By Dr. Carr McClain

I give patients the synthetic opioid fentanyl almost every day in my surgical practice. It’s safer and has fewer side effects than Morphine, yet it’s now by far the leading cause of drug overdose deaths in America.  Fentanyl itself is not the problem. Legal, regulated, properly administered fentanyl kills no one.  Unlabeled, black-market fentanyl, which only exists because of the prohibition of other popular drugs, now kills thousands every year.   If we want consumers to stop buying unregulated narcotics and dying, we should consider allowing adults to have broader legal access to narcotics. It could save tens of thousands of lives every year.

Fentanyl is not a new drug.  It has been used in medical settings for decades. Most Americans who ingest it do so safely, under a doctor’s care.  They do not become addicted, overdose, or die. Today’s fentanyl crisis started because of a principle called The Iron Law of Prohibition.  This holds that when a class of drug is made illegal, the prevailing form will become more concentrated and potent, making it easier to hide and transport while avoiding detection.  We’ve seen this before:  Alcohol prohibition caused hard liquor consumption to explode in a country that previously drank mostly beer.

Over the last 20 years, we have witnessed this phenomenon with narcotics. The over-prescription of legal opioid painkillers was a real problem. But it was met with the ineffective drug policies of the last 50 years: interventions to control the availability of prescriptions, efforts to cut many patients off entirely, then arrests and imprisonment for the crime of being addicted to a socially unacceptable substance. The result? People who previously got properly labeled Percocet and Lortab from a doctor were drawn to obtain unlabeled narcotics from street vendors. At the same time, fentanyl became the perfect additive to increase potency, thereby decreasing the packaging size of other illegal narcotics.  Fentanyl is inexpensive to manufacture, and as a synthetic opioid, it does not require the cultivation and harvesting of poppies – the source of morphine and heroin.  The decrease in access to legal, regulated narcotics has pushed more consumers to buy from the underground market, where the Iron Law of Prohibition has brought us unregulated fentanyl.

The Centers For Disease Control estimates that from November 2020 to November 2021, about 107,000 Americans died from drug overdoses.  Of those deaths, 70,000 were from synthetic opioids – fentanyl. (1)   Almost none of these deaths are suicides. They are accidents. Those seeking narcotics are not seeking fentanyl, and the seller on the street likely does not even know exactly what they are selling.  People obtain what they think is heroin, and instead, they ingest something 25-50 times stronger than heroin.  Their breathing is depressed, and they die. Imagine a diabetic buying unlabeled insulin on the street and inadvertently taking 50 times his needed dose. He would die.

Mississippi will soon have legal medical cannabis, supported by most voters. Cannabis legalization is finally well-accepted, but mention legalizing other drugs, and the tone changes. “Hard drugs? No way. They are addictive and deadly.”

Our approach to drugs is backward. The more harmful or addictive a drug can be, the more important it is to regain regulatory control by legalizing it. No one is dying from cannabis overdoses. They are dying from overdoses of drugs like heroin, cocaine, and now fentanyl.

 Each drug overdose death is a tragedy that should stir our emotions.  These are preventable deaths. We can simultaneously grieve our lost brothers and sisters but be clinical about the circumstances of their deaths and the options for decreasing those deaths.  Legal, regulated, and properly administered narcotics would save the lives of thousands of people and open a much wider door to treatment for those who develop an addiction.  Will many of them remain dependent on opioids?  Perhaps. But isn’t the goal to reduce harm?   Allowing adults to have supervised access to legal, regulated narcotics will keep them from resorting to the deadly unlabeled products sold by criminals. If our goal is truly saving lives and minimizing harm, we must consider policies that actually do that.

1.    www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm

Dr. Carr McClain is a cardiovascular surgeon at Forrest General Hospital.  He lives with his family in Hattiesburg, MS.