The Real Cause Of America's Opioid Epidemic

Authored by Mark Thornton via The Mises Institute,

The Opioid epidemic is spreading across the heartland of America. The number of drug overdose deaths from both prescription (e.g., Oxycontin) and black market (e.g., heroin) opiates exceeded 30,000 in 2015. Initial estimates for 2016 indicate yet another new record of deaths. It is such an enormous problem that I taught a special class on it at our undergraduate instructional conference, Mises University, which you can listen to here.

Recently the Commission on Combating the Opioid Crisis issued a preliminary report and recommended that the president declare a national emergency.

From 2002 to 2015 the number of such deaths has increased by 280%. The chart below shows that prescription opiates were the main contributor from 2002 to 2011. Illicit opiates have been the main contributor since:


It is vitally important that we understand what is causing this epidemic and even more important, how do we solve it. Plus, we need to avoid becoming a victim of it. In the past, most people ignored the issue of drug overdoses as merely an urban “junkie” problem, but this epidemic is hitting ordinary Americans such as coal miners, teachers, and high school football players.

The Washington Post asserted that the problem arose because of “aggressive marketing” on the part of the pharmaceutical companies that sell opiate painkillers. Others on the left think it is an arbitrary explosion of demand. They make it sound like market failure, but the “aggressive marketing” was not slick TV commercials. Rather, the drug companies targeted doctors, not consumers. They provided many lucrative carrots to doctors and spent resources lobbying to change regulations and pain prescribing guidelines in order to rig the FDA/AMA system in their favor.

In terms of solutions, leftists advocate spending lots of more money on just about everything they can think of, especially drug addiction treatment programs, but such programs are both extremely expensive and ineffective.

Conservatives tend to think of the cause of the epidemic in terms of the evil Mexicans and Chinese, along with street dealers and drug gangs. The Trump administration thinks that building the Mexican wall will help. They have also advocated for policies that have been demonstrated to be failures, such as expanding minimum mandatory prison sentences and asset forfeiture programs. They think expanding the D.A.R.E. program will help solve the problem, but several government-sponsored reports have discredited the effectiveness of the Drug Awareness Resistance Education program.

The real cause of this epidemic is various government policies and the real solution is the dismantling of those same policies, in perpetuum.

The Four Causes

Let us start with drug prohibition which dates back to the Harrison Narcotic Act of 1914. Drug prohibition results in a black market where illegal products are not commercially produced and where suppliers are not constrained by the rule of law and product liability law. The result is that illegal drugs are more dangerous than legal drugs. Potency varies greatly from batch to batch and products often contain dangerous impurities and substitute ingredients. Opiate overdoses often occur when an addict is unaware that a particular dose is highly potent or contains Fentanyl, a pain medication that is 50 to a 1,000 times more potent than morphine.

The next cause is called the Iron Law of Prohibition, a phrase first used by Richard Cowan to describe the phenomenon that when drug law enforcement becomes more powerful, the potency of illegal drugs increases. One of the effects of enhancing prohibition enforcement is that suppliers will produce a higher potency drug. For example, during alcohol prohibition in the 1920s suppliers switched from producing beer and wine to highly potent spirits, such as gin and whiskey.

A second result of more rigorous prohibition enforcement is that suppliers will switch from lower potency drug types to higher potency drug types. For example, during Ronald Reagan’s “war on drugs” during the 1980s, smugglers switched from bulky marijuana to highly concentrated cocaine and domestic suppliers turned much of this cocaine into crack cocaine, resulting in the crack cocaine epidemic. The Iron Law of Prohibition explains why we see more and more dangerous drugs on the black market and why we see decreases in overdoses in states that have legalized cannabis.

Government intervention in the economy is a largely unrecognized cause of addiction. Intervention has at least two distinct channels of creating addicts. The first is war. War creates addicts through both painful physical injuries and painful emotional and psychological disorders, such as Post Traumatic Stress Disorders. The second cause is the general impact of widespread government intervention in the economy. Much of government interventionism results in the creation of privileges and monopoly power. For example, licensing requirements provide members of a profession, such as medical doctors, with monopoly profits by restricting the number of practicing physicians. This enriches licensed doctors and impoverishes potential doctors who must find work in another profession. These excess potential doctors thereby suppress wages in other labor markets. Given the pervasiveness of government intervention, this creates two classes in labor markets — the advantaged and the disadvantaged and addiction tends to develop in disadvantaged labor markets where people are more likely to be despondent and lack hope and economic resources.

The three above causes have been around for a long time creating the environment for drug overdoses, but at much lower levels than we see today.

The final cause has only been around for a couple of decades, but it is now responsible for the majority of deaths. Alluded to above, Big Pharma undertook “aggressive marketing” in order to encourage doctors to write massive numbers of prescriptions for opiate painkillers and to change to pain prescribing guidelines in order to sell more of these heroin-like pills.

