The Economist has a major article discussing the fentanyl crisis. This graph has some discouraging data:
I knew about the horrific fentanyl data, but was surprised to see the huge increase in cocaine deaths. I doubt that cocaine usage has increased that dramatically in recent years. Instead, I suspect that cocaine use has become much more deadly. But why?
The graph provides a hint. Since 2013, the increase in cocaine deaths appears highly correlated with the increase in fentanyl deaths. Both lines rise modestly from 2013-15, then very rapidly from 2015-17, then a bit more slowly from 2017 to 2019, then very rapidly for three years, before slowing in 2023. One possibility is that cocaine uses are dying because their drug is adulterated with fentanyl.
The same issue of the Economist has an editorial pointing out that it is impossible to stop the flow of fentanyl into the US (despite the claims of grandstanding politicians who talk of invading Mexico to shut down drug labs.) But their policy suggestions are disappointingly weak:
And they should decriminalise less lethal drugs, such as cocaine, so as to free time and scarce funds to focus on the one that is killing Americans in droves.
This will not solve the problem shown in the graph above. Even a decriminalized cocaine market is still an underground market, with all the associated problems such as lack of quality control. Tens of thousands of Americans will continue dying from accidentally ingesting fentanyl while consuming what they thought was cocaine. This is especially disappointing given that I recall The Economist as previously being one of the few major publications brave enough to advocate the legalization of drugs.
In fairness, they may have assumed that decriminalization was the only feasible reform within the current Overton Window. Their advocacy of decriminalization was followed by this observation:
Politicians of all stripes dislike such ideas, since they appear to condone taking drugs. America’s are unlikely to try anything so radical. But fentanyl is already a problem in Canada and is spreading in Mexico, too. Even more potent synthetic opioids called nitazenes have arrived in Britain. If the world is to cope it will, like the traffickers, have to innovate.
Drugs are not an easy issue for policymakers. Because of the severe penalties associated with the use of hard drugs, there is a correlation between drug use and other problems such as crime, unemployment and mental illness. (To be clear, the correlation is far from perfect—there is a substantial number of hidden drug users with stable jobs, who don’t make the news.) If an individual state legalizes all drugs, it risks becoming a magnet for “undesirables”. That has not been a major problem with marijuana legalization, but it might have played a role in Oregon’s recent decision to reverse its policy of decriminalizing certain drugs. (Reason magazine has an alternative view.)
This is analogous to immigration. If only a single developed country adopts open borders, that country becomes a magnet for the world’s poorest people.
[Editor’s note: For more on the benefits and costs of cannabis legalization, see last week’s Great Antidote episode with Stan Veuger.]
READER COMMENTS
Tarnell S Brown
Apr 2 2024 at 5:29pm
It’s the Iron Law of Prohibition: the more intense enforcement becomes, the more potent substitutes will become in order to maintain profit margins.
robc
Apr 3 2024 at 12:07pm
Yep, and a pretty easy to see example from alcohol prohibition. Which is easier to smuggle, a barrel of beer or the equivalent amount of alcohol in whiskey?
And even easier in pure grain form.
Ahmed Fares
Apr 2 2024 at 9:27pm
A marriage of convenience between two groups, the drug dealers who want to get drug money out of the US, and the Chinese who want to get money in.
How China is helping Mexico’s cartels: Criminals ‘with links to the Communist Party’ are laundering millions in drug money for gangsters including El Chapo’s Sinaloa clan as they flood the US with killer fentanyl
T Boyle
Apr 9 2024 at 1:22pm
This scheme doesn’t work – at least, not as described. The Chinese triad is receiving Yuan, in China, from the wealthy person, but it is spending Pesos in Mexico. For this scheme to work, it has to convert Yuan, in China, into Pesos in Mexico – and that’s the very thing that was difficult in the first place.
Michael Sandifer
Apr 3 2024 at 12:41am
I would love for the US to be a magnet for the world’s poorest people. Of course, it would also mean we’re a magnet for immigrants in every other income and wealth category as well. The combination of AI and extremely high immigration rates could cause a boom such as no developed country has ever seen.
One thing that could be done to help alleviate fears of the impact on fiscal budgets and the political balance would be to allow for open access to resident visas for non-criminals, but severely restrict citizenship. That would mean that anyone could come and live in the US for as long as he/she wants, but would likely never become a citizen, meaning would not be eligible for most social welfare benefits or voting. I see no reason we couldn’t set it up that way.
Of course, that would still mean that children born here would automatically be citizens unless we change the Constitution, but this still seems to be an idea with some merit.
TMC
Apr 3 2024 at 11:39am
Your first paragraph made me do a quick check for the date. I was expecting April 1st.
BS
Apr 3 2024 at 1:19pm
The US already is the world magnet, just not a completely open one.
