The Solution to the Opioid Epidemic

According to many people, the U.S. is in the middle of an opioid epidemic.  It's debatable whether something that ultimately comes down to a personal choice can really be considered an epidemic, but the fact is, there is an unusually large portion of the population that is addicted to opioids, and opioid overdoses are becoming frequent enough in some places to become a serious financial problem.  This has ultimately lead to opioid use, and especially overdose, to be declared a national healthcare crisis.

Several states have started allocating funds specifically to overdose mitigation.  Some are also focusing on prevention.  Drugs designed to treat opioid overdose are likely to be covered by Medicaid in some states (and may already be in some).  States are even petitioning the Federal government for additional funding for this problem, and some have already diverted significant amounts of state tax income to it.

The plan for these funds is first, to administer drugs to reverse opiate overdoses.  This is a good start.  The costs include the cost of the drug and often transport and hospitalization costs.  Once treatment is complete and doctors are confident that the patient is no longer at risk, the patient is sent home.  At home, some of these patients take another hit and overdose again.  This has happened often enough that some places are considering limiting calls for opiate overdoses to one a day per person.  Of course, this is meeting a lot of resistance, as it would let anyone overdosing twice in a day just die.

There is a problem with this: It does not fix the problem.  Many of these addicts are going to keep overdosing.  The problem is also getting worse, as more people are getting addicted to opiates.  This is not going to help them either.  Supposedly some of the money is going to go to mysterious undefined "prevention" measures, but it is unlikely these are going have much effect.  D.A.R.E. has been used in many schools to discourage kids from trying drugs.  Schools that don't use D.A.R.E. generally have some other drug use prevention program.  The fact is, teaching people about how drugs damage the body is clearly not working well anymore.  Prevention funding could go to trying to catch the dealers, but the War on Drugs tried that with little success.  Throwing addicts in jail certainly won't help, as it will ultimately cost more than the treatment, and it will very quickly fill up our jails with people who's only crime is stupidity.

So far, I don't see anyone asking what the cause is.  We know a lot more people are using opiates.  We know the stigma that heroin once had is largely gone, resulting in a lot more people trying it and getting addicted.  It is becoming the hard street drug of choice.  We know people are overdosing, and treatment is expensive.  What we don't seem to care about is why?  Why is opiate abuse increasing at unprecedented rates?

It's not availability.  Yes, opiates are becoming more accessible online, but that started in the early 2000s.  The dramatic increase in use is fairly recent.  Opiates are becoming more socially acceptable among casual drug users, but this is the result of increasing use, not the cause.  The fact is, more people are using opiates, because more people want to use opiates.  One of the big deterrents to heroin and other opiate use in the past was how incredibly addictive they are.  People generally don't want to get addicted to things.  The exception is that alcohol abuse has traditionally been used to avoid thinking about difficult life circumstances.  It is the traditional anti-depressant (ironically, it is actually a depressant).  Now though, it is becoming clear that people are starting to care less about getting severely addicted to opioids.  This attitude suggests that people who are using opioids start with no intention to ever stop.

Why?  And why aren't we asking why?  The fact is, there are two main reasons so many people are starting to use opioids.  It turns out addiction to prescription pain killers is becoming more common among the rich.  Their social status makes it easier for them to convince doctors to keep writing prescriptions for the drugs.  Eventually they either become tolerant to the drugs or their doctors finally cut them off.  The goto drug for these people is now heroin.  This is not where the "epidemic" is coming from though.  Rich opiate users tend to be careful not to overdose, and there are far fewer of them than poor opiate users.  The source of the epidemic is the poor.  Illegal drug use and addiction have been a problem for the poor ever since these drugs were discovered.  So why do poor people use opiates?  In a sense, opiates are replacing alcohol.  Poor people use drugs because they are miserable.  They use drugs to combat depression.

Why has this only just started to become a problem?  What changed to cause so many more poor people to start using illegal opiates in recent years?  The answer is hope.  In the past, poor people hoped to escape poverty.  They saw occasional friends or family get out of poverty, and they had hope that they could do it too.  During the end of last decade and the beginning of this one though, they stopped seeing that.  Many have lived in poverty for generations.  As the recession hit, instead of seeing people occasionally escaping poverty, they saw more and more people sinking into poverty.  What hope is there to get out of poverty when the net flow is downward?  In addition, they were made more aware of the fact that the situation is getting worse, by movements like Occupy Wallstreet, that initially started out powerful, getting people to start talking about the issues, but then ultimately sunk back into nothing, without any substantial changes being made.  This crushing despair lead to depression, and ultimately a life of opiate addiction started to seem better than having to constantly think about the fact that it is only going to get worse.

The "opiate epidemic" is not about opiates at all.  Rising opiate use is the consequence of poverty.  That is the "why".  The poor are turning to opiates, because they feel like they are under the weight of crushing poverty.  When they have to turn to the government for welfare, they feel robbed of their dignity, in part because it is nearly impossible to use government welfare without everyone from your doctor to your cashier knowing about it, and in part because our culture shames people who don't make enough to support themselves, even when they are working 80 hours a week at two or three jobs.  Our culture treats people who can't earn a living working for someone else as lazy misfits, whether it is true or not.  This attacks the psychological need of people to be accepted, and it predictably results in depression.  There are only two logical ends for people with severe, untreated depression, and those are drug use and suicide.  Really, it should come as no surprise that our mistreated, disrespected poor are turning to opiates in droves, right when the last bit of hope was ripped away from them.

I wonder how our elite would be reacting if every poor person who chose to get addicted to opiates committed suicide instead.  Would they take poverty more seriously, or would they start spending tons of money trying to force people to stay alive when they don't want to?  Sadly, probably the second.  Because right now, we are focusing on how to prevent drug users from accidentally killing themselves, when we should be focusing on how to prevent them from wanting to use drugs in the first place.

If we would focus on the right question, the answer is simple: Eliminate poverty.  This is not impossible.  I have done the math (among many, many other people).  Our existing welfare system, excluding medical welfare, already costs 75% of what we need to eliminate poverty, and there are plenty of places the other 25% could come from.  A marginal decrease in military spending would be enough.  A slight reduction in tax cuts for large businesses would do it.  In fact, eliminating poverty would ultimately cover the cost of that 25% by itself in the form of improved economy, reduced law enforcement costs, and reduced medical welfare costs.  We can already afford the basic income that would eliminate poverty in the U.S.  We have been able to afford a basic income since before Nixon's Presidency, when we almost got one, and then it unfortunately failed due to misinterpreted data from an experiment in basic income in Seattle.

Since the Seattle experiment, there have been many other experiments with basic income and handing out free money in general, and they all agree that a basic income reduces crime, drug use, and other negative things, and it increases productivity and innovation, it improves the economy in general, and it improves overall health, reducing medical spending.  In short, the cure to the opioid epidemic, along with a lot of other things, is a universal basic income.