By German Lopez
December 21, 2017
Source: VOX
Photo / Image Source: Unsplash,
Beyond causing a spike in overdose deaths, fentanyl and its analogs also help show the problems with typical anti-drug strategies.
The traditional “war on drugs” approach is to go after the supply of these substances. The thinking is that if you can eliminate or at least hinder the supply of drugs, they will become unavailable — or at least much more expensive due to the laws of supply and demand — and people will, over time, stop using them.
This is what the first reaction to the opioid epidemic was about. When the Drug Enforcement Administration (DEA) and other law enforcement officials found that many doctors were prescribing opioid painkillers unscrupulously, they tried to go after these doctors and shut them out — to cut off users from a source of painkillers. (The DEA didn’t, however, do much to go after the pharmaceutical companies producing the drugs, even though it has the ability to legally limit how many opioids can be produced for sales.)
The opioid epidemic has exposed why this isn’t a good enough strategy to deal with a drug crisis. As drug users saw their painkiller sources cut off, they began to move on to other kinds of opioids. So as painkiller deaths began to level off, heroin deaths began to increase.
The data bears this out: A 2014 study in JAMA Psychiatry found 75 percent of heroin users in treatment started with painkillers, and a 2015 analysis by the CDC found people who are addicted to painkillers are 40 times more likely to be addicted to heroin.
Now, it’s also likely that many opioid users may have moved on to heroin anyway. One of the common characteristics of drug addiction, after all, is people will seek out better and stronger highs over time. So the progression from painkillers to heroin was perhaps inevitable for many drug users.
And as the opioid epidemic continues, there’s evidence that more and more people are now starting their opioid use on heroin instead of painkillers.
Still, the government crackdown likely pushed some people from painkillers to heroin.
A similar story seems to be going on with fentanyl now. Some drug users, seeking out a stronger kick, are looking for something even stronger than heroin. Drug traffickers, expecting that their customers want something stronger, have started lacing fentanyl into heroin to sell a product that’s simultaneously more potent and cheaper per dose — although, as we’ve seen, sometimes drug users aren’t ready for this extra-potent product, so they overdose.
This is an example of what drug policy experts call the “balloon effect”: When a drug’s supply is limited, users and traffickers don’t give up; they instead find other ways to get their high. It’s like pushing down on a half-inflated balloon: The air doesn’t vanish, but instead moves to another part of the balloon.
The balloon effect has been observed not just with the crackdown on opioids, but with anti-drug efforts in Latin American countries. After the governments there cracked down on the illicit drug trade in the 1990s and 2000s, it simply shifted to other parts of Central and South America — which is one reason we now hear a lot more about Mexico in the drug trade than Colombia and the Caribbean. This effect is one of the primary reasons the war on drugs has failed to significantly curtail drug trafficking.
The balloon effect helps explain the rise of fentanyl, as crackdowns shifted people from painkillers to heroin and now fentanyl. And it’s why continuing to crack down on painkillers and heroin without reducing demand from existing drug users for these substances is ineffective and even risky.
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