The silent epidemic

Methamphetamine is in the news a lot, what with meth labs exploding left and right -- recently in a nursing home, for crying out loud, and multiple ton busts in Mexico (most of which I'm sure was back on the market after payment of suitable bribes). We're spending a billion dollars a year to incarcerate tens of thousands of people for marijuana offenses, and we've so far spent half a trillion dollars in Afghanistan accomplishing exactly nothing to reduce heroin production. (Basically 100% of heroin comes from Afghan opium.)

However foolishly we are dealing with those issues, they are not any of them our biggest drug problem. (It's unclear that marijuana is much of a problem at all, except to the extent we make it one by prohibiting it. But that's for another day.) Anyway, the truth is that overdose deaths from prescription opioids are more common than deaths from heroin and cocaine combined. And for every OD, there are 461 abusers and 161 addicts, according to a SAMHSA survey -- and that's people who tell a survey taker they are addicts, presumably an underestimate.

As the CDC report linked above tell us, this represents an astonishingly explosive problem. Physicians in the U.S. are now prescribing the equivalent of 700 mg of morphine per capita in the U.S., which is enough to give every single living person a standard dose of hydrocodone every 4 hours for 3 weeks. A lot of these are diverted -- sold to people to whom they are not prescribed. Some of the problem is from prescription mills -- unscrupulous physicians who hand out prescriptions indiscriminately. Much of it is from physicians who are legitimately trying to meet the needs of people in pain but are either scammed by patients or don't have adequate training in pain management.

It used to be, in my view, that doctors were too reluctant to prescribe opioid analgesics, and many people with disabling pain were not adequately treated. A lot of people shared that view and medical culture changed to be more accommodating of opioid prescription but we've gone too far, it seems. These drugs are a great boon to humanity when used properly but they are obviously very dangerous as well. It's a wicked hard problem, as they say in my former hometown of Boston. There should be a very high threshold for prosecuting physicians -- there are clear cut cases where they aren't evaluating patients and are simply in business to hand out scrips all day. But there have also been cases of egregious prosecutorial overreach where DAs just had a different view of what constituted appropriate prescribing. And addicts can be very resourceful about conning people, including doctors.