We are told daily that there is an epidemic of opioid-related deaths in the united states. Those to blame, according to our would-be masters and their loyal servants in the news media, are the usual suspects: unethical drug dealers, greedy pharmaceutical manufacturers, reckless doctors, and careless patients. The approved script is that the drug companies market narcotics too aggressively, physicians and other healthcare providers prescribe too casually, and the recipients then become habituated to and dependent on these drugs and/or allow the medications to fall into the hands of friends and relatives who do not have a medical need for them. Once hooked, the “addicts” then turn to illegal sources to feed their habit where they risk injury and death from using drugs whose contents they are unable to verify, mixtures which often include drugs like fentanyl, which is more easily to cause an accidental overdose than heroin.
Assigning Blame
While there is some truth to this story, it is far from a complete explanation of how the current state of affairs came to be. The increase in medical prescriptions for narcotics over time was primarily a result of a needed change in the approach to pain management among medical and nursing health care providers. Sure, Pharma marketed their products heavily, but it was to a willing audience who were free to prescribe such drugs or not. Instead of demonizing opioids, providers came to see them as largely safe and effective tools to control pain, especially in the setting of chronic and cancer-related pain. Narcotics can be used with minimal risk of harm and great benefit in those experiencing pain, but since they create a pleasurable experience for some, they are also commonly used by people not in pain to get high. And that is the rub. The government—and all too many people in general—believe it is OK for people in pain to use these drugs but not OK for those who simply want the rush. That is why there is a war on drugs. And the commanders and soldiers in that war bear a large portion of the blame for the deaths we are now seeing among narcotics users.
Of course, the ultimate responsibility for any harm suffered lies with the users of opioids. While the conventional wisdom is that these users are addicts, compelled by their “disease” to use opioids at any cost, there are many, including this writer, who reject out-of-hand the medical model of drug use. While it is pretty clear that some people are more prone to using these drugs unsafely, there is no reason to believe they have an illness, or that their drug use is out of their control. Sustained use of narcotics produces tolerance and dependence, so that increasing doses are sometimes needed to maintain a desired effect, and weaning off them is necessary to prevent withdrawal effects. But they do not take over one’s mind and body and compel the user to consume more and more. People make choices, often bad ones, but they are still choices.
Primum non nocere
Even though the numbers of people using, and dying from the effects of, narcotics have been steadily increasing, it is also just as true that narcotics are essential to providing relief to the large numbers of people with chronic pain, including many people with cancer. So any ethical attempts to reduce the harm caused by narcotics must at the same time ensure that those in pain are not deprived of an effective remedy. And the statist approach of more regulation of the prescription of opioids, suing drug companies, and criminalizing non-medical users of narcotics is not only unethical, but counter-productive.
The government is trying to restrict the legal supply of narcotics by scrutinizing the practices of medical and nursing providers and frightening them into prescribing fewer opioids. The result is that more people in pain are suffering. In addition, less than ideal medications, such as those that include acetaminophen as well as a narcotic, are being used in situations where a pure opioid is more appropriate because the combination product limits the total safe daily dose of the combination drug, even though this results in inadequate pain control. These drugs are also less lucrative when sold on the black market, which delights the drug warriors. Pain management strategies are now often driven by the desire to avoid the notice of the DEA, instead of the goal of optimizing the relief of suffering while minimizing adverse effects. When it comes to medical treatment of people in pain, instead of “first, do no harm,” the new operating principle for doctors and nurses is “first, cover your arse.”
The statist approach to the illegal market is just as flawed—and destructive. Dealers and users will always find a way to get opioids of one sort or another. Restricting the flow of pharmaceutical grade drugs simply promotes the use of black market concoctions made up of unpredictable ingredients and with unknown potency. This is why people are dying. By criminalizing the non-medical drug market, the government prevents people from openly testing drugs for contents and strength so that users can make an informed decision. Instead, consumers of illegal opioids are forced to take the word of the supplier, who in a non-competitive and illegal trade has less incentive to deal honestly with customers than they would in an open and transparent market.
A New Anti-war Movement
The anarchist solution to the opioid “crisis” is simple. Stop the drug war. Keep the state out of the business of regulating medication prescription and use. Eliminate the DEA and police drug squads. Let people to purchase any drug they like on an open market. Such an approach is not popular, largely because people have believed the lies about addiction and narcotics that have been spread by the state and the medical authorities for so long. But opioids are just another chemical, like alcohol or caffeine or marijuana or nicotine. They are not uniquely demonic. Marijuana was, until recently, considered as nefarious as heroin, but I can now buy it openly at my local herb shop. That took a sea-change in public opinion to bring about, and was the result of years and years of agitation to show that pot could be used safely and that the reefer madness which drove the campaign against cannabis was nonsense based on junk science. The similar lies that drive the current attack on opioid users need to be confronted and similarly demolished.
I have been a nurse for 40 years, and an oncology nurse for half of them. I have personally seen the havoc that has been wrought by the drug war. I have cared for people whose bodies were ruined by using illegal drugs. I have seen unintentional overdoses. I provide services to people infected with HIV and hepatitis C from sharing needles and syringes. I constantly speak with people with cancer-related pain and other chronic pain symptoms who struggle to live full lives because the government has kept the appropriate pain medications out of their hands. Politicians and regulators have taken it upon themselves to be our overseers and determine who can have narcotics and who cannot, and under what circumstances. This is an unacceptable infringement of people’s freedom to control their own bodies and what they wish to put into them.
Prohibition has never been an effective approach to preventing the use of chemicals that people enjoy taking. In the case of the war on opioids, it promotes dangerous behavior among both dealers and consumers in the illegal market and deprives others of an effective means of mitigating their suffering. And besides the awful results in the united states, the international drug war, driven largely by the american government, creates suffering worldwide. Because of a misplaced concern about “addiction,” poor people in much of africa commonly have little or no access to narcotics to ease the pain of cancer and injury, while opium produced in afghanistan and elsewhere, which could easily and cheaply fill their and others’ need for relief, is either destroyed by the united states military and its allies or funneled into the lucrative illegal trade. It is outrageous that people stand by and cheer while the drug warriors deprive others of access to cheap narcotics in the name of their (remarkably ineffective) fight against addiction.
The only beneficiaries of the drug war are those in government who have made careers out of regulating and policing opium use, and those who have made fortunes in the illegal markets created by drug laws. They are far outnumbered by the victims: those who accidentally overdose, people with unrelieved cancer pain, people murdered by the governments of many countries for the non-violent use or sale of narcotics, those killed daily in latin america by participants in the illegal drug trade—a trade that exists only because of prohibitory drug laws.
As an anarchist I oppose any intervention by the state in my life or that of others. But that is clearly a minority opinion. Drug laws, like so many other statist interventions, promise protection from harm at the expense of personal freedom. And even though these laws actually cause more harm than good, while severely restricting individual liberty, most people appear to believe the hype and kowtow to the authorities. They are unwilling to think and act for themselves and would rather just accept the information fed to them by the government and its supporters without question. Unless people reject the authority of the state and start taking responsibility for themselves we will never see the end of the drug war and the bodies will continue to pile up.