A crack cocaine addict in LA. Credit: David McNew / Getty

August 9, 2018   3 mins

America’s opioid epidemic is a story UnHerd has returned to several times – and with good reason. In 2016 alone, opioid overdoses in the US killed more that 42,000 people.

However, as Charles Fain Lehman points out in a must-read article for the American Conservative, “rates of overdose deaths have exploded across drug types, not just from opioids”:

“Those from methamphetamine and benzodiazepines have risen. But the least-discussed drug in proportion to its deadliness is the one that almost certainly killed around 10,000 people in 2016: cocaine.

“After a years-long lull, cocaine overdose death rates have spiked, more than doubling between 2009 and 2016. The swift increase means that cocaine may soon outpace opioids in terms of deadliness, thanks to a declining numbers of prescriptions.”

The cocaine epidemic is smaller than the opioid epidemic, but there may be another, more sinister, reason why it’s being overlooked:

“…the opioid epidemic—which has consumed much of the nation’s drug policy oxygen—is overwhelmingly impacting white people, the victims of cocaine overdose deaths are overwhelmingly African Americans.

“…one can’t help but conclude that the color of the addicted person’s skin plays a major role in how much sympathy he receives, both from the general public and especially from policymakers.”

Of course, there’s nothing new about racism in America. Nor is there anything novel about the presence of cocaine and crack cocaine in black and other communities. Moreover, there’s no cocaine equivalent to the legal prescription drugs that primed the opioid epidemic. So what has caused the recent spike in cocaine-related deaths?

Charles Fain Lehman looks at recent trends in the supply of, and demand for, cocaine, but finds no clear explanation there as to why so many more people are dying now compared to just a few years ago. So, if it isn’t about the quantity of cocaine on the street or the number of people using it, could it be about the ‘quality’ of the product and/or the other drugs it’s consumed with?

“A study in the American Journal of Public Health attributes almost the entirety of the population-wide increase in cocaine overdose deaths to deaths also involving opioids. Its authors, in a letter to the Journal of the American Medical Association, find that 40 percent of cocaine deaths also involved synthetic opioids as of 2016.

“While these analyses don’t look specifically at African Americans, adulteration with synthetic opioids appears to explain much of the cocaine overdose increase among that group.”

On the strength of these findings, it would seem that the cocaine epidemic is not separate to, but another aspect of, the opioid epidemic.

Synthetic opioids can be extremely potent. Fentanyl is 100 times stronger than morphine. while carfentanil is 10,000 times stronger. This multiplies the risk of overdose – especially when users aren’t aware that the substance is present.

The ever-present danger of adulteration and accidental overdose is a key argument for the legalisation of drugs. The theory is that if a public agency or appropriately regulated private enterprises were to supply drugs instead of criminals, then they could do so by dispensing standardised, unadulterated units (along with advice on ‘harm reduction’).

But, of course, that’s exactly what the US already has in respect to widely available legal opioids like oxycodone. The existence of this ample and regulated supply hasn’t stopped the large scale abuse of the prescribed drugs, nor the increase in opioid dependency, nor the expansion of the criminal trade in opioids, nor the deadly spread of fentanyl and other super-strength synthetics.

Of course, what is true of one type of drug is not necessarily true of another. Differences in context and chemistry matter. It could be that a legal regime for cocaine would have a less disastrous outcome than the legal regime for opioids – but I wouldn’t want to be the politician who took the risk.

Peter Franklin is Associate Editor of UnHerd. He was previously a policy advisor and speechwriter on environmental and social issues.