American Cartel - Opiods Part One

Grim linked to a WaPo piece about American Cartel, an expose of pharmaceutical company corruption, enabled by politicians and corruption, and its effect on the opioid crisis

I asked my friend Tim McMahan-King, author of Addition Nation to comment. You have been introduced to him here more than a few times before. He dashed off some thoughts immediately, which I pass along, largely unedited. He spent more time on related questions, but did offer some thoughts based on the article. We exchanged a couple more emails, and I will likely pass one of those along as well.  The section of video he links to with Jeffrey A Singer of Cato Institute in a debate sponsored by Reason is quite good. 

This spurred further thinking of mine on treatment and punishment, which I will put up shortly in a Part Two.  There will likely be a Part Three in a day or so. 

Tim welcomes your comments.

I haven't read the book but if I do I will update my thoughts. 

But, based on this article I have thoughts. And, these are all things I've been mulling over with Bethany... so you might be getting a longer email than you bargained for. 

Pharmaceutical companies trying to up profits while mocking people using their products checks out. 

DC politicians listening to lobbyists for powerful corporations and failing to do basic regulatory due diligence checks out. 

It doesn't take much for me to believe bad things about large corporations or the corrupt influence of big money lobbyists.

What doesn't check out is the implied message that the overdose crisis is "big pharmas" fault. Or, that if DEA regulators were able to stop the flow of prescription pain meds back in 2016, we'd have fewer overdose deaths today. 

Opioid prescribing peaked in 2012. Diverted prescription opioids became a lot more expensive and so a lot of users shifted to illicit opioids. 

There have been some methodological changes in how the CDC has tracked the percentage of the population with an opioid use disorder but we don't actually have a lot of reason to believe that the percentage of the population addicted to opioids has changed that much since at least 2002. 

The three big driving factors for overdose are the number of people who use, how often they use, and the likelihood of harm in any given use. The two things that have shifted the most is the frequency of use and potential harm per use. 

I'm painting with some broad strokes but... you can pop a pain pill 2-3 times a day or so and function fairly normally. Crush and snort those pills and now your life gets more complicated as the highs are more intense and you need to use them more often. 

Switch to IV heroin and things get even harder. You aren't always sure what the dosage is or if there are adulterants. But, at least the high last 6-8 hours so you can get through a work day without bad withdrawal. Or, you can spend the night at a shelter and not use while you are there. 

But, drug traffickers figure out that you can smuggle illicit fentanyl a whole lot easier and make a whole lot more money. Fentanyl is a shorter-acting  and withdrawal kicks in around 4 hours in. Now, you can't go to work without shooting up during the day and you can spend the night in a shelter without using or going into withdrawal. 

So, our population of opioid users hasn't grown, it's possible it's even gone down. But, of that population of opioid users, their frequency of use has gone up increasing the chaos in their lives and the likelihood of them being unemployed and on the streets. Likelihood of dying goes up because dosing is even harder for fentanyl and the frequency of use is higher. 

The danger of the drug supply is tragically on display with teen overdoses. Since the pandemic began, teen drug use has plummeted. Teens tend to get their drugs from each other and at parties, lockdowns stop the parties and fewer teens have access to drugs. BUT, teen overdoses have more than doubled in two years. Drug traffickers aren't very good at dosing and mixing and so you can have a batch of 1,000 fake pills and 100 of them are weak and 100 of them could have a lethal dose. 

Here is an interesting debate hosted by the folks at Reason. I've linked to the portion where the Cato Institute guy, Jeff Singer, goes over addiction rates and shows they aren't correlated with overdose rates. 

I think he overstates his case but he is an important antithesis to some of the dominant narratives. 

All that to say is that I won't be surprised if it is some good reporting on bad people who did bad things. But, the analysis on what is driving the overdose crisis will be way off.