Walter Boggs
Apr 10 2024 at 11:36am
Maybe the US is an immigrant magnet *because* it’s not completely open. Many people come here to escape from bad people back home.
Todd Ramsey
Apr 3 2024 at 9:37am
As a former pharmacy owner, I can testify to the truth of this statement: “there is a substantial number of hidden drug users with stable jobs, who don’t make the news.”
We had dozens of customers, each living normal lives with good jobs, who were daily taking doses of Oxycodone that would kill a unhabituated patient.
It’s not good to be dependent on Fentanyl or Oxycodone (or nicotine). But the dependency is not killing people. People die because of the lack of standardization due to the drugs being illegal. Decriminalization does not stop this problem.
Scott Sumner
Apr 3 2024 at 12:41pm
Yes, this is exactly what I suspected. Glad to see it confirmed by a former pharmacist.
Michael Sandifer
Apr 3 2024 at 1:43pm
Unfortunately, it’s not that simple. Drug tolerance is stimulus context-dependent. This can lead to, for example, overdose caused by using a drug in a novel physical setting, or during a sufficiently humorous comedy show.
This is a well-known phenomenon, so see here, for example:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1196296/
Todd Ramsey
Apr 4 2024 at 9:51am
Federal drug policy also explains the rapid increase in synthetic opioid deaths shown in your chart.
In 2014, the DEA implemented policies making it more difficult for patients to obtain prescriptions for oxycodone, hydrocodone and other opiates: by requiring patients to visit the doctor more often; by increased scrutiny, threats, and actions against the doctors; and by limiting the amount of these drugs pharmacies could purchase, requiring drug wholesalers to enforce those limits, and by limiting the amount the wholesalers themselves could purchase.
Although undoubtedly well-intentioned, the policies had the foreseeable effect of incentivizing some patients to turn to the black market to service their addiction. Drug dealers were happy to provide illegal, unstandardized fentanyl.
And I think it’s too late to turn back now that fentanyl has gained a foothold in the market. Fentanyl is so cheap, and so transportable because of its potency, that it’s here to stay.
Scott Sumner
Apr 4 2024 at 2:14pm
That’s right. I have some previous posts discussing that effect.
T Boyle
Apr 9 2024 at 1:28pm
Todd, I think we may have a semantic problem. You wrote two sentences: “People die because of the lack of standardization due to the drugs being illegal. Decriminalization does not stop this problem.”
To the layman, you’re saying that people die as a consequence of the drugs being illegal; and that making them non-illegal would not stop the deaths. I don’t think that can be what you meant.
I think what you may be saying is that non-prosecution of the drug users, while continuing to prohibit or control access to drugs, will not solve the problem because the users will still have to procure supply from illegal sources. What you’re not saying is that allowing people to sell non-contaminated drugs could stop the deaths (which it might, or might convert into deaths from other causes).
My understanding of the argument for decriminalization was not that it would cause people to stop taking illegal drugs. It was that the harm caused by enforcement was additive to the harm caused by the drugs; it makes things even worse. And the counter-argument is that fear of the consequences of enforcement would reduce drug use – and therefore drug-related harms – by enough to justify all the harms directly caused by enforcement.
bb
Apr 3 2024 at 2:09pm
Scott,
This sounds like an acknowledgement that the FDA has value?
Scott Sumner
Apr 3 2024 at 2:30pm
Not really. I think a free market can provide quality control without an FDA. The FDA doesn’t regulate TV sets, and I find TV quality to be very high.
steve
Apr 4 2024 at 1:53pm
You only lose money with a bad TV.
Steve
Scott Sumner
Apr 4 2024 at 2:17pm
You can lose your life with a bad FDA, one that worries more about the type 1 error of allowing dangerous drugs than the type 2 error of not allowing life-saving drugs.
Unfortunately, research suggests that we are stuck with a bad FDA.
Jim Glass
Apr 3 2024 at 7:14pm
A good friend from my law school days joined the police, then went on special assignment heading a group leading anti-drug efforts in city housing. He dealt with the drug gangs up close and personal, an Eliot Ness of our time. He’s retired from that job now but consults with property owners around the country. His opinion about dealing with the particular type of drug activity he’s faced (obviously only a small part of the total picture)…
Partially decriminalize but do not legalize. (Legalizing permits open commercial availability.) Provide ample supply (safely quality controlled) at minimal cost to the addicted. Do so through unattractive locations, like a clinic in a side office at the DMV. Keep other sources of the drugs extremely illegal with sellers facing severe penalties.
