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Last year, nearly 90 people a week in the UK died as a result of drug use – the highest number on record.
More than 60 per cent of these deaths involved an opioid – that is, a drug derived from the opium poppy or based on its chemistry. Heroin is the most well-known opioid, but the family includes methadone, a synthetic drug which is used to help people off heroin; prescription painkillers like Tramadol and Oxycodone; and fentanyl, which is 50 times more potent than heroin and was responsible for the death of Prince last year.
As well as being addictive, opioids affect the part of the brain that regulates breathing, and so high doses can result in overdose and death.
The rising number of opioid deaths is an appalling indictment of the UK government’s blinkered approach to drug policy, and its unwillingness to try anything new in the face of failure. But the UK situation is dwarfed by tragic developments across the Atlantic, where the US and Canada are in the grip of a full-blown epidemic that is claiming lives at an horrifying rate.
A raging epidemic
In 2016, 64,000 people died from drug overdoses in the US, the vast majority involving opioids. Incredibly, overdose is now the leading cause of unintentional injury death in the United States. Annually, it kills more than car accidents and takes more lives than US soldiers were lost in the deadliest year of the Vietnam War, or at the height of the HIV/AIDS epidemic.
What on earth could have caused this crisis? Well, unlike many other drug epidemics, this one has its origins in the world of prescription medicines. In the 1990s, US authorities encouraged medical practitioners to prescribe more opioids to deal with pain, in all its various forms, experienced by millions of patients.
The pharmaceutical companies sensed an opportunity. Lenient regulation of pharmaceutical marketing and direct selling to doctors allowed commercial interests to drive up more and more opioid prescriptions, often without any clinical justification.
The result? Hundreds of thousands of drug-dependent patients, particularly in poor rural communities with high rates of joblessness. Realising their mistake too late, the US authorities intervened to limit prescriptions and to introduce pills that were harder to crush and snort or inject. But the withdrawal of drug supplies and the inadequacy of drug treatment services in many parts of the US simply drove addicted people into the hands of criminals who were ready to offer them heroin or fentanyl – drugs which, as a result of their potency and unregulated status, were far more likely to result in fatal overdose.
Criminalising addicts does not help
This week the Global Commission on Drug Policy, of which I am a member, released a position paper on the opioid crisis which makes for grim reading. It describes how people with acute physical and psychological problems have been lured into reliance on highly addictive medicines, only to have their supply cut off without any attempt to support them with safer alternatives.
We call for a rapid expansion of measures which have been proved to reduce harm and cut overdoses, from methadone treatment to heroin maintenance programmes for the most addicted users; from supervised injecting facilities to drug checking services that would allow users to tell if their heroin was mixed with fentanyl.
We also draw attention to the fact that in US states where medical cannabis is available for pain management, levels of opioid use are lower. Most importantly, we reiterate our strongly held view that criminalising people who are addicted to drugs does nothing for their health, and simply adds to the problems which gave rise to their addiction in the first place.
At the moment, in the UK, we’re not experiencing an opioid epidemic comparable to North America. Prescribing rates are lower, and care in the NHS is available to everyone free at the point of use. However, fentanyl has started showing up in the statistics – in August, the National Crime Agency issued a warning that the drug was involved in 60 deaths over the previous 8 months. So we would be foolish to imagine that the UK is immune.
The opioid crisis is a salutary tale of the dangers of bad regulation, and the perverse incentives and cosy relationships that can develop between ‘big pharma’ and people in positions of power.
It is a wake-up call for drug reformers to ensure that we pay as much attention to the unglamorous work of producing good regulations as we do to the positive arguments for decriminalization and legalisation. If we are going to reduce the appalling toll of drug deaths, we cannot afford to leave control in the hands of the criminal gangs – but nor can we simply hand that control over to commercial interests either.