Sunday, June 15, 2008

Prescription drugs kill more people than illegal ones; new harm reduction strategies needed

Lately on this blog, discussions of "harm reduction" have centered around the Attorney General's nonsensical legal opinion and Bexar District Attorney Susan Reed's efforts to bully out of existence a legislatively approved needle exchange program in San Antonio. But to judge by newly available data, drugs targeted via needle exchange programs cause less "harm" to the general public than the ones distributed by pharmacists.

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):

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 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.

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.


Anonymous said...

Warning! wrant coming forth....

Darn, now people are looking to lock up more useful medicines? As if taking Sudafed off the shelves and back to the pharmacy isn't bad enough when you're stuffed up, and there isn't anything even close to being as effective. And then having parents use Tylenol rather than aspirin on their children (Tylenol still injures or kills more children each year than Aspirin ever did) (Use Motrin/Advil instead). And then removing the child dosing labels and infant cold medicines. Yes there are sometimes problems with these meds but we need to know the problems not have them removed. Removal just ties up the doctors offices more.

We don't need removal of medicines just information on how to use them properly (and limits on on how of meth forming drugs can be sold without gathering information [CA used to have that on Sudafed]).

Don said...

Dear Anon. 10:27
Sorry, but I am having a little problem connecting your "wrant" with Grits' post. Said naught about Sudafed and the like. Talking about prescription drugs. Aside from that, how does moving Sudafed behind the counter make it inaccessible to you?
In other words, did you read the post, and what are you talking about?

Anonymous said...

The entire healthcare delivery system in this country needs a complete overhaul. First on this list should be prescription drugs.

I noticed with glee that marijuana killed -0- people.

Prescription drug abuse is a very serious public safety issue. I strongly agree that the public needs far more education regarding drugs and their health care.

The mentality of "a pill will fix it" is sooooo.......1950's, it should be trashed along with the "I must have the best health care, the more I pay, the better care I'll receive" attitude.

Thanks for another good post!

Anonymous said...

Sooo, let's assume all ILLEGAL drugs were made legal, What do you do with the now penniless THUGS, who were robbing and killing each other to make their living, instead of WORKING like millions of LAW ABIDING citizens? Free handouts from the LAW ABIDING citizens government? I don't think so.
I'm so sick of the "No Victim mentality" in this country! Don't feel like working, then get the HELL out.
By the way how many of those overdoses were by the elderly, cildren and those who were abusing alcohol while taking drugs????????
Remember the good old days when people were actually responsible for thier behavior?

Anonymous said...

Does anybody else understand 12:30's comment? Is there anybody who doesn't think the vast majority of drug users don't have jobs and pay for their drugs just like Joe Sixpack pays for his beer?

The people robbing to keep up a habit are a function of what Grits called "strategies that force the product to be delivered through a black market." Everybody thinks driving up drug prices is a good thing, right up until somebody robs your house to pay for a gram of blow.

Anonymous said...

The problem with Grits post is that it appears that someone's solution to the problem is to lock up more drugs. Right now if you use meth you might try convincing an MD you have ADD/ADHD and get an Rx for Adderall. Or if you would use heroin, convince a pain MD you need Oxy or Codeine.

The solution isn't to make your doctor and pharmacist responsible, but rather the end user: In China they used to have a serious drug problem, it was largely solved by the execution of users. I don't suggest we go that far on the first conviction but maybe after three convictions with other dangerous actd with rehab in between, we should consider it.

And lets free up our limited pharmacists for actually filling needed Rx's and not dealing with providing Claratin with decongestants. That's like asking to give all those elderly people, standing in line, picking up Rx's the cold or flu.

Gritsforbreakfast said...

Re: the idea that "maybe we should consider" executing drug users, a) Communist China is hardly where I draw my suggestions for law enforcement reforms, and b) SCOTUS has ruled that death is too harsh a punisment for raping an adult, so the idea of using it for drug use would never stand muster. (SCOTUS will soon decide in the Kennedy case out of Louisiana whether the death penalty is an acceptable punishment for child rape, but that's about as far as they could conceivably go under existing stare decisis.)

Executing users is a notion that may sound pleasing as political demagoguery, but the proposal has no basis in reality, could not occur, ever, and as such shouldn't be part of any serious discussion on the topic.

I'm not advocating for further criminalizing prescription meds, though some folks are. My view is that the system is overwhelmed already from using jails and prisons as implements of what's really a public health policy. I'm just citing a data point that impacts many drug policy debates and IMO contributes insight into a number of broader discussions occurring over time on this blog.