Epidemics of addiction may be created by deliberate supply not uncontrollable demand
An addict taking heroin - Julien Behal/PA Archive/PA Images   

The opioid epidemic continues to rage across America. To better understand its impact at a human scale, the Cincinnati Enquirer sent “more than 60 reporters, photographers and videographers into their communities to chronicle an ordinary week in this extraordinary time.”

The result is a truly extraordinary and harrowing piece of journalism that is impossible to summarise.

Nevertheless, we need explanations.

Writing for Bloomberg, Justin Fox looks at the latest research. Elevated levels of mortality caused by suicide, drug overdoses and alcohol poisoning are often referred to as ‘deaths of despair’. The name suggests a particular direction of cause and effect – i.e. people are killing themselves (one way or another) out of desperation at the condition they find themselves in.

Furthermore, the phenomenon appears to have a disproportionate impact on middle aged, white Americans – especially those living outside the big urban centres. Thus the implication is that the ultimate cause of the despair is the loss of economic opportunity (and perhaps cultural status) caused by globalisation.

But does the new research support these assumptions?

“None of [the new] studies have refuted the key finding of the [original] Case-Deaton research, which is that something disturbing is going on with the mortality rates of middle-aged white Americans. But they do seem to be shifting the explanation away from an economic one to something more epidemiological. The really big driver of the mortality shift is the opioid epidemic, and many of these opioid overdoses may not be the direct result of economic troubles. They’re not really ‘deaths of despair.’”

If economic hopelessness really was the big driver, then why the dominant contribution of opioids to the mortality shift? Wouldn’t one expect equally-striking contributions from suicide and alcoholism (the other deaths of despair)? As for the notion that whites are reacting to the erosion of their position in American society, how does that explain the fact that “American Indians and Alaska natives have seen even bigger mortality increases”?

Then there’s the geographical distribution of the opioid epidemic:

“…it’s striking how different things look from state to state. In New York, it’s the New York City exurbs that have been hardest hit; in California, it’s rural mountain counties far from any big city; in Ohio, it’s everywhere. These seem to be patterns that can be better explained by peer effects and the shape of drug-distribution networks than by underlying economic conditions.”

In other words, it is supply that is creating the demand for opioids not any external factor – people are using these substances because they are readily available (from both legal and illegal sources). They don’t call them pushers for nothing.

This accords with the argument that Damian Thompson made in his book The Fix: How Addiction Is Invading our Lives and Taking Over Your World. Thompson contends that epidemics of addiction are created by deliberate supply not uncontrollable demand. Writing for the Spectator in 2012, he gives the example of previous American drug epidemic:

“In the late 1960s, new techniques for manufacturing pure heroin coincided with the arrival of bored, scared and disorientated troops in the Mekong delta. By 1970, 15 per cent of soldiers were snorting or smoking heroin. The Nixon administration panicked at the thought of thousands of helpless junkies arriving back home after their tours of duty… In the event, though, the near impossibility of scoring high-grade heroin in Middle America meant that the vast majority of GI heroin users became almost instantly un-addicted.”

Today, scoring high-grade heroin – and all manner of other opioids – is all too possible in Middle America, which is why the epidemic exists.