Rationale: Drugs gangs in housing projects operate for the profits, obviously. Gang violence and extortion is driven by fighting over profits. To keep consumer demand (and profits) high in spite of its illegality the gangs aggressively market drug use to youths as macho, sexy, fun, etc. Making drugs available for free on a large scale will crash the street price and profits, and also free addicts from having to commit crimes to get money for drugs. On the demand side, there’s nothing macho, sexy, fun about getting party juice from the DMV. As that connection is made in the consuming group’s mind (counter-marketing) from watching people do so, demand will fall. The potential penalty-to-profit ratio for illegal sales becomes much worse, reducing them accordingly. The amount of violence supplied to society by both sellers and buyers should go down a lot.
Not a miracle solution. There’d still be drugs and abuse. Decriminalizing/legalizing always leads to a next generation of problems (say, Amsterdam). My friend knows that better than most. But he’s an informed guy with an opinion, FWIW.
Lizard Man
Apr 4 2024 at 7:46am
On net, legalization will lead to more users being high more of the time. Given reports that opiate addicts seek out more potent drugs (dealers sometimes advertise that they are selling killer doses after one of their clients dies in order to increase prices and drive volume), my suspicion is that on net, more people would be dying from overdoses under legalization, not fewer. It would be the case that people using cocaine wouldn’t die from unknowingly taking opiates. But my understanding is that deaths due to alcohol use disorder have been rising recently as well, so if the problem that you want to solve is that too many people die from overdoses, legalization isn’t obviously the solution. More narcan and more accessible treatment for addiction are what you need. And even under legalization, you still need a mechanism to force people into treatment programs if their behavior is hurting others/ breaking the law. And even people who don’t die and don’t overdose but spend most of their waking hours intoxicated will still be bad parents and spouses. People wanted prohibition not because alcohol was killing people, but because it played a large role in making men violent and abusive fathers and husbands who also impoverished their families with their drinking. I don’t see any desire among libertarians to pair legalization with a legal regime that provides ample and easily accessible effective treatment for substance use disorder and has the teeth to force sobriety upon parents who do not use drugs responsibly (we don’t even have this now, when the drugs are illegal!). When what people expect from legalization is a large increase in people neglecting or abandoning their families and children, I think it is right for them to oppose legalization. (My understanding of why Portugals experiment worked is that they did increase access to treatment and did retain and use their ability to punish people who broke laws or abandoned their families due to substance use and used that power to force people into treatment).
Anders
Apr 4 2024 at 10:32am
Is this too simple?
Everyone can buy drugs legally at pharmacies. That destroys illegal drug trade and guarantes dosage and quality, preventing crime and overdoses. Pharmacists can advise customers on dosage and precautions.
To buy drugs, you have to register so that use is monitored. Below a certain level, you are fine. Exstacy once a month to be your charming best at a party? No reason that should not be a personal choice, and alcohol is ayway far worse. In fact, driving fast is as well. Only when use exceeds a threshold that might indicate abuse is there a problem to deal with.
Opiates would be the exception as they can disable the opiod system and become highly addictive. So keep controlling them and expand distribution to maintain or treat addiction. Several programmes successfully enable addicts to lead a normal lives or even to get treatment for quitting. But only opiates and for some alcohol are that addictive. Most drugs are not at all. Amphetamines only in very high doses after years of abuse. I have never heard of an extasy addict.
Not perfect, but liberal in spirit and far better than what prohibition has brought us. And taxing them highly would bring more than enough to spend on public health and treatment for the small portions of drug users who suffer.
What am I missing?
Lizard Man
Apr 5 2024 at 12:58am
A revocable privilege seems like a much better model than making drug use a right. We already limit how pseudoephedrine people can buy. Why not limit the amount of drugs and alcohol that parents can buy? Why not bar people who have been convicted of a crime while intoxicated from buying or using drugs? The point being that the only people who can use drugs without committing crimes are legally sanctioned to use them. If the drugs and alcohol make people commit crimes (real crimes, like violence, child neglect/endangerment, property crimes) is it libertarian to say that being victimized is just the price of freedom? How is being victimized by crime with impunity freedom?
Todd Ramsey
Apr 5 2024 at 9:42am
“Everyone can buy drugs legally at pharmacies.”
“What am I missing?”
You are missing the restrictions the FDA has placed on legal drug use. See my reply above about the 2014 FDA changes.
Floccina
Apr 6 2024 at 6:00pm
As a compromise should sale be legal but use illegal as a secondary offence?
Philo
Apr 9 2024 at 1:45am
The U.S. is already a magnet for the world’s poorest people, in that they are attracted to the country. The very poorest cannot finance the journey hither, but many of the not-quite-poorest do come, though they can enter only with difficulty and then have illegal status.
I (a U.S. resident) do not object to living in a country where there are a lot of poor people, but most of my fellow Americans evidently prefer to keep such people beyond their notice, except possibly when they (the Americans) are on vacation abroad–and maybe not even then.
Comments are closed.