The most recent econtalk is one of the most fascinating episodes ever. It made me want to read Quinones’ book on the evolution of the opiod crisis. I’ll pick one random excerpt:
Oxycontin is a game-changer for another reason, not just how it’s marketed. … it takes people up to very, very large addiction levels, daily addiction levels, so you have to be doing 100, 200, 300 milligrams a day of these pills–that’s $1 dollar a milligram on the street. So, it’s 100, 200, 300 milligrams a day. Well, you can’t sustain that. There’s no way you can continue with that. So you begin to look for something very cheap and just as potent. And cheap Mexican heroin fills that bill perfectly. And their heroin fills that bill absolutely. And it’s easy to get. And it’s available. And they’ll give you free come-ons and discounts, etc. And so it’s that kind of encounter, between the heavy marketing of pain pills and Purdue Pharma, and …these heroin traffickers with this new system and this very cheap, very potent dope that creates the first examples of what we’re now seeing all across the country, almost in every state of the union. Which is: people getting addicted first to pills, and then transitioning to very cheap Mexican heroin.
Bootleggers and Baptists.
Quinones gives the standard narrative of the so-called “opioid epidemic”, but there are good reasons to doubt it. My comment is the first one in the comments section on that podcast; in it I explain my doubts. In short, we’re not seeing an increase in illicit use of prescription opioids in the major drug use surveys (despite a trippling of the sheer tonnage of opioids prescribed). And it’s harder than most people realize to determine the cause of death. Some people walk around with very high levels of opioids in their system, which would be toxic to a naive user. If such a person drops dead of a sudden heart problem (for example), it’s likely their death would be wrongly attributed to the drugs. Nobody seems to know if the increase in drug poisoning deaths is really tracking with an increase in deaths *caused by* opioids or if it’s simply tracking the number of dead bodies that happen to contain opioids. I suspect that part of this measured trend is spurious and part is real, but I’m not sure in what proportions.
It gets worse. Chinese fentanyl makes Mexican heroin look expensive.
There’s also domestic fentanyl.
I read his book very hurriedly about a year ago and found the ethnography of the “Xalisco Boys” trafficking cells to be intriguing. The business model, the “chain migration” from the sending town, the continual search for new markets, etc.
I tended to skip the 1/2 of the book on the history and pharmacology of heroin and opiate addiction–it just wasn’t what I was interested it, and it seemed less grounded in Quinones own core competency which was investigative journalism.
One salient claim in the book is that the trafficking cells made heroin readily available in “new” parts of the country–untapped markets. He documents a drive from Columbus Ohio into Appalachia and the Carolinas. There was a conscious strategy among Mexican dealers to avoid (1) Mafia dominated cities, (2) places where drug markets were dominated by ghetto Blacks, (3) Miami where “everything was just kill kill kill”, etc.
The Mexican dealers seemed to have a Bayesian prior to “avoid Blacks.”
= – = – = – =
Long ago James Q. Wilson wrote an essay about heroin (anthologized in _Thinking about crime_, ca. 1975?) in which he said that many GIs who used heroin in Vietnam couldn’t easily find it when they came back to the US. It wasn’t readily available to most newly returned veterans. In many places veterans lacked the social networks, the geographical proximity, and the ability to get any decent black market opiates without the risk of getting ripped off, robbed, hurt, killed, etc.
The new business model detailed by Qinones has apparently changed that. He wrote that a lot of people who bought from the cells started out with legal opiates, but the black tar heroin was actually cheaper and more reliably available (intuitively there is a quality tradeoff, methinks).
James Q. Wilson was firmly strongly against legalization of most hard drugs. He claimed that prohibition of hard drugs markedly reduced the incidence of addiction.
That, of course, is an empirical question, and there are major tradeoffs.
It might be a digression but here goes. Rumor has it that during the British gin mania 200+ years ago, gin parlors advertised like this:
Drunk for a pence
Dead drunk for two pence
Free straw!
(The straw was to sleep on, passed out in a stupor, since after you had fully gotten your two pence worth you were in no shape to leave the premises and go anywhere)
Yep, we have millions of Americans living in chronic pain, but let’s make it really hard for them to get painkillers so that we can attempt to put a dent in the 16k opiod-related deaths (which is prob an overestimate as GregS pointed out). And don’t forget that most of these victims chose to take those drugs!
Yes, I know it’s not politically correct to say that, but I have far more sympathy for the huge number of people who suffer from chronic pain through no fault of their own than the much, much smaller group of people who choose to abuse these drugs and then die.
Remember how every previous panic about the drug-of-the-week was overblown and we ended up doing more harm than good fighting it? Well, this time it’s different, we’re told. Painkillers are destroying our country and we need a bigger DEA to fight it. Oh yeah, and we need to put more doctors in jail. That’s the ticket.
The problem is that they aren’t that good at remedying pain, which is one reason why and evidenced by people getting hooked on them.
A lot of the pharmaceutical drugs were also developed (marketed?) to alleviate addiction and have ironically (?) become actual gateway drugs.
Not good at remedying pain? Have you ever used them post-surgery? I have never before heard anyone say it didn’t work for them.
This is a great episode with fascinating stories but I also baulk at the conclusion of the private sector is the problem, community has been destroyed, and stop blaming the government.
That purported answer is like firing a blunderbus. Such a response also seems to skip over the extent to which the size of government has grown and undermined community (through social welfare crowding out personal responsibility and local organizations) and the extent to which bureaucracies can be driven by either incentives to expand (standard public economics rationales) or the failure to grasp how little they really can understand about a lot of social problems (behavioural economics might explain why regulators aren’t rational just as much as why people can be irrational).
This is too broad a canvas. It would be better to tackle the illegal drug / opioid dependence issues more directly as health issues rather than creating some new bureaucracy to enforce creation of community.