Iron Law of Prohibition at Work in Overdose Death Epidemic

72,000 overdose deaths is the latest Center for Disease Control estimate for 2017. It’s a huge number; more deaths than AIDS took in a single year. Beyond speaking of increasing support for vague “public health” measures, the New York Times story blamed substances more than policies for this painful failure.

But drug war opponents do blame criminal justice. It’s called the iron law of prohibition: the greater the intensity of law enforcement, the higher the potency of the drug. A former director of NORML in 1986, Richard Cowan, summed it up “the harder the enforcement, the harder the drugs.”

When alcohol was prohibited, beer and wine disappeared, and the bootleggers made gin often described with gallows humor as “bathtub gin” industrial alcohol mixed with flavoring in a tub that on occasion poisoned the drinkers.

Today the poison is fentanyl ordered on the internet from China and delivered in packages like the thousands of other items. Of course, if we had friendly relations with this emerging power we could negotiate restrictions, but under Trump such requests are impossible.

The kick this drug adds to heroin and lately to stimulants like methamphetamine and cocaine is an example of the iron law.  None of these drugs are made with any protection for the consumer. Different policies can produce different results.

In 2015, the European Monitoring Center for Drugs and Drug Addiction published comparative statistics for overdose fatalities. Portugal which decriminalized all drug use in 2001meaning drug users and their street level suppliers no longer fear arrest or police intrusions had 3 overdose deaths for every million citizens. The second lowest rate. Clearly decrim hadn’t caused the disaster of increased use and endangering children that the prohibitionist warns will happen if police are replaced by public health officials.

The European average overdose deaths per million was 17.3, the United Kingdom was way above average at 44.6, while for the Dutch it was 10.2

In the United States, using a different statistical base from the UN Office of Drug Control, in 2015 the death rate was 245.8 per million people between the age of 15 to 64 [].

August 31 is International Drug Overdose Awareness Day and the United States is pledged to increase treatment and access to overdose prevention medicines while also increasing police enforcement.

The iron law of prohibition suggests the increasing the intensity of law enforcement and implementing tolerant public health measures will conflict or an even create worst public health problem.

With desperate brevity, the current problem in the U.S. can be examined under this lens. In 2000 when doctor prescriptions for pharmaceutical opioids were high and before warnings spread that doctors oxycontin pills caused addiction, the pills were easily diverted. But 20-20 hind sight reveals opioid related overdoses were low during this unregulated era.  As restrictions on pharmaceutical supplies increased overdose deaths started to increase.

The overdose deaths examined in 2000 were traced to pharmaceutical pills, by 2010, pharmaceuticals were a declining cause while heroin was on its way up. People who formerly depended on pills had become injecting heroin users. In 2000 deaths from fentanyl were virtually non-existent by 2017 it was the major problem and what’s worse fentanyl is now mixed with meth and cocaine making these stimulants surprise killers. This is the paradox of the iron law, when pharmaceutical pills were easily found, there were overdoses, but history makes it clear the level of overdoses deaths were low, and public health measures could have kept this number down without any police involvement.

Today the drug war is renewed by alarm over overdose deaths, Sheila Vakharia Phd a Policy Manager at the Drug Policy Alliance reports that stimulants are a growing cause of overdose deaths. The CDC’s latest national overdose data [] – for the period between December 2015 and December 2017, she wrote in an email, showed “cocaine-involved overdose deaths  went from 6,841 to 14,058 (over doubled) and methamphetamine-involved deaths went from 5,777 to 10,523 (80+% increase).” In NY state over the same period “cocaine-involved overdose deaths went from 354 to 690 (almost double- 95% increase) and methamphetamine went from 36 to 133 (269% increase!!).” This problem is not going away.

What should have been done around 2000 when it was discovered pharmaceuticals were being used by drug users was an intensive education campaign about how to recover from overdoses and instruction on how to minimize harm from using the pills.  A long-range strategy would also have looked at why these pills were becoming attractive to users while regulators attacked the false advertising of Purdue Pharma. One reason for the increase in addiction is that users thought pills were safer than injecting heroin.

This perception is correct but these pills being legal could also be controlled with relative ease and that is exactly what happened; the pills were cutback and users started injecting heroin and then dealers started cutting heroin with fentanyl and we really saw deaths explode reaching the 72,000 figure.

Enforcement also creates other problems. So-called synthetic marijuana, it’s plant matter that isn’t pot and why this is critical will become apparent shortly. What gets a person high is spraying a chemical, designed to mimic pot but never tested for safety, on the plant matter.

This is another way enforcement enters the picture. Synthetic marijuana is potent but cheap, $2/3 for a joint that can get a person high most of the day because one toke makes most people blasted. This makes it attractive to the homeless and it is also attractive to people on parole (who are often homeless) who are drug tested constantly, but because the chemical that is sprayed hasn’t been labeled illegal by the DEA and can be sold legally. And what this means if the parolee is drug tested, he or she is listed as clean. Surveillance of drug users follows the iron law, it makes user seek ever more dangerous and potent substances

Criminalizing a person’s intimate habits is a bad even fatal idea.

And let us conclude with a great leap of faith. Opposing the prosecution of users and their dealers is something that conventional politicians like Andrew Cuomo support reluctantly, while the inexperienced politicians like Cynthia Nixon and Zephyr Teachout are proving to be open minded about new methods of coping with drug use. From this perspective their inexperience becomes an asset.