Most patients prescribed narcotic painkillers do not descend into the seamy web of crime and addiction, just as most people who take a drink of alcohol easily avoid hopeless, homeless alcoholism. The opioid issue is real, no doubt, but it’s far from an epidemic that we are helpless to address. In fact, if opioid withdrawal were classified as a purely physiological disease, and if we could treat other diseases like cancer or Alzheimer’s as easily and effectively as we can treat opiate dependence, the entire world would rejoice! The global human average life expectancy would tick up by several years overnight.

Speaking of that, the term “opioid epidemic” covers a huge range of phenomena, from nothing-burgers to deadly. When we talk about opiate addicts, do we mean people who take prescribed pills regularly, who have built up a mild tolerance, and might need to taper off slowly if they stop? Or people that started out taking prescribed doses and upped the number they took to get high and/or achieve greater relief? Are we talking about those unfortunate folks who started on legal scripts and moved to street drugs? Or do we mean long-term recreational heroin addicts who never had a legal prescription or legit medical condition that got them hooked in the first place?

Because right now the discussion mostly lumps all those very different cases together, often conflating those with chronic pain who rely on legally prescribed meds with the latter recreational users.

One point that should be clear: we don’t need a government program to freely hand out black tar heroin or black market fentanyl. We can provide those seeking help with substitutes, drugs with a long, successful track record. This would actually reduce the problem, and it would also be the moral and compassionate thing to do—for the same reasons we would give a victim of blood poisoning antibiotics, or provide someone suffering from complications of diabetes some insulin: out of compassion, out of sympathy. And we can do so secure in the knowledge that the treatment is effective, far safer than street drugs crudely refined in third-world shacks, and best of all, available in pharmaceutical grade and mass quantities for mere pennies per dose.

But we don’t do that in most cases. Instead we slam patients with fines and threaten them with jail, and create an easily accessible felony record guaranteeing more police scrutiny at every turn. We publicly name them and shame them, and then expect them to get well on their own. We do this even though they now have no job prospects, despite many being homeless and outcast, branded a criminal, and alienated from what little support of friends and family they might still have. The rest of us give up civil rights, put up with searches, and read about out-of-control police who seize property without charges or arrest of the owners. All in all, the consequences of our failed war on drugs are arguably as bad or worse for everyone concerned as the drug use itself.

Useless posturing and ineffective fixes are tempting for politicians, and plenty of Democrats have fallen for it. But since the issue often involves imprisoning the powerless, the poor, and minorities, and since those people need medical treatment, it’s like a trifecta for conservatives. They can appear tough on crime, show no mercy for lawbreakers, depict health care programs as catering to violent drug addicts, fill prisons with black and brown people, eliminate likely Democratic voters from the rolls in the process, and seize bank accounts, homes, cars, and just about any other kinds of personal property that have value—all without a warrant or even an arrest.

The problem of course isn’t just the danger of abuse: it’s also the harsh overreaction. The easy fix is to make a big deal about cracking down on doctors and patients, and politicians are drawn to easy fixes like a moth to an electric arc. Maybe that would stop a few people from becoming addicted, and it could arguably therefore save lives. But every time painkillers are made harder to get for those who abuse them, a bunch of legit patients, many of whom are in no condition to negotiate ever more convoluted hurdles, will pay the painful price. And if you think that won’t affect you, you’d better think again. Some of us may die tragically young and fast. But most of us will grow old, and most of us will develop chronic diseases along the way. Many will get seriously injured and/or undergo surgery. Which means the majority of you reading this will, at some point, encounter chronic pain, pain so bad and so searing you can’t think of anything else. 

But it’s doubtful any reasoning or data will matter to the usual suspects. There is a seemingly endless supply of money for courts and prisons and police. But when it comes to treating the condition, right now we’re not even debating how to treat it: we’re debating how much we will cut what little treatment is available. 

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