Look What Dragged the Cat In: The rise of an opioid crisis

Excerpted from the 2018 USA Best Book Winner, Look What Dragged the Cat In.

The decade of the 2010’s shelled hospitals and first responders with an explosion of opioid-related illness, injury, and death. Preventable drug overdoses tallied 54,793 lives lost in 2016 – an increase of 391 percent since 1999. Accidental drug overdose deaths increased 327 percent over the same period. The majority of OD deaths (38,000) involve opioids, The drug category most frequently involved in opioid overdoses and growing at the fastest pace includes fentanyl, fentanyl analogs, and tramadol. The fentanyl category of opioids accounted for nearly half of opioid-related deaths. The dirty cat in the litter, heroin, accounted for the second highest number of deaths, claiming 14,606 lives.

America struggles with what the opioid cat dragged in: Hard-to-treat opioid addictions, fatal relapses, and needless loss of mainly young lives. Now legislators, first responders, treatment pros, and those in the medical field are forced to focus not on the death toll the cat dragged in, but instead what dragged the cat in.

Every opioid related death is alcohol related

The abuse of drugs, regardless of classification, begins with the permissiveness granted the world’s most lethal drug and third-leading cause of all preventable deaths: Alcohol. It’s a straight line.

Nearly every non-Muslim civilization on this rock has embraced alcohol. As a result, ours is largely a numbing planet, especially in the sedation-happy Americas. This is the root. This is the seed of the opium trade that has gone unstemmed since prehistory. There is legit medical use for opium derivatives: What has driven growth is demand – not by the sick but by people who cannot get the mind alteration they desire through alcohol use alone.

Alcoholics and non-alcoholics alike drink the first drink for the same reason: To relieve a stress. In the U.S., which has a laissez faire agenda toward alcohol since its prohibition failure, the culture embraces a drinking lifestyle. Americans normalize alcohol use. In other words, Americans (like many cultures) normalize drug use. The 1960’s have nothin’ on the 2010’s.

What you ignore, you permit. What you permit, you condone.

Opioid abuse happens when a person can’t get where they want to get with alcohol. The opioid crisis wasn’t created by doctors overprescribing, manufacturers wooing doctors, China shipping heroin and cheaper fentanyl via cartels and the U.S. mail. Drinking, especially binge drinking, is the pandemic that dragged in the opioid ‘epidemic.’ Americans condone the buzz, the sedation. We created this monster on our own.

What’s the way out?

Legislative attempts to curb use of potentially lethal drugs resemble shooting an arrow and then drawing a target around where it hit. Locking up dealers and traffickers, creating prescription databases and prescribing limits, and promoting Narcan availability all deal with control of the supply and its aftermath. The demand is unchanged. Within a cultural adoration of the buzz, our current crisis can only be curbed by control of the demand. If a drug user wants a drug, theywill get that drug. It’s the American freedom thing.

In 1967, 72 percent of adult men smoked. Today, 72 percent don’t. Prevention works. If there is genuine interest in healthy outcomes and preventing premature death from opioids, Americans’ permissiveness of the starter or feeder or gateway or predecessor drug has to be addressed on five levels to reduce demand for all antecessor drugs.

• Advertising agencies court alcohol manufacturers with a promise of creating demand for the drug. You can ban advertising without banning the product. When cigarette marketing/advertising was banned, demand dropped without banning the product. The National Bureau of Economic Research (NBER) studied bans in 20 countries over 26 years. The results indicate that an increase of one ban could reduce alcohol consumption by five to eight percent.

• Public drinking encourages drug use. Smoke-free regs cut down on the demand by curtailing where cigarettes can be smoked. Applying the same model for drinking – instead of popping up a brew pub on every corner – can reduce demand. The idea of having a cocaine bar on every corner is absurd, but a pub peddling a drug that kills more people (89,000 Americans per year) is somehow acceptable. The availability of alcohol can be regulated either through restricting the hours or days it can be sold or by reducing the number of alcohol retail outlets, according the a World Health Organization (WHO) study. Logicaly, reduced sales hours have been found to be effective in lowering consumption. In the former Soviet union in the mid-1980s, strict alcohol regulation, which included among other measures restricted hours and fewer outlets, led to a dramatic reduction.

• The ‘Smoking Stinks’ campaign brought an anti-smoking message down to the earliest grades. A modest effort to create similar anti-drinking messages demonstrating health risks of even moderate use (see viewbook.at/prehab) will stunt demand by discouraging the very first drink of the gateway drug.The American Journal of Public Health analysis of the anti-smoking campaign suggests that per capita consumption would have been one-fifth to one-third larger than it actually is, had the years of anti-smoking publicity never materialized.

• Increase the tax on the gateway drug. The bottom line is that many states and municipalities balance their bottom lines with so-called ‘sin taxes.’ The sin taxes on alcohol haven’t kept pace with inflation. These taxes are usually based on the amount of beverage purchased (not on the sales price), so their effects can erode over time due to inflation if they are not adjusted regularly. The Community Preventive Services Task Force (CPSTF) recommends increasing taxes on the sale of alcoholic beverages, on the basis of strong evidence of the effectiveness of this policy in reducing excessive alcohol consumption and related harms. Opioid use is a related harm. The CPSTF is an independent, non-federal panel of public health and prevention experts that provides evidence-based findings and recommendations about community preventive services, programs, and other interventions aimed at improving population health.

• Many will argue that legalizing recreational use of marijuana will reduce opioid abuse and erroneously point to Colorado as an example. (By the Center for Disease Control and Prevention’s (CDC) numbers, you can call BS: Colorado’s death rate from opioid overdose is barely in the top half of the state-by-state death-rate comparison … if you wanted to complete the morbid, pointless comparison. One death is too many.) What’s entirely missing from the debate is that no evidence exists that encouraging recreational use of another drug furthers public health in general. Marijuana is revenue-neutral when you subtract societal, medical, and legal costs.

When we rethink the drink we can douse the pandemic that begat the current opioid crisis. Legislators and treatment experts must lead the transition from managing aftermaths of the current crisis to prevention of the next one. And phase out the ancient alcohol crisis – the elephant in the room – America ignores.

Stevens is author of four alcohol, health, and recovery books and is principal of alcohologist.com. He is a founding influencer of the world’s largest medical portal, healthtap.com. He will Chair the 2018 International Conference on Addiction Therapy and Clinical Reports in Paris, France.