 deaths (which will take about three years at current rates), we need to take drastic action.