A Dirty Word

Everyone has a few words they don't like, but there is one word which elicits acute pain in my heart. The word is fentanyl. Maybe you heard about it in 2016 when an overdose took the life of Prince. My introduction was from a Midland, Texas, police detective who called two months after my precious son Walton's death to tell me the cause. I had to ask him to repeat the word, then spell it. Now I know that fentanyl is a synthetic opioid. It's 50 times more potent than heroin and 100 times more powerful than morphine. Most of the world's supply is produced legally in China, but it ends up in the hands of the drug cartel in Mexico.

Aggressively marketed synthetic opioids like oxycontin and hydrocodone have led to an epidemic of opioid addiction in America. These drugs are marketed so well that they're prescribed 3 times more often here than in Europe. Patients don't realize how addictive opioids can be until it's too late. Once addicted, any opioid feeds the addiction; the stronger, the better.

Fentanyl's potency makes smuggling easier and selling more profitable than heroin. A kilo of heroin can be purchased by the cartel for $6,000, sold wholesale for $80,000 before fetching a few hundred thousand dollars on the street. A kilo of fentanyl might cost $4,000 and have a street value of $1.6 million. Its potency makes overdosing easy, too. Two milligrams are fatal. That's one reason why 91 Americans are dying from opioid overdose every day, more and more from fentanyl. To make matters worse, the cartel has been experimenting with even stronger variants. Among them is an elephant tranquilizer called carfentanyl. It recently killed a Texan who merely touched it.

So, what should we do? Suppressing it's legal manufacture in China would simply push that elsewhere. The Mexican drug cartel would, within months, find another chemist and build another lab. One suggestion would be to restrict the legal use of opioids in pain management, realizing the obvious dangers of these drugs. That's a no brainer, but there are still 2 million opioid addicts today. For current addicts, and the number is growing exponentially now, restricting it's legal use, without other measures, would simply redirect them to the dark web where fentanyl can be purchased easily and secretly. That's how Walton purchased for $25 in Bitcoins enough to cause his death. There's no way of knowing if he even knew what he was buying.

The answers are not easy, so we shouldn't expect much help from Washington. For starters, federal drug laws make no sense. Marijuana, which has no overdose potential but known benefits in pain management is classified as more dangerous than fentanyl. Currently there are mixed messages coming from the Trump administration. The President has appointed NJ Governor Chris Christie to chair a panel on opioid addiction, but the House Health Care Bill, which Trump supported, slashed Medicaid, a crucial funder of drug treatment programs. Trump's draft budget cuts 75% from the White House Office of National Drug Control Policy. Attorney General Jeff Session wants to fight drug addiction with criminalization. But with millions of opioid addicts, even his buddies in the private prison business couldn't keep up with the demand for prison beds.

So here's an idea: It's a complex problem and it takes courage to legalize and dispense drugs when people are dying from them. But it's better that addicts take safe doses of familiar substances under controlled and sanitary conditions than for them to risk their lives enriching the drug cartel. Government funded and supervised clinics to legally help addicts get clean would be a step in the right direction. Switzerland tried this in the 1980's, treating drug addiction as a public health problem. Since then drug use and drug related deaths have fallen.

I've never known an addict who didn't want to get clean, but I've also never known one who could do that without help. Neglect, stigmatization and criminalization got us where we are today. It's time to help.