The drug overdose epidemic

Writing about drug policy in the US is always a tricky thing, given the history of moral panic and wildly dysfunctional and unjust politics that have surrounded the issue since at least the reefer madness scare in the 1930s. (In this post I’m drawing on conversations I’ve had with my brother Isaac Campos, a historian who is an expert on Mexican historical and legal attitudes toward marijuana, and how these have intersected with US drug policy. He’s written a book about that).

The big problem at the moment is that we actually are having a serious drug crisis, that far eclipses previous historical moments, when policy makers were passing draconian criminal laws in response to the perceived crises of those earlier times:

Overdose deaths soared to a record 93,000 last year in the midst of the Covid-19 pandemic, the U.S. government reported Wednesday.

That estimate far eclipses the high of about 72,000 drug overdose deaths reached the previous year and amounts to a 29% increase.

“This is a staggering loss of human life,” said Brandon Marshall, a Brown University public health researcher who tracks overdose trends. . . .

While prescription painkillers once drove the nation’s overdose epidemic, they were supplanted first by heroin and then by fentanyl, a dangerously powerful opioid, in recent years. Fentanyl was developed to treat intense pain from ailments like cancer but has increasing been sold illicitly and mixed with other drugs.

“What’s really driving the surge in overdoses is this increasingly poisoned drug supply,” said Shannon Monnat, an associate professor of sociology at Syracuse University who researches geographic patterns in overdoses. “Nearly all of this increase is fentanyl contamination in some way. Heroin is contaminated. Cocaine is contaminated. Methamphetamine is contaminated.”

There’s no current evidence that more Americans started using drugs last year, Monnat said. Rather, the increased deaths most likely were people who had already been struggling with addiction. Some have told her research team that suspensions of evictions and extended unemployment benefits left them with more money than usual. And they said “when I have money, I stock up on my (drug) supply,” she said.

More historical context: According to the CDC, there were fewer than 7,200 total U.S. overdose deaths reported in 1970, when a heroin epidemic was raging in U.S. cities. There were about 9,000 in 1988, around the height of the crack epidemic.

Let me emphasize that last number: Last year we saw more than ten times as many overdose deaths in the US than at the height of the crack epidemic!

One result of this pharmacological carnage is that last year the mortality rate among 25 to 34 year old Americans was the highest it’s been since 1953, when overall age adjusted mortality rates in the USA were nearly double what they were in 2019. (Unintentional drug overdose deaths — meaning those that did not involve suicide and homicide — by themselves accounted for nearly 30% of the deaths of young adults in the USA last year).

The big driver of all this are opioids, especially fentanyl, although good old fashioned street heroin is making a big comeback, essentially because of price considerations.

Fortunately the obviously destructive policies of the 1980s — just say no plus mass incarceration via mandatory minimum sentences — seem to have been largely discredited, although the latter is still a major factor in federal prosecutions, largely because of political inertia (Joe Biden, who played an unfortunately prominent role in all this back in the day, should push back more on the legal and institutional remnants of that disaster).

As to what sorts of more positive steps can be taken, that’s a complex but increasingly urgent question.