Deaths are exploding across all ethnic groups and around the country
America’s opioid epidemic is as complex as it is terrifying. It should be impossible to summarise the key trends in one chart, but nevertheless here it is:
red lines=opioid mortality trends in non-Hispanic white pop.; blue=non-Hispanic Black pop.
green arrow–WTF is going on & why hasn't it been declared an emergency
New paper in JUH by @mathewkiang, @monjalexander, @drehkopf, @SanjaybMDPhD and myself https://t.co/ojV3W2DRjH pic.twitter.com/dJTyMkbiIv
— Alexander Tsai, MD (@drdrtsai) October 19, 2021
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It shows opioid-related deaths in each state from 1999 to 2019. This is still a regionalised phenomenon, with deaths exploding in some states but not others. However, the stereotype of this being a problem for poor whites in rust belt states no longer holds. Opioid deaths are also climbing fast among sections of the black population too. The near vertical trend in Washington DC is especially alarming.
The geography of the epidemic is changing, but so is its chemistry — thanks to the spread of synthetic opioids. The potency of these substances, especially fentanyl, has made it much easier for users to overdose. Their extreme concentration means that they’re also easier to smuggle compared to bulkier plant-based drugs like heroin.
In a stunning long-read for The Atlantic, Sam Quinones writes about the chemical revolution in America’s other synthetic drug epidemic — the trade in crystal methamphetamine.
As dramatised in Breaking Bad, innovations in the manufacturing of the drug allowed a ‘purer’ product to be made from cheaper ingredients. Prices and profit margins have come tumbling down. However, the criminal trade has adapted just like any other economic sector in the same position: by increasing volumes.
The consequence is a growing population of meth addicts. Indeed, among some users, the new meth is winning market share from opioids. In part that’s a function of price and availability, but also because the risk of overdose is lower. As Quinones puts it, “you don’t typically overdose and die on meth; you decay.”
Compared to the old meth, the new cheaper meth has a particularly devastating impact on the mental health of its users. Thus the meth epidemic means a mental illness epidemic and consequently a homelessness epidemic too. The evidence can be seen in the lawless encampments of Los Angeles and San Francisco — the toleration of which has created an environment in which addictions are reinforced and financed.
Unfortunately, while these epidemics grow and mutate at breathtaking speed, the public debate over drug policy is still stuck in the past. Liberalising drug laws will not the make the problem disappear as if by magic. Unless we systematically dismantle the conditions that lead to and perpetuate addiction, then the legal situation is of secondary importance. The dealers will still find a way of meeting demand — and won’t care about the damage they do in the process.