Prescription Drug Abuse and Broader Drug Policy

Damien Cave reports that the upsurge in diverted pharmaceutical use is causing a re-thinking of drug policy generally. I’m all for a re-thinking, and especially for a new policy not based on the fantasy that drug law enforcement can substantially reduce international drug flows if we just keep doing it, or do more of it, or do it in some more clever way.

But it’s not as if the upsurge in abuse of oxycodone and hydrocodone has displaced the abuse of other drugs: indeed, there’s good evidence of a stepping-stone effect from the prescription opioids to heroin, which is much cheaper on a dose-equivalent basis. The volume of cocaine has been shrinking as the cocaine-using population ages, but cocaine (along with meth) remains a major problem, especially among people arrested for non-drug crimes. So the notion that the prescription-drug problem makes the problem of strictly illicit drugs irrelevant doesn’t seem to make much sense.

If the argument is that strictly illicit drugs represent a small fraction of the total drug abuse problem, that’s true, but it’s true primarily because alcohol dwarfs everything else.

So, yes, we need a prescription-drug-abuse policy, with the usual triad of enforcement-prevention-and-treatment looking even less promising than usual. And we need a better approach to the strictly illicit drugs. And we need to pay some serious attention to alcohol. Those are “ands,” not “buts.” Drug policy should be able to walk and chew gum* at once. Right now, it can barely do either one.

* (No, Lyndon Johnson did not say “walk.” But the newspapers weren’t willing to print what he actually said.)

[Cross-posted at The Reality-based Community]

Mark Kleiman

Mark Kleiman is a professor of public policy at the New York University Marron Institute.