In an effort to “combat the opioid crisis” in America, Congress is calling for a slate of governmental interventions that have been tried, tested, and shown to cause more harm.
Too much of the new legislation is grounded in the “overprescription” hypothesis, which blames the current unprecedented rates of overdose on an expansion in the number of opioid prescriptions that began in the 1990s.
In responding this way, Congress is ignoring decades of its own data and a lesson Americans should have learned long ago: When government restricts access to something people want, it drives demand to the black market. In this case, as opioids have become increasingly difficult to obtain legally in the last decade, users have switched to “diverted” prescription medications and illicit alternatives, including heroin.
Thanks to prescription drug monitoring programs (PDMPs), state-level limits on the number of pills a patient can receive, and Drug Enforcement Administration (DEA) orders to reduce opioid manufacturing, prescription rates are now at their lowest level since 2006. Yet the overdose death toll over the last eight years is at a historic high.
It is true that leading up to peak prescribing, at the end of the last decade, prescription opioids caused the majority of drug overdoses.
But cracking down on those prescriptions not only failed to stem the tide of overdose deaths—it threw the crisis into high gear. The opioid overdose mortality rate has increased by more than 90 percent since 2010.
It’s clear that the black market has claimed the economy ceded by restrictions on the legal market.
Notice on the following chart the sharp increases in fatality numbers that follow legislated reductions in opioid prescribing. That relationship holds throughout the country and becomes more profound as the length and magnitude of opioid restrictions increase.
The goal of these programs is to stop negligent opioid overprescription, but there is strong evidence that fearful practitioners are now giving people less medication than they need to keep pain at tolerable levels.
Although most doctors want to prioritize their patients’ needs, they are understandably willing to sacrifice patient comfort to avoid criminal prosecution, and prescriber infractions are treated differently than most crimes under federal law.
The Controlled Substances Act authorizes the DEA to circumvent Fourth Amendment judicial approval and seize PDMP records without a warrant.
Congress needs an intervention.
America is not alone in grappling with an overdose crisis, yet many of our peers in the developed world are on the road to recovery. We’re still searching for rock bottom.