How Taking Drugs Off the Street is Killing People
Heroin, Jenga, and the Law of Unintended Consequences.
Written in collaboration with The Real Edition.com
Jenga.
Surely, you’ve played Jenga at some point in your life, no? You know, the game of tiny wooden blocks, pieced together just right to create a tower? The point of the game is to then remove the blocks, one at a time, and not be the one who causes the whole thing to come crashing down.
To do so, you can’t just look at the piece you’re pulling out. You must assess the pieces beneath the one you’re pulling out, the blocks that will have to support the structure above, and make sure they’re adequately prepared to bear a greater weight-load. The structure below that must absorb the additional weight.
If the structure below is inadequate, your tower will fall.
Over the next few years, we’re going to hear a lot from the government, telling us what a great job they’re doing in curtailing prescription drug abuse.
It’s going to sound impressive.
They’re going to talk about drug take-back programs, where they’ll take your unused prescriptions and dispose of them properly, ensuring they don’t accidentally find their way into the wrong hands.
*Jenga piece pulled*
They’re going to talk about how law enforcement is now hip to the pill game, working closely with doctors to catch those abusing the medical system.
*Jenga piece pulled*
They’re going to tell us how nurses and practitioners are being trained on what to look for in identifying drug-seeking behavior. They’ll tell us how both doctors and pharmacists, in 49 of 50 states, will be plugged into a Prescription Drug Management Program (PDMP), which will almost eliminate the problem of patients filling multiple prescriptions from multiple doctors.
*Jenga piece pulled*
Each of these attempts is admirable, and the individuals fighting to implement these programs are good, decent, hard-working people who really do have the public’s best interest at heart.
I also believe they’re inadvertently doing more harm than good.
In fact, without adequate support at the foundation to treat the addicts who are going to be cut off from their prescription drug supply, I believe what they’re doing will kill people.
*Epic tower collapse*
This is not my opinion. It’s a fact. Multiple studies, the most significant of which was published by the New England Journal of Medicine (NEJM) in July, 2012, showed us exactly what happens when you cut the supply of pharmaceutical opiates while leaving the demand for the drug untreated.
The NEJM study showed us what common sense should have. Pharmaceutical opiate addicts — be it hydrocodone, oxycodone, fentanyl, Roxies, Opana, whatever — don’t simply return home when a doctor cuts them off, or their street connect can no longer find pills, and stop using their drug of choice.
“Oh shit, my doctor cut me off and my dealer can’t find pills. I guess I’ll just quit right now,” said no drug addict I’ve ever known.
Studies show these people are turning to heroin. The NEJM study surveyed 2,566 people entering treatment, across 39 states, from 150 different treatment centers. It found that of the patients coming in for treatment for heroin, 76% began by abusing prescription drugs. Of those, more than 90% say they switched from prescription drugs to heroin for two reasons:
- The prescription drugs became too expensive.
2. The prescription drugs became more difficult to find.
The timing of this study is important. The NEJM study came in the wake of Purdue Pharmaceutical changing the make-up of OxyContin tablets so that they could no longer be crushed up and snorted, smoked, or injected intravenously. Overnight, the supply of the 1990s-2000s drug du jour was cut, leaving opiate addicts to seek out whatever drug would keep them from getting sick.
The easiest replacement also happened to be the most affordable: heroin.
This is what’s called the Law of Unintended Consequences. Sure, they got people to stop abusing OxyContin. But at what cost? A heroin epidemic? Addiction experts from around the country were left shaking their heads, wondering how in the world they didn’t see this coming.
Fool me once, shame on you.
Three years later, we find ourselves still in the midst of a prescription drug epidemic that is ever growing, a forest fire with no shortage of trees or oxygen. Grasping for answers and desperate for results, we’ve begun implementing the aforementioned drug take-back programs, doctor and pharmacist education, law enforcement training, PDMP databases. The goal of each of these will indeed be met, and they will make a huge dent in the supply of prescription drugs on the street.
But at what cost?
None of these solutions actually treat the problem. None of these treat the demand for the drug. They simply cut off the supply, where two very results emerge:
- Illicit prescription drugs will become more expensive.
- Illicit prescription drugs will become more difficult to find.
Fool me twice, shame on me.
Worse, the problem didn’t end in 2012. The most recent national statistics just came out, and it’s not pretty.
Drugs are a commodity, pure and simple. Legal, illegal, does it really matter? Much like any other product bought and sold in a free-market system, the rule of supply and demand dictates pricing.
Unless we focus an equal amount of time, resources, and money on treating the demand for the drug, we’re actually doing more harm than good to our community by going after the supply. That pill addict who’s doctor shopping and scamming doctors to score narcotics? Sure, she’s abusing the system. But at least she’s in the system. From within the system, help and treatment can be offered. Resources can be presented. Once she makes that leap from prescription drugs to heroin — that’s a much more difficult road to travel back from. A doctor can present her with inpatient programs, outpatient programs, 12-step options. Do you think her heroin dealer is going to do the same?
We have to start treating the disease of addiction. We have to attack the demand for the drug with as much fervor as, if not more than, we attack the supply.
I’m not saying we don’t go after the drug supply. I think prevention plays a crucial role in ensuring the next generation comes up in an environment not so saturated in narcotics.
What I’m saying is prevention without treatment is dangerous. Without the proper support to catch the addict cut off from his or her prescription drug supply, the tower will collapse. And when it collapses, rest assured, the boys from Sinaloa will be there with a nice pile of China White or Blacktar heroin to soften the fall.
Treatment is not cheap, and some counties are solving this problem by suing Purdue and other drug makers in an attempt to offset treatment costs, reminding many of the tobacco class action lawsuits of the early 1990s. I’d urge all of us demand our counties join Santa Clara and Orange counties in this fight.
Think about it: In any other industry where addiction is a byproduct, the producer shares in costs for prevention, education and treatment. Alcohol, tobacco, gambling, all help pay for treatment for those addicted to their products, because they realize they are profiting off of a product with high abuse potential.
Why have we not demanded pharmaceutical companies do the same?
Companies like Purdue Pharmaceutical, who pleaded guilty in 2007, along with three executives, to lying about the dangers of OxyContin to doctors and patients, during the exact period the OxyContin epidemic was just taking off — why are we not demanding they spend a percentage of their corporate profits on funding treatment?
If we’re only going to attack the drug supply, then we would be better off doing nothing at all. Simply leave the Jenga pieces in place. We should just build more prisons, and continue treating a national health crisis with more incarceration.
But when we’re ready to start treating the demand, at least we’ll know where to start.
Jason Smith is the creative director for TheRealEdition.com, and author of The Bitter Taste of Dying. You can contact him directly on his website, authorjasonsmith.com.
