THE DRUG PROBLEM

To understand the scale of America’s current drug problem, look backward. In 1999, 16,849 people died of overdoses. If that number had grown in line with the population, in 2021, we would have lost 20,048 people.

The actual number was more than five times as many: 106,699. Moreover, this was a roughly 50 percent increase from 2019 . To address this crisis effectively, it’s essential to examine not just the scale, but the nature of the problem. Charles Fain Lehman’s recent essay on drug markets in National Affairs makes clear what the numbers show: a radical shift in the drugs themselves.

While rates of addiction have grown since the 1990s, this change has been modest compared with the soaring number of deaths. This is because high-potency synthetic drugs are crowding out agriculturally derived products such as heroin and cocaine. Because synthetic drugs start with precursor chemicals rather than plants, their production is more efficient and harder for authorities to detect. Because they’re highly potent — a kilogram of pure fentanyl is up to 50 times as strong as an equivalent amount of heroin — they’re easier to smuggle. And also because they’re so potent, the user margin for error is smaller, which means spiraling overdose deaths.

All this changes the nature of the drug problem. The old argument about treatment and harm reduction versus enforcement no longer addresses the core problem. Today, the question is not “What can be done about drug addicts?” but “What can be done about drugs that are harder to interdict and easier for users to kill themselves with?”

Lehman’s answer is that government policy should simultaneously discourage addiction and divert people into treatment alternatives. More treatment beds are needed, as is more expansive use of medicationassisted treatment, using drugs such as methadone and buprenorphine. (Unfortunately, no such alternatives exist for cocaine and methamphetamine.) Also needed are coercive mechanisms to ensure those beds are used, such as civil commitment and drug court diversion programs for addicts who become a danger to themselves or others.

It’s here where I would argue that Lehman’s solution doesn’t go far enough. Follow his case to its logical conclusion, and it seems to me there’s a strong argument for simply legalizing these drugs so that users are assured an uncontaminated supply of known and consistent potency.

Lehmann is skeptical, as are many other drug policy researchers I respect, and not without good reason. Most obviously, if the drugs were legal, it’s almost certain that more people would take them. In places that have legalized marijuana, for example, survey data suggest that use has increased significantly. Moreover, Lehman argues that the illegality of stronger drugs provides a mechanism for society to help people stop using them — for example through drug diversion programs for arrestees.

However, enforcement also has costs, for drug addicts and for the rest of us, even beyond the fact that a felony conviction can wreck a person’s life much more thoroughly than a drug habit does. Consider that, in one large Indiana county, nearby overdoses actually rose in the wake of drug busts, according to a new paper in the American Journal of Public Health. While the researchers can’t establish causation, this is consistent with the hypothesis the researchers started out with: When regular drug supplies are interrupted, users find that their tolerance diminishes at the same time that they are forced to seek out new suppliers selling products of unknown potency. The combination

We might have to settle for an option resulting in fewer deaths.

appears to be lethal.

And the potency of new supplies is unknown precisely because the product is illegal. When my dentist prescribes Vicodin, I don’t worry about filling the prescription at Walgreens instead of CVS. I trust that our well-regulated pharmaceutical supply system will deliver the correct dosage no matter where I buy it. I also don’t worry about getting caught in the crossfire when rival drugstores compete for territory.

That said, legalizing drugs also has real costs, and it won’t work to simply decriminalize and hope for the best. Lehman is right that a lot more funding for treatment is needed, and it is crucial to remove every barrier, regulatory and financial, that impedes people with opioid addiction from accessing medication-assisted treatment. We’ll also need more funding for law enforcement, because while tolerating some increase in the number of addicts will reduce the death toll, it is not necessary to tolerate the kind of public disorder that unchecked drug use has created in cities such as San Francisco.

Indeed, such tolerance would only undercut support for legalization. Drug users must understand that if they cannot take drugs without also committing crimes, injecting in public places or camping on the street, they will be forced into treatment.

Now, as a libertarian, I was pretty uncomfortable writing that last sentence, and reading it may well have made you uneasy, too. Many people will no doubt be equally wary of giving up on controlling the use of indisputably harmful drugs. But overdose has become the leading cause of nonmedical death in the United States, and we seem to be out of comfortable options. We might have to settle for one that results in fewer deaths.