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April 23, 2017

"I used to support legalizing all drugs. Then the opioid epidemic happened."

The title of this post is the headline of this lengthy Vox commentary authored by German Lopez.  I recommend the piece in full even though I take issue with some of its particulars.  Here are some extended excerpts:

In terms of overdoses, the opioid epidemic is deadlier than any other drug crisis in US history — more than crack, meth, and any other heroin epidemic. In total, more than 560,000 people in the US died to drug overdoses between 1999 and 2015 (the latest year of data available) — a death toll larger than the entire population of Atlanta. And while many of these deaths are now linked to illicit drugs like heroin and fentanyl, the source of the epidemic — what got people started on a chain to harder drugs — was opioid painkillers, and legal painkillers are still linked to most opioid overdose deaths.

This was exactly what anti-legalization activists have warned about: Companies got a hold of a dangerous, addictive product, marketed it irresponsibly, and lobbied for lax rules. The government’s regulatory response floundered. The government even worked with the drug companies in some cases — under the influence of lobbying, campaign donations, and drugmaker-funded advocacy groups. And people got addicted and died.

Looking at this crisis, it slowly but surely dawned on me: Maybe full legalization isn’t the right answer to the war on drugs. Maybe the US just can’t handle regulating these potentially deadly substances in a legal environment. Maybe some form of prohibition — albeit a less stringent kind than what we have today — is the way to go.

I should be clear: I am talking about the legalization of harder drugs, so none of this applies to marijuana legalization. While there are real concerns with pot dependence and people doing stupid things on weed, my perspective is that it’s such a relatively harmless drug, according to the best scientific evidence, that the government can afford to screw it up. Especially since the alternative is a prohibition regime that leads to hundreds of thousands of needless arrests in the US each year and fosters violence as traffickers fight over turf or settle other beefs related to the drug trade.

But with the harder drugs, there’s a lot of room to mess up — as the opioid epidemic demonstrates....

Consider the US statistics: In 2015, drug overdoses killed more than 52,000 people, and more than 33,000 of those deaths were linked to opioids. That’s much more than the number of people who died to homicides: nearly 18,000 in 2015, only some of which were linked to violence in the war on drugs. Based on these figures, the legal drug led to a crisis that is killing way more people than black market–related violence possibly could.

while it is true that there are other metrics for suffering under prohibition (such as arrests), the same also applies for the opioid epidemic: There are a lot of people suffering from addiction, along with their friends, family, and broader community, yet haven’t overdosed and may never die of an overdose.

So while it’s hard to draw a perfect comparison in terms of overall suffering, the opioid epidemic, at the very least, seems to be much deadlier than violence related to drug prohibition is in the US.

Still, it’s hard to deny that the current model of prohibition has serious costs. Just like lenient regulation through legalization is dangerous, so too is excessive regulation — via punishment — through prohibition. There’s really little argument that America has been excessive in its punishment: the harsh mandatory minimum sentences, the three-strikes laws that can get someone life for drugs, and the ridiculous probation and parole rules that can get someone thrown back into prison for little more than possession. Not only can these measures cause a lot of human misery, but they also seem to be totally ineffective for actually deterring drug use.

The research is clear on this point: Severity of punishment does little to nothing to deter crime. In particular, a 2014 study from Peter Reuter at the University of Maryland and Harold Pollack at the University of Chicago found there’s no good evidence that tougher punishments or harsher supply-elimination efforts do a better job of driving down access to drugs and substance abuse than lighter penalties. So increasing the severity of the punishment doesn’t do much, if anything, to slow the flow of drugs.

As drug policy experts emphasized in a piece I reported out in 2016, there’s a lot of room for the US to relax its severity of punishment before legalization. One possibility is essentially the Portuguese model: Drugs are decriminalized for personal use, so you can’t be punished with prison time merely for possessing or using illegal substances like cocaine and heroin. But the drugs remain illegal for big companies to produce and sell for profit — effectively stopping the kind of commercialization that’s spurred the tobacco, alcohol, and opioid epidemics....

This milder form of prohibition isn’t a perfect solution. I don’t think there is a perfect solution. As with many policy debates, this is really about picking between a bunch of unsatisfactory options. Faced with an excessively harsh criminal justice system and a legal industry that carelessly causes drug epidemics, I have come down somewhere in the middle of these two extremes.

As Keith Humphreys, a drug policy expert at Stanford University, once told me, “There's always choices. There is no framework available in which there's not harm somehow. We’ve got freedom, pleasure, health, crime, and public safety. You can push on one and two of those — maybe even three with different drugs — but you can’t get rid of all of them. You have to pay the piper somewhere.” After witnessing the opioid epidemic firsthand, I have learned this lesson all too well — and I am genuinely scared of how America would pay for full legalization.;

April 23, 2017 at 03:29 PM | Permalink


Before I opposed the death penalty, I discussed the dose response curve likely attached to all remedies. Too little is ineffective. Too much is toxic. So the strongest poison, botulinum toxin, has 753 medical benefits, and still counting, when diluted. Water causes seizures and death if ingested at an amount greater than can be excreted by the kidneys.

I had estimated around 10,000 executions of the violent birth cohort each year would significantly reduce violent crime. They would do so by attrition and permanent incapacitation. They would prevent 200 serious crime a year over a 50 year crime career, or 10,000 crimes, each. Value the destructive effect of each at an ultra-conservative, and under-estimated $10,000, and each would bring in $100,000,000 in loss prevention to our economy.

The opioid epidemic far exceeds that estimate, and may really put a dent in violent crime. These deaths are caused by Chinese imported carfentanyl, an opiate 10,000 more powerful than morphine. Heroin is three times more powerful than morphine, i.e. 1 mg milligram of heroin will relieve pain the same as 3 mg of morphine, intra-venously, twice intra-muscularly, and close to the same by mouth.

Addiction is defined by a resistance to punishment. Loss of money. Loss of health. Loss of job. Loss of freedom. Loss of family, including children. Loss of life. This death epidemic may really drop crime even more than mandatory sentencing guidelines, definitely more than drops in blood lead levels. It may render sentencing law and policy into a tiny, marginal, esoteric and unimportant legal specialty, instead of its central role in the law, today.

Posted by: David Behar | Apr 24, 2017 7:09:18 AM

For perspective. Legal, and advertised alcohol and tobacco kill 500,000 people a year. Half of murderers, half of murder victims, half of suicides, likely more than half of most violent criminals are legally intoxicated. Any advocate of prohibition of any substance must address that monster addiction problem.

Posted by: David Behar | Apr 24, 2017 7:15:57 AM

David is correct - alcohol may be the most addictive drug, yet we know that everyone who ingests alcohol does not become addicted. Many of the deaths recorded as opioid overdoses are also alcohol related.

The rhetoric that is being used to ramp up law enforcement budgets and also treatment and recovery programs strangely resembles the rhetoric used decades ago to place marijuana on the CSA Schedule I. Drug addiction is a medical problem and should not be part of the criminal justice system. Treatment and recovery businesses are now dependent on on court mandated treatment in order to have clients (patients) which has polluted the science and the data.

Posted by: beth | Apr 24, 2017 11:26:42 AM

This was flagged here:


Some interesting and worthwhile comments.

Posted by: Joe | Apr 24, 2017 11:53:21 AM

I recommend that folks read Dreamland, by Sam Quinones. It's all there -- everything but a solution.

Posted by: Late Inning Relief | Apr 24, 2017 3:29:28 PM

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