Letter: A perspective which would reduce the number of unintended overdose deaths from opioids

by beth on March 27, 2019

[Ed note: My Southborough accepts signed letters to the editor submitted by Southborough residents. Letters may be emailed to mysouthborough@gmail.com.]

To the Editor:

This is not meant to be the answer to all the questions about the opioid crisis in our country. We know that in 2016 there were almost 64,000 deaths caused by opioids. Autopsies revealed that 80 percent of them were caused by Fentanyl, which is much more potent that Morphine, and Heroin caused 20 percent of them. In 2017 the toll was 72,000!

Virtually all of these deaths were the result of the fact that each of the victims obtained the drug they injected from a street dealer and not from a prescription. The ultimate source of whatever was injected was outside the country which could have been Mexico, South America, Europe, Asia or elsewhere. Street dealers usually want their customers to live to buy another day. I wouldn’t be surprised if the Fentanyl is added to the Heroin sold on the street by an enemy such as Iran, Cuba, or China but I have no way to know for sure. It has killed more young Americans than have died in the wars in Korea, Vietnam and Afghanistan combined.

Our politicians have chosen to continue the misguided War On Drugs in a failed attempt to stop the flow of drugs into our country. They should have learned from the failure of Prohibition of alcohol in the nineteen twenties. The advocates of that Prohibition at least realized that no power to prohibit was granted by the Founders and that the Constitution had to be amended in order to do it. Another amendment had to be passed in order to end Prohibition. The Founders had established a unique country based on the principle of individual freedom and liberty was the banner to be upheld in all matters.

Most people with whom I have spoken over the years are unaware that in their attempt to maintain a free society and to ensure that their children would never have to live under a tyrant such as King George the Third of the British Empire the only granted certain powers to the Congress and listed those powers in the Constitution in Article 1 Section 8 for all to see.

Unfortunately our own politicians who wanted the federal government to have more powers than were granted have found ways around those limits. One way was to simply get enough votes to pass an unconstitutional law and to choose Supreme Court justices who would find ways to interpret the Constitution to conclude that their new law was constitutional. An example would be the Selective Service Act of 1917 known to us as the Draft which clearly is an instance of “involuntary servitude” but this was ignored in the Supreme Courts decision which upheld the Draft. Their argument was simply to point out that “the power to raise an army”, as stated in the enumerated powers in the Constitution, gave the government the power to use force to do so.

There are other examples.

Portugal had a problem such as we are facing, unintended overdose deaths. Portugal chose to decriminalize all drugs in 2001 and the death rate plummeted. Drug users no longer feared arrest and jail time for using drugs and came forward for help with their addiction. Police who caught anyone with drugs in their possession did not arrest them rather offered them treatment options.

We could avail ourselves of that solution which still prevails in Portugal and other countries in the world but our own politicians are aware of how unpopular it is from polls since most people do not want it to be legal in our country. The politicians fear that if they advocated repeal of the drug laws they would not be re elected. 

If we simply decriminalized drug possession users or addicts could obtain drugs they want without street dealers. Black markets have no quality control. You do not know what you are being sold. It might be heroin but you do not know the dose. If you get a higher dose than you are used to it might kill you. If what you buy on the street is laced with Fentanyl it will kill you.
People don’t die from prescription medications though they may become addicted.

Legalization would be even more effective at saving lives.

There is in fact a resolution being considered in the Massachusetts Medical Society to advocate for decriminalization and for legalization of opioids. It will be decided to either adopt or not to adopt at their annual meeting in early May.

You might want to inform your own physician that you want him or her to plead for passage of this resolution with his or her delegate in the medical society as it is the House of Delegates who determine policy.

I work as a psychiatrist in the prison system and encounter many who need to be detoxed upon admission. Most all of them know of friends or family who have died from the Black Market drugs brought about by the Drug War. It is time that laws banning opioids be repealed so that those who are addicted could be treated instead of arrested and imprisoned. It is a public health problem not a criminal issue.

William R. Cohen, M.D.

{ 8 comments… read them below or add one }

1 tony_montana March 27, 2019 at 7:41 AM

I strongly agree!

Decades ago I watched the movie Scarface and realized where the money went when people bought illicit drugs – to the underworld and crime syndicates. If, as a society, we wish to keep funding criminal enterprises, then, by all means, keep up the ‘war on drugs’ – which we have been losing for the last 40 years.

On the other hand, if we wish to put these criminal enterprises out of business and funnel the money to the state, where it can be put to use to benefit society, then it’s time to move forward and decriminalize the possession of these substances.

By now, it is likely that someone you know personally or a friend of a friend has lost someone to the opioid epidemic in the US. Our society ignored the crack epidemic decades ago, resulting in a tripling of the US prison population. Let’s not make the same mistake again.

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2 Jerry C. March 27, 2019 at 11:11 AM

When I read this letter, I had to do some research because the author states that virtually all opiod deaths are the result of a street sale, not a prescription. This seems inconsistent with what I’ve been reading in the news… so I checked.

I went to the drugabuse.gov site and learned the following: Drug overdose deaths in 2017 were approximately 70K. Of that amount, 47.6K were opiod overdose deaths, and 17K of these deaths were deaths involving an opiod prescription. So approximately 35% of all opiod deaths were the result of a prescription overdose. Overdoses from prescription opiods increased from 3.5K in 1999, to 17K today. This is a 485% increase.

So.. I’m a little confused as to the source of your numbers…. and I don’t agree with your conslusion that legalizing all drugs, including opiods, would somehow fix the situation. The numbers that I’m seeing don’t support that conclusion.

The Insys and Purdue pharma situtation seem to indicate that pharma’s are more than glad to create a nation of addicts if given the opportunity. I think we want to make sure that never happens again.

