When my son was four years old, he was given the synthetic opioid fentanyl. Twice. We were in the emergency room at the hospital after his finger was crushed in a door. A cheerful nurse gave him fentanyl two times to numb the pain while a doctor stitched him up. At that time, grown men and women were dying by the thousands from overdoses involving fentanyl. Today they’re dying by the tens of thousands1. What’s the difference? My son got fentanyl in a legal, regulated environment where it was protected from contamination and dosed accurately. People dying from fentanyl are getting it on the underground market where there’s no quality control and dosing is a risky guess. To save lives we have to address why people buy contaminated drugs on the street, and why those drugs are increasingly potent.
The Centers For Disease Control recently released provisional data on overdoses for 2020, showing fentanyl as a factor in almost 85% of opioid overdose deaths2. Increased restrictions on prescriptions over the last decade have made legal, regulated drugs harder to get. But they haven’t stopped consumer demand. As restrictions on legal drugs mount, people buy illegal ones. This includes some pain patients who are desperate for relief after being cut off of their medication3. Basic economics tells us supply will always meet demand, whether legally or illegally.
Suppliers of illegal drugs are risking arrest, though, so they need to smuggle small packages with big profit margins. Fentanyl fits the bill perfectly. It’s 50-100 times more potent than morphine4, making a small quantity extremely profitable. Increased potency of drugs is a predictable outcome of the incentives of prohibition. Today we have fentanyl, but tomorrow it will be carfentanil5 or any number of increasingly potent drugs.
Decreased availability of legal drugs has led to increased demand for illegal ones. The incentives of prohibition have made illegal options increasingly potent while removing quality control. The collision of these policy disasters is driving today’s overdose epidemic.
Society’s knee-jerk reaction to do something – anything – to stop overdoses is understandable. More than 100,000 people died last year alone6. A breathtaking tragedy. We often look to the criminal justice system to address drug problems, but cracking down is futile. There are hundreds of billions of dollars being offered by adult consumers every year, and a never-ending line of people willing to supply whatever drug consumers want. Getting consumers to stop buying potent, contaminated drugs off the street will require allowing them some form of legal access to quality-controlled options.
This is an uncomfortable idea for many people to grapple with, myself included. But the evidence is clear that prohibition is causing enormous loss of life. As someone whose deepest values include the sanctity of human life, I have to reckon with this. Another 100,000 families will pay the ultimate price for our failed drug policies in the next year alone.
But there’s hope. As we look towards a new year, we can choose a new path on drug policy. We can explore the least harmful ways to allow adults to access a safer supply of drugs. And we can simultaneously offer honest education about the risks as well as help for those struggling with addiction. This will give people the best chance of taking the most important step towards a thriving life – staying alive.
Fentanyl didn’t kill my son. Rather, it helped a traumatized little boy make it through a hard night in the hospital. I’m thankful for it. It helps thousands of patients in medical settings every day. Fentanyl is not the cause of our overdose epidemic. Our overdose epidemic is a result of policies that incentivize consumers to buy potent, contaminated drugs from the underground market. Allowing a pathway to legal, regulated options could save thousands of lives every year.
Christina Dent is the Founder & President of the nonprofit End It For Good. Her TEDx Talk details the journey that changed her mind on drug policy. She lives with her family in Ridgeland.