David Siegel says that he is no expert on the opioid crisis, but I found his article on narcotics to be more informative than most other essays I’ve read.  Here’s an excerpt:

When I fell 30 feet off a rock in Central Park, I went to the emergency room, where they refused to give me any pain killers, fearing I was just telling them a story to get narcotics. My knee was badly swollen, yet the hospital rules would not let me get pain relief without a doctor’s exam, which had to be postponed until the next day. That night was agony.

When I fell ice skating in Zurich and couldn’t get up because my hip was broken, the ambulance person came and started a line of Fentanyl immediately, waited for it to kick in, and then moved me onto the gurney and into the ambulance. That was when I learned how amazing Fentanyl is. It’s a wonder drug. It removed the pain, yet it left me clear-headed enough to do research on my phone about the upcoming operation, call family, and manage my medical affairs. The Zurich hospital kept me comfortable until I went into the operating room.

The US and Switzerland have similar per capita GDPs (PPP adjusted).  Both are among the highest in the world.  I suspect that Switzerland has higher living standards than the US, mostly due to having a more sensible attitude toward pain relief.

Here’s another excerpt:

Carfentanyl is made by many labs and in many different strengths. It’s cheap. It’s easy to get into the country. At its most concentrated, the amount in a normal size suitcase could kill everyone in Boston. This is what makes the opioid epidemic so deadly — people easily kill themselves with uncut or poorly dosed Carfentanyl.

When it’s illegal to get safe doses of pain medication, then people are likely to get unsafe doses.

Scott Alexander’s essay on addiction is also well worth reading.