Last year, more than 93,000 people died from a drug overdose in the United States, the most in recorded history. This number shocks me, but I’m even more shocked by our country’s inaction. We could save many of these lives if we took a few simple steps to reduce the harms of drug use. As a nation, we choose not to.
When I was hospitalized in 2009 for a severe medical condition, doctors sent me home with heavy doses of opioid painkillers. While far from inevitable, what followed happens to thousands like me: I developed a substance use disorder.
But the drugs were not the greatest danger to my life; the War on Drugs was far more life-threatening. President Richard Nixon set this war in motion 50 years ago. The war has taken and ruined far more lives than it has saved, and if I had gotten caught in the crossfire, it could have taken mine. Often, wars worsen the problem they are supposed to address.
My doctor's reaction to my disorder was rare. When he noticed that my prescriptions were running out faster than they should, he did not shame, blame, or accuse me of any grave moral failing. With kindness and compassion, he noted that I had developed an addiction and immediately assured me that I had done nothing wrong.
It would have been easier for him to stop my prescriptions and give me just a few days to taper off. But he acknowledged that the greatest threat to my life and health was not the opioids he prescribed but illicit opioids sold on the street. The most important factor for my eventual recovery would be staying alive.
Rather than fighting a war against me or the drugs I was taking, he chose to enter a partnership of support.
The United States’ failed War(s) on Drugs
We know that:
The War on Drugs is racist in its origins.
The War on Drugs perpetuates and exacerbates racial disparities in its implementation.
The War on Drugs is one of the drivers of mass incarceration.
The War on Drugs destabilizes other countries and economies.
The War on Drugs is a giant waste of money.
The War on Drugs is not just an ineffective approach at addressing overdoses, it has become a leading cause of overdoses. Nixon and his successors, both Republicans and Democrats, have poured trillions of dollars into drug interdiction and punishment. Yet they should have known from the start that another round of prohibition would never work.
To understand why the War on Drugs isn’t just a bad strategy but a part of the problem, we can take a look at one of the United States’ favorite drugs: alcohol.
The implementation of the 18th Amendment in 1920 made the creation and sale of alcohol illegal, but it did not stop demand for the drug. Beer and wine drinkers shifted to more potent and dangerous liquor because the underground dealers found it easier to smuggle. Bootleggers tried to get around the rules and experimented with dangerous new substances like “Ginger Jake,” which contained a toxic chemical that left an estimated 100,000 people with partial paralysis and lifelong health complications.
To try and stop the drinking of grain alcohol manufactured for industrial use, the federal government created a new requirement to spike the alcohol with poisons they believed would deter use. The policy was unsuccessful in curbing alcohol use but did poison hundreds of thousands, with an estimated death toll of up to 50,000.
“Normally, no American government would engage in such business,” opined the editorial board of the Chicago Tribune in 1927. “It is only in the curious fanaticism of Prohibition that any means, however barbarous, are considered justified.”
The authors of those sentences were correct in their condemnation but incorrect to believe that these policies would be outside of the norm for the American government.
In 1999, 8,048 people died from an opioid-related overdose, according to the Centers for Disease Control and Prevention. It was clear that the United States was facing a crisis. Many policy makers already understood that the War on Drugs had failed. They faced a clear choice: Do we try to address the demand for dangerous drugs, or do we cut off supply? Our government hadn’t learned from the Prohibition-era fatalities: They chose to go after supply, and the results are both tragic and predictable.
Just as happened during Prohibition, overdoses skyrocketed as people moved from prescription opioids to underground market heroin.
As federal agents sought to stem the tide of heroin entering the United States, the underground market responded in the same way it did under the prohibition of alcohol: Traffickers turned to an even more potent substance, fentanyl.
Fentanyl is a potent synthetic opioid, typically considered 50 to 100 times stronger than morphine. It is highly effective for controlling pain and relatively non-toxic. When administered in a medical setting, it is considered so safe and free from adverse side effects that it has become one of the go to pain relievers for women during childbirth. It was a drug I was prescribed and was critical for my pain management.
But the fentanyl available on the streets today isn’t made by expert chemists in regulated facilities. Instead, it is created and distributed in the underground market and varies wildly in potency and purity. Often when drugs are cut with fentanyl, street-level dealers and users are not even aware that fentanyl is present in their drugs. Ongoing efforts to stop the distribution of this illicit fentanyl has only served to make the drug more dangerous.
War is not the answer
In 2001, Portugal ended their War on Drugs and saw their overdose rate plummet. When they shifted massive resources away from enforcement and towards treatment, they saw that the war they had been fighting was a part of their problem, not a potential solution.
Switzerland, when faced with a similar dilemma in the 1990s, saw the same patterns at work. In addition to increasing access to treatment, they also made sure that those who struggled the most had what I had: access to a safer supply of prescription grade opioids. HIV and Hepatitis C cases plummeted. Overdoses from opioids dropped by 64 percent. Drug users and low-level dealers left the underground market to participate in the medical program provided by the government. Theft and opioid-related crimes dropped substantially.
In contrast, the U.S. Prohibition enriched criminal enterprises, increased violence associated with alcohol, killed tens of thousands, and hurt hundreds of thousands more. Drug users don’t need a war, they need support.
As a Christian, I believe that the greatest transformation in my life was a free gift of grace. When I was addicted to opioids, the same thing was true. My doctor realized my health and well-being were of the highest importance, and that the only thing that could take away a chance at recovery was my death.
I don’t know if my doctor was religious at all, but I do know that when he recognized that I was struggling with a substance use disorder, he responded with care and compassion, not judgement or a threat of punishment.
It’s time the United States truly ends the War on Drugs and starts to heal the harms this war has created.
Timothy McMahan King is the author of the forthcoming book Addiction Nation: What the Opioid Crisis Reveals About Us, available June 11 from Herald Press.
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