As a result, doctors began prescribing drugs such as Oxycontin and Vicodin, which are similar to opiates, such as morphine and heroin, for ordinary injuries and minor surgeries. The problem with this is that if you take these pills for 30 or 60 days, there is a distinct possibility that you will become physically addicted to them. The doctor is not going to write you refills for the prescription once the injury has healed.

This leaves the addict with three bad choices.

One, you can enter a drug addiction rehabilitation program, but these programs are expensive and are not necessarily effective.


Two, you can go cold turkey. However, detoxification comes with a slew of physical and psychological symptoms and can result in suicide and death.


Three, you can go into the black market and buy illegal Oxycontin and Vicodin pills. The problem with this option is that such pills are expensive and have an unstable supply. What happens if you choose this option, but run low on money or have trouble acquiring the pills? Well, very often the drug dealer who sold you the pills can also sell you heroin or tell you where to buy it. Heroin is often cheaper per dose and has a more stable supply. This is how people who would never even consider entering a room in which heroin was present become heroin addicts. This process is what has caused the major surge in drug overdoses.

The solution to the epidemic is to legalize drugs. Doctors should be able to put their patients on drug maintenance and recovery programs. Commercially produced opiates would be pure and relatively safe. Addicts could go about their lives, attempting to recover physically, psychologically, socially, and economically without having to worry about how to obtain and pay for their drugs. Drug addiction is often a multi-faceted problem that simply cannot be fixed with a 30 day rehab experience. Addicts that are successfully detoxed, but without solving more basic problems, often relapse and die because the dose they take is now too strong for their detoxed body.

Legalizing cannabis would also be a key to solving the epidemic. Legal cannabis improves the epidemic through two channels. First, medical formulations of cannabis can be a potent, but non-addictive pain killer. Therefore, legalization leads to a reduced level of opiate use, abuse, and mortality and there are several peer-reviewed studies that confirm this. Second, because cannabis reduces pain and anxiety, and improves sleep and appetite it is very helpful for those who are trying to beat their heroin addiction.

The Opioid epidemic is killing more than 30,000 Americans a year. For most experts, the epidemic is a mystery with regard to its cause and solution. A little progress has been made, but to really eliminate the problem we need to legalize drugs, reduce the size of government, and increase freedom in our lives. We also need to find an answer for the pain epidemic which has shackled too many Americans to Big Pharma and the medical belief that every symptom requires another prescription!


Croesus philipat Mon, 08/21/2017 - 21:18 Permalink

"expanding the D.A.R.E. program will help solve the problem"

Yeah, ok.

Kiddies, these are Drugs. This is what they look like, smell like, taste like. This is how they make you feel. Do your parents use drugs? Drugs are bad kiddies. Drugs are bad. Don't do them.

The above, is the message delivered to kids at school. When they get home to TV and Interwebs, this message is reinforced with imagery of celebritards using drugs...and never facing consequences the same way normal people would.

Dare program my ass.

In reply to by philipat

PT bamawatson Mon, 08/21/2017 - 23:34 Permalink

Re " ... and where suppliers are not constrained by the rule of law and product liability law. The result is that illegal drugs are more dangerous than legal drugs. Potency varies greatly from batch to batch and products often contain dangerous impurities and substitute ingredients ..." :What?  You mean a free market does not work without government regulation to ensure quality?  Gee, what a surprise!

In reply to by bamawatson

PT PT Mon, 08/21/2017 - 23:52 Permalink

Now imagine a world where drugs had never been made illegal.  First think of the legal stuff now ... like sugar, salt and caffeine.  Now imagine that food companies were using illegal drugs instead - sugar, salt and caffeine are all there to create addictions too, so why wouldn't the food companies jump straight to the more potent substances?  There would still be Cocaine in Coca Cola, but how much?So can we at least agree that unfettered legality would create more problems than it solves?  At least innocent people can protect themselves simply by obeying the law (errr, except for the doctor thing.  They can no longer trust doctors - but they can read the warnings on their medication and ask themselves why the hell the doctor is prescribing something with those kinds of warnings on it.) People can't protect themselves when they break the law?  Since when has that ever been a solveable problem?  Granted, it would be nice to take the money out of illegal drugs so it is tempting to legalize the lot - I would add making it legal to grow and take your own but illegal to Sell.  Plus putting all liability for addiction and other bad effects onto the drug seller / provider.  You want someone to take this crap?  You give it to them for free.  Forever.   Perhaps the existing court system could sort out that kind of stuff.Much easier just to shoot the pushers.  They're called "pushers" for a reason.  That word did not magically appear.  Those fuckers won't take a polite "no", they'll hassle you for the rest of the night.  They know what they're doing.

