Over-Regulation Is Fueling the Opioid Crisis
Over the last few years, the opioid crisis has become a dramatic part of America’s national narrative. Some, including J.D. Vance, author of "Hillbilly Elegy," construe it as a symptom of economic and cultural dysfunction, while others like the poet Wendell Berry, insist that the crisis prevails “because we have lost each other.”
In a moment of characteristic optimism, President Donald Trump declared last year that, “We can be the generation that ends the opioid epidemic.” And thanks to extensive recent federal and state efforts, deaths from prescription opioids have decreased significantly. However, according to the Center for Disease Control, overdoses involving stronger, synthetic opioids trafficked here by Mexican cartels, Chinese smugglers, and online vendors, have risen by 10 percent.
There are two types of synthetic opioid at the forefront of this surge: fentanyl and carfentanil. Fentanyl, which has near-immediate effects, is substantially stronger than morphine and many varieties of heroine. Between 2015 and 2016, the period when the opioid crisis started garnering national attention, fentanyl deaths doubled. According to the Drug Enforcement Administration, fentanyl is so potent that it only takes two milligrams — roughly equivalent in size to four grains of salt — to kill a man. Unlike heroin, Fentanyl is extremely easy to transport because of its potency. Fentanyl’s chemical cousin, carfentanil, has similar qualities: Just a single grain of it can be lethal.
It’s no accident that these particular opioids are so popular. Regulations that make prescribing opioids harder have proliferated in recent years — and for good reason. The regulatory schema of yesteryear encouraged dangerous amounts of over-prescription. However, regulation can be counterproductive.
Almost half of the states in the U.S. and the District of Columbia currently have regulated mandatory three to seven day limits bounding the amount of opioids that a doctor can prescribe a patient. These recently instituted laws are likely responsible for the sizeable reduction in overdoses from prescribed opioids, but they also encourage patients to turn to the black market for their opioid fix.
These black market opioids are often trafficked into the U.S. in bulk by criminal smugglers. Often, cartels will receive components of fentanyl and carfentanil from China and manufacture the ingredients into a powder before smuggling the finished product across the border. As an example of just how much fentanyl makes it into the U.S. via cartels, consider that state troopers in April seized 118 pounds of fentanyl in a tractor-trailer during a traffic stop — enough to kill approximately 8 percent of the U.S. population.
Unlike heroin, fentanyl and carfentanil flow into the U.S. both though traditional cartel routes, as well as a welter of online vendors that accept untraceable cryptocurrency payment. In a Senate report released earlier this year, for example, the majority of online fentanyl vendors investigated were found to be based in China. These vendors sent their product to at least 300 people using nothing other than the U.S. Postal service. In the words of Sen. Rob Portman (R-OH), “We now know the depth to which drug traffickers exploit our mail system to ship fentanyl and other synthetic drugs into the United States.” Realistic prospects for detecting small amounts of these drugs delivered via conventional mail, however, are few, expensive, and excessively invasive.
The prevalence of synthetic opioid-based counterfeit prescription pills makes these drugs even harder to detect. One variety, called “Mexican Oxy,” is produced by drug cartels in Mexico and looks virtually indistinguishable from authentic oxycodon, though it contains heroin and fentanyl, making it far more dangerous. One emergency room doctor describing a case involving Mexican oxy said, “I’d never seen any medication or drug present with multi-organ failure, mimicking stroke, sepsis, all at the same time.”
Laws that make authentic oxycodone harder to get partially fuel the demand for this product. Granted, abuse of prescribed, medical-grade opioids isn’t ideal. However, in the same way that abuse of Jack Daniels versus homemade moonshine, which isn’t held to federal and market standards, is preferable, so is access to real, prescribed oxycodone preferable to the use of illicit fentanyl and carfentanil.
Like the Hydra of Greek myth, legislators have taken their regulatory swords to prescription opioids and watched in horror as fentanyl and carfentanil sprung up in its place. To defeat this Hydra, legislators must work with Chinese and Mexican authorities to cut off the supply chains of these illicit opioids while keeping safe, prescribed opioids available under the stewardship of legally accountable medical institutions.
Michael Shindler is a Young Voices Contributor, and writer living in Washington, DC. His work has been published in outlets including The American Conservative, The American Spectator, and National Review Online. Follow him on Twitter: @MichaelShindler.