The biggest public safety threats related to illegal drugs in the United States arise from drug enforcement strategies that force the product to be delivered through a black market, resulting in violent conflicts among distributors, dangerously impure products, coercion and bribery of police, and a variety of other anti-social outcomes. Purely from a safety perspective, however, new data reveals that prescription drugs cause more deaths related to the drugs' actual effects, reports the New York Times ("Legal drugs kill far more than illegal, Florida says" June 15):
The implications of this shift are enormous: More than one in five people in Texas prisons are there for crimes related to illegal drug sales or possession, but those strategies don't affect the drugs killing the most people. The same tactics could never be applied en masse to prescription drug abuse - the economies of scale would quickly overwhelm police and prisons. It would also tick off powerful political constituencies like doctors and drug companies who hire armies of lobbyists to promote their interests, as opposed to their Mexican drug cartel counterparts who just hire armies.
An analysis of autopsies in 2007 released this week by the Florida Medical Examiners Commission found that the rate of deaths caused by prescription drugs was three times the rate of deaths caused by all illicit drugs combined.
Law enforcement officials said that the shift toward prescription-drug abuse, which began here about eight years ago, showed no sign of letting up and that the state must do more to control it.
“You have health care providers involved, you have doctor shoppers, and then there are crimes like robbing drug shipments,” said Jeff Beasley, a drug intelligence inspector for the Florida Department of Law Enforcement, which co-sponsored the study. “There is a multitude of ways to get these drugs, and that’s what makes things complicated.”
The report’s findings track with similar studies by the federal Drug Enforcement Administration, which has found that roughly seven million Americans are abusing prescription drugs. If accurate, that would be an increase of 80 percent in six years and more than the total abusing cocaine, heroin, hallucinogens, Ecstasy and inhalants.
The Florida report analyzed 168,900 deaths statewide. Cocaine, heroin and all methamphetamines caused 989 deaths, it found, while legal opioids — strong painkillers in brand-name drugs like Vicodin and OxyContin — caused 2,328.
Drugs with benzodiazepine, mainly depressants like Valium and Xanax, led to 743 deaths. Alcohol was the most commonly occurring drug, appearing in the bodies of 4,179 of the dead and judged the cause of death of 466 — fewer than cocaine (843) but more than methamphetamine (25) and marijuana (0).
The study also found that while the number of people who died with heroin in their bodies increased 14 percent in 2007, to 110, deaths related to the opioid oxycodone increased 36 percent, to 1,253.
Florida scrutinizes drug-related deaths more closely than do other states, and so there is little basis for comparison with them.
The substitution effect here is palpable: People abuse prescription drugs largely because of the stigma and legal difficulties arising from gaining access to illegal ones, even though they're not as safe. So to that extent, the shift toward prescription drug abuse counts as a drug war "success," but only if you redefine the term "success" to mean causing more deaths instead of preventing them. (The Economist recently declared it a success to shift people from using meth to cocaine, but the Florida study says coke is much more dangerous to users than crank; by that logic, to judge by these data, it'd be a public safety success to get people to shift from Vicodin or Xanax to marijuana, which didn't kill any Floridians last year.)
"Harm reduction" historically focused on illegal drugs, but what if that's not main source of drug-related harm? What's needed now, apparently, are more addiction treatment resources and harm reduction strategies aimed at legal prescription drugs.