The risk of legalization – The New York Times

news7g04/25/2022

5 4 minutes read

The risk of legalization - The New York Times

A cautionary tale

The number of drug overdose deaths in the US reached the highest level ever recorded last year, with more than 100,000 people died over 12 months. The death toll has increased by nearly 50% since the start of the Covid pandemic.

Whenever I write about fatal overdoses, some readers ask: Why not legalize and regulate drugs? They argue that the government does more harm by outlawing drugs and enforcing those prohibitions through control and detention. They suggest that legalization and regulation could better mitigate the risks involved.

So today I want to explain why that argument only goes so far – and why many experts are skeptical.

Jonathan Caulkins, a drug policy expert at Carnegie Mellon University, told me: “Drugs fighters say we should have a drug-free country, which is completely bogus. “But the other side is completely bogus to say we can legalize and all problems will be over.”

We are, in fact, going through a crisis that exposes the perils of legalization: the opioid epidemic.

The problem started with a legal, regulated drug: prescription pain relievers. Pharmaceutical companies promise the drug will help tackle pain, a major public health problem. But when these pills became widely available in the 1990s, their use skyrocketed – along with addiction and overdoses. And instead of carefully managing drugs, officials repeatedly made concessions to for-profit drug companies, which sold opioids to millions of people.

The crisis has grown from its roots, with street drugs like heroin and fentanyl – and increasingly stimulants like cocaine and meth – behind most overdose deaths. dose. But like I previously wrote in this newsletterRadical opioid pain relievers: Many people who now use heroin or fentanyl have started with pain relievers. And drug cartels began to get more aggressive in shipping heroin and fentanyl to the US as they saw a promising customer base with a growing number of pain relievers.

Instead of curbing addiction and overdose, US regulators have triggered the current crisis.

Bad regulations

Some experts say the US is not ready to legalize and regulate drugs. It tends to be more anti-regulatory and pro-free-market solutions than other developed nations. It is one of only two countries that allows direct-to-consumer pharmaceutical advertising. The First Amendment protects some commercial speech, making it difficult to regulate drug marketing.

“Policy has to be culturally relevant,” says Caulkins. And “we are not good enough to have bureaucracies whose job it is to protect the people against industry.”

The story of the painkiller illustrates this. Aggressive marketing and messages from companies like Purdue Pharma have convinced not only doctors but also regulators of the drug’s safety and effectiveness. That allowed Purdue’s approval of OxyContin in 1995.

As we all know, those opioids are not as safe or effective as claimed.

Yet federal agencies repeatedly failed to act as painkiller deaths quadrupled, says drug policy historian Kathleen Frydl Debate:

After approving OxyContin with data errorThe Food and Drug Administration did not explicitly restrict its use until the 2010s.
The Drug Enforcement Administration set limits on the amount of opioids that could be produced, but it increased those limits for several years, until the mid-2010s. The quotas for oxycodone were nearly 13 times higher. at its peak in 2013 compared to 1998. Without the higher quota, “we wouldn’t have an opioid crisis,” Frydl told me.
The Centers for Disease Control and Prevention did not release guidance calling for stricter opioid prescribing until 2016, more than two decades after OxyContin was approved.

A spokeswoman said the FDA is taking “a holistic, science-based approach” to curb abuse of pain medication and expand addiction services. An official said the DEA is changing the quota-setting process with advances in data and information technology. The CDC did not respond to a request for comment.

But federal regulators have done too little, Frydl said: “None of these agencies were required to do any kind of due diligence and accountability process so that we could. confident in their decision-making going forward.”

A spectrum of policies

Experts widely agree that the US government has failed to properly regulate opioids. But that doesn’t justify banning and criminalizing drugs, argues Kassandra Frederique, executive director of the Drug Policy Coalition, an advocacy group. “It was a false binary,” she told me.

Many choices exist between legalizing commercialization and banning criminalization, experts say. Portugal decriminalized personally owned all drugs in 2001, but did not manufacture or distribute. Canada bans drugs, but allows facilities where trained personnel monitor drug users and may even supply substances for use.

Different drugs may also warrant different approaches. Cannabis is much safer than cocaine and heroin, and the law probably reflects that.

And while the opioid crisis presents the dangers of legalization, it also carries the dangers of prohibition. People who die from a fentanyl overdose often believe they are consuming heroin, cocaine, or some other drug, without knowing it is actually fentanyl or contaminated with fentanyl. It’s an issue of unregulated supply.

Key point

No drug policy is perfect, and it all involves trade-offs. Stanford drug policy expert Keith Humphreys told me: “We have freedom, joy, health, crime, and public safety. “You can push one and two of them — maybe even three with different drugs — but you can’t get rid of them all. You have to pay a passerby somewhere.”