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3 tony_montana March 27, 2019 at 2:01 PM

Never happen again?

What about: alcohol, tobacco, sugar (yes, sugar!)?

It isn’t some new concept that opioids are addictive, it’s been known for hundreds of years! Why physicians bought into Purdue’s arguments that their product(s) were not addictive is beyond reason. Physicians! Highly educated people, so we’ve traditionally believed. Suddenly opioids are no longer addictive?

So, we’ve ended up with some percentage of the population addicted – parents with broken bones or bad sprains, kids of all ages with sports injuries, people injured on the job, etc. They tell their doctor their current medication isn’t taking care of the pain and they end up on some opioid medication. Then – the prescription runs out or cannot be renewed. Enter the black market drug trade.

This would be a good time to recommend you read Dreamland, which describes the development of the current crisis in exquisite detail.

It is now possible to obtain high quality Mexican ‘black tar’ heroin for as little as $5 per fix – and get this – delivered to your home or whatever location you specify. Frightening? Yes! Where does the money go? Not into keeping the roads plowed and the streetlights burning!

Watch Dr. Ruth Potee’s presentation to learn about how a person becomes addicted. It’s insidious:

https://www.youtube.com/watch?v=kphJMVMd0Oo&feature=youtu.be

It will provide some insight as to the difficulty faced by these people once they’ve become addicted. You know, your neighbors, the kid down the street, the guy you work with, etc.

Treating these people as criminals is, in itself, criminal.

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4 Wm March 28, 2019 at 6:56 AM

You should be more skeptical of numbers provided by the government. For example, the national debt is officially 22 trillion. But they don’t include the promises made to the Baby Boomers who are becoming eligible for retirement and Medicare at a rate of 10,000 a day. A prominent Boston economist, Lawrence Kotlikoff estimates the cost over the next decade to be about 256 trillion dollars!
You can’t tell at an autopsy whether heroin is from a doctors prescription or a street dealer. But doctors don’t prescribe Fentanyl to out patients and 80% of unintended overdosage deaths contained Fentanyl in 2016. I do see patients who tell me they never used Heroin only Fentanyl carefully measured out from their street dealer.
My essential point is that there is no power granted to the Congress in the Constitution to ban drugs. The Declaration of Independence states each of us possess the inalienable right to life, liberty and the pursuit of happiness. It is that liberty exercised by you when you choose to have a drink of alcohol, a cigarette, climb a steep mountain, scuba dive, sky down a slope, or inject a drug. It is none of the government’s business, unless you live in a tyrannical dictatorship, a Communist State or a democratic socialist state as advocated by Bernie Sanders or Alexandria Ocasio-Cortez such as Venezuela. Beware what you wish for.

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5 Kelly Roney March 28, 2019 at 1:41 PM

I’m skeptical of numbers. Anyone who thinks Social Security and Medicare are going to cost more than the complete size of the economy over the next decade is going to have to show some evidence.

The other stuff about the Constitution and the Declaration has been an extreme interpretation of our founding documents for a century. Those rights, as asserted and adjudicated, derive from the commerce clause, of course.

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6 Wm March 28, 2019 at 5:46 PM

Kelly Roney,
I will have to do some homework to make the case that the cost of Social Security and Medicare for the entire Baby Boom will be in the hundreds of trillions. The size of the economy is only about 14 trillion now.

I don’t know what you mean in your second paragraph. What rights derive from the commerce clause? I am talking about the rights of citizens to act as they see fit based on the liberty which attracts people all over the world to come to America, including the right to use drugs, even heroin. Only. tyrannical dictatorships order their own people around and tell them what they must do and not do. Is that what this country has become. Show me just where in the Constitution the Congress is given the power to dictate what a citizen may inhale, imbibe or inject? Do you find that in the commerce clause which was meant to eliminate tariffs and make trade between the states “regular.”

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7 Kelly Roney March 29, 2019 at 3:06 PM

So, Wm, we’ve lived in a tyrannical dictatorship for 50 years, huh? After that previous tyrannical dictatorship called Prohibition… You would also need to be opposed to mandatory vaccination and to required attendance at school, not to mention pollution and safety controls.

There’s never been any suggestion outside a tiny minority of libertarians that injecting heroin is a right.

The commerce clause gives the right to regulate interstate commerce, which we’ve construed very broadly for a century. That includes regulating business products – and prohibiting them. No one has a right to sell a dangerous product. This is well established, long-standing precedent. Sure, you and the Kochs would like to get rid of it, but you haven’t yet.

US GDP – the size of the economy – in 2017 was $19.4 trillion. But your original incorrect claim was that the cost of SS and Medicare would be $25.6 trillion every year for the next 10, which is silly. Kotlikoff, by the way, counts the generational ledger differently from most anyone else, which you seemed to know but then forgot in your attempt to back it up with numbers.

8 Safdar Medina March 31, 2019 at 1:43 PM

An interesting conversation. Being on the frontline of epidemic, I firmly agree that we need to not punish users. Most law enforcement officers in our state now partner with mental health professionals to help victims get treatment. Addiction is a disease, that starts in adolescence and we need to help those suffering. However, we also need to make sure that those who make addictive substances available to our youth, be held accountable. The three common gateway drugs: nicotine, alcohol, and marijuana (all harmful by themselves) can lead to use of other drugs. Unfortunately, nicotine vapor products and marijuana are being targeted to our youth. Prescription drugs are a huge problem as well; laws need to be tightened further. It is still very frightening that a teen can get up to 30 narcotic pills for wisdom tooth extraction, which is totally unnecessary and can lead to addiction.
Safdar Medina, MD

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