In reply to by PT

PT PT Tue, 08/22/2017 - 00:01 Permalink

Now consider another industry where "drugs" are legal:  The body building industry.  Those guys are trying to bulk up as big as possible and many are happy to only use substances that are legal.  How's it working out for them?  Genuine question, I really don't know.  I know that some of them get  huge health problems after a decade or two.  I just don't know whether it is caused by legal substances or illegal substances.  These guys want to get big and strong and they put in a huge effort to educate themselves on what works, what doesn't and how to avoid bad side effects.You want a best-case control of a society where drugs are legal, and what problems may still come up, examine the world of body building.  You could learn alot from those guys.

In reply to by PT

WarPony junction Mon, 08/21/2017 - 20:46 Permalink

Four (((better))) reasons:Poppy production up over tenfold since (((ISAF))) went into Afghanistan 16 years ago(((Federal))) crack down on doctors prescribing opiate medsThe financial crisis and unemployment (I.e., the (((O'Zero))) effect, destroying the U.S.)(((See eye aye))) cranking up the profits

In reply to by junction

UselessEater WarPony Mon, 08/21/2017 - 21:24 Permalink I can hardly praise this article enough or overestimate its importance. It is the first of three such articles on the subject of Big Pharma and the opiate addiction epidemic it has irresponsibly unleashed in America under the influence of organized Jewry in the form of the oligarchic Sackler family. This is Edmund Connelly at his best. We are taken right into the heart of darkness here. You owe it to yourselves and your families to acquaint yourself with the grim facts of this man-made epidemic if only for this reason: your own survival and happiness depend upon it.

In reply to by WarPony

not dead yet hibou-Owl Tue, 08/22/2017 - 03:26 Permalink

Guess you don't have much experience other than taking the easy way out and ignorantly blaming food like a good food police poodle. I worked for a living for 40 years doing very heavy lifting. Probably lifted more in a week than most wussies do in a year. Both knees are gone and the CT scan says deteriorated spine. Both hurt a lot but I stay active as it makes it less painful. Just a couple of over the counter pills a day so I can walk. Never drank or did drugs. Unless the sciatic acts up or I've been very active I only have problems when I'm on my feet unlike those with cronic pain who never get any relief. The worst is standing and reaching and bending. Making the beds after washing the bed stuff tears me up badly. A few minutes work and the pain exhausts me for hours. Can swing a golf club no problem but bending to tee a ball is a bitch. Lots of people that are bent and broken got that way by working for a living doing jobs the POS pussies won't do as they sit in their cubicles doing as little as possible spouting the BS that people without a degree shouldn't be paid squat. Doing jobs that made the products that paid Mr Chair Jockies wages. Working stiffs get retired, if they make it that far, to go home and die early while the desk rider who never lifted anything or had to breath dirty chemical laden air or coal dust for 40 years has a nice happy time in retirement.

In reply to by hibou-Owl

techpriest BeepBeepRichie Tue, 08/22/2017 - 01:55 Permalink

My wife is doing some research in this space - drugs have finally gotten high enough in price that the research world is giving up on the approach and moving toward food-based alternatives. Dark blue/purple/yellow/red plants and herbs = awesome. Real eggs with orange yolks = great tasting and great for you. And of course, deep green veggies too.

And to your comment, turmeric, specifically the curcumin in it, is a hot topic in the food-as-medicine world, and it is getting real funding.

On a whim she bought us some Hot Pockets, and having eaten a lot of real food the last year, I've noticed that foods I used to like are pale and bland, like there's no nutrition there. Something to that...

In reply to by BeepBeepRichie

stocktivity BeepBeepRichie Mon, 08/21/2017 - 20:53 Permalink

Exactly! But the large drug companies contribute millions of dollars to politicians reelections so the politicians can keep marijuana classified as a schedule 1 drug - same as heroin. Schedule 1 drugs are not able to be used for medical research. Without the medical research into whether med marijuana works to releave pain, the large drug companies are free to continue selling opium perscriptions. A terrible circle jerk.

In reply to by BeepBeepRichie

not dead yet BGO Tue, 08/22/2017 - 03:46 Permalink

About 6 years ago I ran into a lady who worked for a sherrifs department in Northern Wisconsin. She said the heroin epidemic up there was huge. Don't know if it's true or not but there are some that claim once an opioid is in the body they can't tell if it's heroin or a prescription opioid. If true that sheds a new light on blaming doctors or big pharma. Especially when the FED's claim that even though huge quantities of heroin are coming in from Afghanistan Mexico is number 1. FED's also claim that even with the big drug busts they only get 5 to 10% of the stuff coming in.

In reply to by BGO