My Unpublished Letter to the Editor on the Tragic Drug Overdose Report

On November 18 the Wall Street Journal ran a front page story entitled “Drug Overdose Deaths, Fueled by Fentanyl, Hit Record High in U.S.” It reported on provisional data from the Centers for Disease Control and Prevention that reveal a heartbreaking 100,306 drug overdose deaths for the 12 months running through April 2021, a 29 percent increase over the previous 12 month period.The report released by the CDC on November 17 stated that 75,673 of the more than 100,000 overdose deaths were opioid‐​related, up from 56,064 the previous year. The remainder of overdose deaths involved cocaine, methamphetamine, and other psychostimulants with abuse potential. Fentanyl was involved in 85 percent of the opioid‐​related overdose deaths in the most recent data.The WSJ article went on to state:Fentanyl has for years been a major catalyst in an intensifying U.S. overdose crisis. The nation was reporting fewer than 50,000 fatal overdoses as recently as 2014. In 2020, the number surged to a record of about 93,330.I submitted a letter to the editor of the Wall Street Journal, shown below, that reflects on the tragic new numbers. Regrettably, my letter wasn’t published.Dear Editor:Of the 75,000 opioid‐​related overdose deaths reported by the Centers for Disease Control and Prevention for the 12 months ending in April 2021, 85 percent involved illicit fentanyl, made in labs and smuggled into the U.S. by Mexican drug cartels. Meanwhile, opioid prescription volume has dropped roughly 60 percent since 2012. Powerful anecdotes of patients developing addiction notwithstanding, government data show no correlation between prescription volume and non‐​medical use of opioids or opioid addiction. The overdose crisis has always been fueled by drug prohibition and the lucrative, dangerous black market that results. In recent years fentanyl–50 times more potent than heroin, and easy to make in labs–has emerged as the main cause of overdoses. Initially used to fortify heroin, it now is used to make counterfeit prescription pain pills sold to unsuspecting non‐​medical users, mixed with cocaine or methamphetamine for “speed balling,” or as a heroin substitute. The latter has become more prevalent as the COVID pandemic has disrupted heroin supply chains.This was never really an “opioid crisis.” It has always been a prohibition crisis. Depriving patients of needed pain relief only makes matters worse. One way to ameliorate the problem is to promote harm reduction, and to permit cities like Philadelphia and states like Rhode Island to have safe consumption sites, currently banned by federal law. But harm reduction will only go so far to alleviate the situation. The deaths will continue to mount until drug prohibition ends.Sincerely,Jeffrey A. Singer, MD–Senior Fellow, Cato Institute