December 11, 2012

Every War Has Unintended Consequences

The latest popular cause amongst drug warriors is the abuse of prescription drugs, particularly powerful pain killers like oxycodone. Resources have shifted to prosecuting those who sell pills and more vigorous regulatory schemes have sprung up around the legitimate distribution of them. This is having some impact, as the use of prescription drugs in some areas is decreasing.

But is it really a success, or are these initiatives just forcing a change in the behavior of users? As with any war, were the drug warriors prepared for this kind of unintended consequence (via):
As efforts to crack down on the abuse of prescription drugs have worked, a new problem has emerged, with addicts who can no longer get their fix by popping pills turning to the old-fashioned street drug heroin, health and law enforcement officials say.

The trend shows up in local arrests, drug seizures and overdose deaths. Drug dealers are finding new markets in the suburbs, where teenagers once got their stash from local drugstores or their parents’ medicine cabinets, some experts say.

‘The kids who got addicted to prescription pills are flipping to heroin, and, as a result, these kids are dropping like flies,’ said Mike Gimbel, a longtime drug counselor in Baltimore County who now works at University of Maryland St. Joseph Medical Center.
It’s not just increased criminal crackdowns producing that kind of shift. As the New York Times reported last year, when pill makers reformulated their products to make them harder to use illicitly (i.e., crush and snort/shoot), users turned elsewhere:
Michael Capece had been snorting OxyContin for five years when a new version of the drug, intended to deter such abuse, hit the market last summer. The reformulated pills are harder to crush, turning instead into a gummy substance that cannot be easily snorted, injected or chewed.

Instructed by his dealer, Mr. Capece, 21, tried microwaving one of the new pills, then sniffing up the burnt remains. Other addicts have tried to defeat the new formula by freezing, baking or soaking the pills in solvents ranging from soda to acetone. Many are ending up frustrated.

* * *

Purdue Pharma, the maker of OxyContin, may have succeeded for now in reducing illicit demand for its reformulated drug. But in several dozen interviews over the last few months, drug abuse experts, law enforcement officials and addicts said the reformulation had only driven up interest for other narcotics.
In the words of one treatment specialist, rather than stopping, users shifted
to what appears to be a more economical high, which is heroin. 
It’s like a game of pharmacological Whack-a-Mole.

Ultimately the problem isn’t that oxycodone is worse than heroin is worse than cocaine or what have you. The problem is that the War on (Some People’s) Drugs is a war a human nature and one that fundamentally cannot be won.

Years ago I saw an HBO documentary about methamphetamine, back before it was the momentary focus of the drug warriors. It was about a group of people somewhere in the Midwest (I want to say Missouri, but I might be wrong) who were users and minor dealers, selling to fund their own habits. At first, they appear like the pathetic junkies of popular conception, shiftless and no good for anything but getting high. But the more you pay attention to the world around them, depressed and filled with a vacuum of opportunity, it becomes clear why they seek solace in drugs. It’s not pathetic that they want a better life, it’s pathetic that, we fail to provide them any better ways of finding it.

If the war can’t be won, why are we still fighting it? It’s not as if the war on mind altering substances never had any unintended consequences:
Instead of resurrecting from the pit a body politic of newly risen saints, Prohibition guaranteed the health and welfare of society’s avowed enemies. The organized-crime syndicates established on the delivery of bootleg whiskey evolved into multinational trade associations commanding the respect that comes with revenues estimated at $2 billion per annum. In 1930 alone, Al Capone’s ill-gotten gains amounted to $100 million.

So again with the war that America has been waging for the last 100 years against the use of drugs deemed to be illegal. The war cannot be won, but in the meantime, at a cost of $20 billion a year, it facilitates the transformation of what was once a freedom-loving republic into a freedom-fearing national security state.
One of the problems with declaring “war” on something is that it’s hard, if not impossible, to admit defeat and move on. Too much invested, too much time, too much money (too many lives, in some cases). But holding out for things to turn around when they won’t only prolongs the misery. As I’ve said before, sometimes the only winning move is deciding to stop the fighting.

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