Fentanyl is not a problem. Drug laws are the problem.

Robert Charles, a political appointee of George W. Bush, sounds the alarm that "we are nearing the falls."[1] Supposedly all we need to do is "care." Apparently this will miraculously cure "the problem."

Others have declared that "Fentanyl is the reason why deadly overdoses from painkillers continue to climb in the US."[2] Like Charles, they commit the logical error of declaring that the last step in a multi-step process is the source of a problem.

Such an assessment is simply wrong. Pundits use factual but context-free language to paint certain drugs as somehow evil. Fentanyl is "illegally made" and "synthetic."  It is "50 times as powerful as heroin." As Herman Cain notes in his new book, we have to tackle The Right Problems.

In my thirty-six years in anesthesiology, I administered literally gallons of Fentanyl. It is a very safe drug, primarily because it's a pure narcotic with limited and very well understood side effects. Its more potent relative Sufentanyl is similarly useful. Each has a specific niche. The fact that they were synthesized in a lab is irrelevant.

Narcotics exist because we need them. Your body makes them in forms called endorphins. Various plants such as the opium poppy have been found to make narcotics, and those plants have been used for millennia to treat pain. They have been an important cash crop for almost as long. As our knowledge of chemistry has advanced, we have learned how to purify and modify them, creating synthetic narcotics.

After the Civil War, Chinese labor gangs were used on many construction jobs, including the Trans-Continental Railroad. Opium (about 12% Morphine) was their recreational drug of choice. William Randolph Hearst slandered "the coolie" as "the yellow peril" in his newspaper, and other demagogues joined the outcry. Racism on parade led to opium restrictions and the Chinese Exclusion Act.

The facts about opioids are fairly simple.

Drug

Milligrams for Equal Effect

Duration (hrs)

Morphine

10

3-4

Heroin

5

3-4

Dilaudid

2

3-4

Methadone

20

22-48

Fentanyl

0.1

30-60 minutes

Sufentanyl

0.01

30-60 minutes

Oxycodone

15

2-4

Demerol

75

2-4

Codeine

130

4-6

Listed duration is approximate, and varies with age, health, and route of administration. The most common side effects are respiratory depression, drowsiness, and nausea.

A quick look at the table shows that all of these drugs are well-understood. It also shows that the supposedly "bad" drugs, Heroin and Fentanyl, are not fundamentally different from the others. As I noted, Fentanyl is widely used in medicine, and without the legal ban Heroin would be as well. It's just as good a pain reliever as Morphine or Dilaudid. Since those drugs make some people sick, Heroin would be a potential alternative for them. But legal hysteria has made it unavailable.

So why are people dying from Fentanyl overdoses? The root of the problem is the drug law itself. Like aspirin, all of these drugs are dirt cheap to produce. But at the curbside pharmacy they become expensive because of what economists call a "risk premium."

If I want something illegal, I'll either forget about it or find someone to provide it. But since it's illegal, the supplier will insist on a high price to compensate for the risk he's taking. If I'm going to pay that higher price, I'll demand better quality. It's a vicious circle. Any student of history can explain how that happened with alcohol during Prohibition.

If it were legal to grow opium poppies, someone who wanted a mild effect would simply dry some sap and smoke it. It produces a mild buzz, and that's all most people really want. Certainly a purer preparation could be used, but since we know the doses, it would be easy to get the desired small effect. That's why many people drink "lite beer." Opium would cost almost nothing. Just grow your own poppies. The flowers are pretty.

With Drug Prohibition, street drugs become more and more potent, responding to the market. Opium is processed to make Heroin. Fentanyl is purloined from the hospital. With potency and high prices come a myriad of new problems. Instead of taking a small graded hit, the user now takes a big hit that makes addiction more probable. That big hit is more expensive, putting a strain on personal finances. High profits for suppliers create incentives to give "freebies" that create new addicts/customers. And the money leads to crime.

The real problem that leads to Fentanyl deaths is not Fentanyl. It's Drug Prohibition. Our drug laws don't materially reduce addiction to alcohol, tobacco, or narcotics. Instead, the risk premium they create leads directly to the perverse effect of more addiction.

Addicts deserve proper treatment. Family tragedies need to be averted. But we must go forward by asking the right question: "What causes more harm? Drugs? Or Drug Laws?"


[1] R Charles, "Nearing the Falls in America's Drug Crisis", http://www.americanthinker.com/articles/2016/12/nearing_the_falls_in_americas_drug_crisis.html, Accessed December 12, 2016

[2] J Kamp, A Campo-Flores, "Hooked: One Family's Ordeal With Fentanyl", Wall Street Journal, May 13, 2016.

