Remember the opioid crisis? It didn’t go away; it got worse.
A Jan. 13 report from Maryland’s Opioid Operational Command Center and the Maryland Department of Health found that there was a 12% increase in overdose deaths in the first nine months of 2020, compared with the same period a year earlier: 2,025 versus 1,806 in 2019. Nationally, opioid deaths are up over 38%, while deaths from cocaine overdose are up by 26% and methamphetamine by 35%.
Since 1970, when President Richard Nixon escalated the politically motivated war on drugs in an attempt to undermine so-called “hippies” and Black Americans, the rate of drug use and abuse has not decreased, except for minor fluctuations that have never become permanent. New drugs have claimed victims, and vast commercial empires have arisen, built on drug money.
Violence has increased on our streets and in Mexico. As Joaquin “El Chapo” Guzman put it: “If there was no consumption, there would be no sales.” Mexico could justifiably blame us for their domestic crisis.
As an emergency medicine physician, I often ask patients about their upbringing. Some describe terrible situations where I admit to myself that if I had been raised similarly, I might be escaping with drugs, too. I ask where they get the $50-$200 a day needed to sustain their habit. Many get others hooked because new users become paying customers. Then there’s petty crime, prostitution, and the major violence that plague our streets. I remember a discussion with one patient who had been a big-time dealer, and I asked him what he was making. His answer, “$25,000 per week, tax free.”
When I was in the General Assembly, in a 2018 public hearing, I asked Baltimore State’s Attorney Scott Shellenberger how much crime in the greater Baltimore area was due to drugs. His answer: “Upwards of 85%.” Those numbers apply across our state.
The drug trade is vast in scope and sophistication. People with substance abuse disorders need drugs daily, and there’s a global network to meet that craving. It starts overseas, where opioids and cocaine are processed and then distributed via well-established lines. The billions spent on drugs are funneled back to the drug cartels by financial mechanisms that would rival a Wall Street investment bank. Where does all that money end up? Ultimately, it goes to dangerous overseas drug cartels and terrorist organizations, like the Taliban, ISIS and al-Qaida. We continue on a policy trajectory that is destroying our society from the inside while shipping vast sums of money to those who would destroy us from the outside.
No one is for drug abuse, but the war on drugs has not just failed; it continues to make the situation worse. The stress from the COVID-19 pandemic has fueled increases in drug and alcohol use, suicide, depression and domestic violence.
The question we don’t want to confront is this: Why do so many Americans turn to drugs? Perhaps our focus on material wealth, endless media distractions, the daily stress most people endure, hurtful behaviors spanning generations, and the emphasis on the individual over community leave too many of us feeling isolated, angry and unfulfilled. As author Johann Hari observed: “The opposite of addiction isn’t just sobriety; it’s connection.”
It’s time to admit that we have a problem as serious as any foreign aggressor or economic calamity. Is it possible to manage drug addiction as a disease? Can we separate dangerous or criminal behavior from the act of using the intoxicating substance? What are the underlying social circumstances that make drug use appealing? How do we effectively warn youth about the risks of drug use?
Substance abuse treatment ought to be immediately available, 24/7/365. Treatment plans should be individualized, as is done for all other medical conditions. Some may need long term care, others medicated assisted treatment (e.g. methadone, buprenorphine), and others a faith-based approach. One size does not fit all.
Supervised consumption facilities are proven to work, reducing deaths, addiction, discarded needles and crime. Other efforts should include: disposing of medications safely; using naloxone to minimize overdose deaths; allowing people to go to fire or police stations when they need help without penalty; using methods other than narcotics to treat pain unless absolutely necessary; continuing public education regarding substance use.
Our greatest weapon is not the criminal justice system, whose resources have been taxed to the limit by acting as the front line in this struggle, but rather our public health and educational institutions.
How can we afford to do this? The real question is: How can we afford not to?
Dr. Dan Morhaim is a physician and former state legislator (1995-2019) and can be contacted via www.thebetterend.com.