Recently, mainly because of opioid-related deaths - mostly of our white siblings - the president Donald Trump proclaimed that the problem of opioids was national. emergency. He promised to "devote a lot of time, a lot of effort and a lot of money to the opioid crisis" because "it's a serious problem like we've never had one." ".
That's wrong. From the late 1960s, the heroin crisis happened in the same way, except that the heroin addict then in the media was black, without resources and engaged in repetitive little petty offenses to feed his habit. One solution was to lock up the users, especially after the adoption in 1973 of the infamous New York state drug laws Rockefeller. In the early 2000s, more than 90% of convicts under these laws were black or Latino, out of all proportion to what they represented.
I am concerned that declaring the opioid crisis as a national emergency is primarily used to increase law enforcement budgets, precipitating an escalation of this type of systematic racial discrimination. Recent federal data show that more than 80% of people convicted of heroin trafficking are black or Latin American, even though whites consume opioids at higher rates than other groups and tend to buy drugs within their racial group.
The president also said that the opioid crisis "is a global problem". This is not the case. In all of Europe and in other areas where opioids are readily available, people do not die at rates comparable to those in the United States, largely because addiction is not not considered a crime but a public health problem.
It is certainly possible to die from an overdose of an opioid alone, but this represents a minority of thousands of opioid-related deaths. Many are caused when people combine an opioid with another sedative (such as alcohol), an antihistamine (such as promethazine) or a benzodiazepine (such as Xanax or Klonopin). People do not die because of opioids; they die because of ignorance.
There is now one more opioid in the fentanyl mix, which produces a high heroin but is considerably more potent. To make matters worse, according to some media reports, illicit heroin is sometimes falsified with fentanyl. This, of course, can be problematic - even fatal - for unsuspecting heroin users who ingest too much substance thinking that it is only heroin.
A simple solution is to provide free and anonymous drug testing services. If a sample contains adulterants, users will be informed. These services already exist in countries like Belgium, Portugal, Spain and Switzerland, where the first goal is to protect users. Law enforcement officers should also conduct such tests whenever they confiscate illicit drugs, and they should inform the community whenever potentially dangerous adulterants are discovered. In addition, the antidote to naloxone against opioid overdoses should be made more affordable and easily accessible not only to first responders but also to opiate users and their family and friends.
The vast majority of opioid users do not become addicts. The chances of addiction of users increase if they are white, male, young and unemployed and have concurrent psychiatric disorders. That is why it is essential to conduct a thorough assessment of patients who are starting treatment, paying close attention to these factors rather than just focusing on the unrealistic goal of eliminating opioids .
In many countries, including Switzerland, the Netherlands, Germany, and Denmark, opioid treatment may include daily heroin injections, just as a diabetic can receive daily injections of insulin and treat the medical and psychosocial problems of the patient. These patients work in jobs, pay taxes and live long, healthy and productive lives. Yet, in the United States, such programs are not even discussed.
For about 20 years, the number of Americans who have tried heroin for the first time has been relatively stable. The use of heroin specifically and the use of opioids in general are not going anywhere, whether we like it or not. This is not an endorsement of drug use, but rather a realistic assessment of empirical evidence. Addressing the opioid crisis with ignorant comments from politicians and the inappropriate use of public funds contribute little to ensuring user safety. Perhaps, for once, we should try interventions that are informed by science and proven at work.
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