Robert Charles, a political appointee of George W. Bush, sounds the alarm that "we are nearing the falls."[1] Supposedly all we need to do is "care." Apparently this will miraculously cure "the problem."

Others have declared that "Fentanyl is the reason why deadly overdoses from painkillers continue to climb in the US."[2] Like Charles, they commit the logical error of declaring that the last step in a multi-step process is the source of a problem.

Such an assessment is simply wrong. Pundits use factual but context-free language to paint certain drugs as somehow evil. Fentanyl is "illegally made" and "synthetic."  It is "50 times as powerful as heroin." As Herman Cain notes in his new book, we have to tackle The Right Problems.

In my thirty-six years in anesthesiology, I administered literally gallons of Fentanyl. It is a very safe drug, primarily because it's a pure narcotic with limited and very well understood side effects. Its more potent relative Sufentanyl is similarly useful. Each has a specific niche. The fact that they were synthesized in a lab is irrelevant.

Narcotics exist because we need them. Your body makes them in forms called endorphins. Various plants such as the opium poppy have been found to make narcotics, and those plants have been used for millennia to treat pain. They have been an important cash crop for almost as long. As our knowledge of chemistry has advanced, we have learned how to purify and modify them, creating synthetic narcotics.

After the Civil War, Chinese labor gangs were used on many construction jobs, including the Trans-Continental Railroad. Opium (about 12% Morphine) was their recreational drug of choice. William Randolph Hearst slandered "the coolie" as "the yellow peril" in his newspaper, and other demagogues joined the outcry. Racism on parade led to opium restrictions and the Chinese Exclusion Act.

The facts about opioids are fairly simple.

Drug

Milligrams for Equal Effect

Duration (hrs)

Morphine

10

3-4

Heroin

5

3-4

Dilaudid

2

3-4

Methadone

20

22-48

Fentanyl

0.1

30-60 minutes

Sufentanyl

0.01

30-60 minutes

Oxycodone

15

2-4

Demerol

75

2-4

Codeine

130

4-6

Listed duration is approximate, and varies with age, health, and route of administration. The most common side effects are respiratory depression, drowsiness, and nausea.

A quick look at the table shows that all of these drugs are well-understood. It also shows that the supposedly "bad" drugs, Heroin and Fentanyl, are not fundamentally different from the others. As I noted, Fentanyl is widely used in medicine, and without the legal ban Heroin would be as well. It's just as good a pain reliever as Morphine or Dilaudid. Since those drugs make some people sick, Heroin would be a potential alternative for them. But legal hysteria has made it unavailable.

So why are people dying from Fentanyl overdoses? The root of the problem is the drug law itself. Like aspirin, all of these drugs are dirt cheap to produce. But at the curbside pharmacy they become expensive because of what economists call a "risk premium."

If I want something illegal, I'll either forget about it or find someone to provide it. But since it's illegal, the supplier will insist on a high price to compensate for the risk he's taking. If I'm going to pay that higher price, I'll demand better quality. It's a vicious circle. Any student of history can explain how that happened with alcohol during Prohibition.

If it were legal to grow opium poppies, someone who wanted a mild effect would simply dry some sap and smoke it. It produces a mild buzz, and that's all most people really want. Certainly a purer preparation could be used, but since we know the doses, it would be easy to get the desired small effect. That's why many people drink "lite beer." Opium would cost almost nothing. Just grow your own poppies. The flowers are pretty.

With Drug Prohibition, street drugs become more and more potent, responding to the market. Opium is processed to make Heroin. Fentanyl is purloined from the hospital. With potency and high prices come a myriad of new problems. Instead of taking a small graded hit, the user now takes a big hit that makes addiction more probable. That big hit is more expensive, putting a strain on personal finances. High profits for suppliers create incentives to give "freebies" that create new addicts/customers. And the money leads to crime.

The real problem that leads to Fentanyl deaths is not Fentanyl. It's Drug Prohibition. Our drug laws don't materially reduce addiction to alcohol, tobacco, or narcotics. Instead, the risk premium they create leads directly to the perverse effect of more addiction.

Addicts deserve proper treatment. Family tragedies need to be averted. But we must go forward by asking the right question: "What causes more harm? Drugs? Or Drug Laws?"


[1] R Charles, "Nearing the Falls in America's Drug Crisis", http://www.americanthinker.com/articles/2016/12/nearing_the_falls_in_americas_drug_crisis.html, Accessed December 12, 2016

[2] J Kamp, A Campo-Flores, "Hooked: One Family's Ordeal With Fentanyl", Wall Street Journal, May 13, 2016.

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