Fentanyl Hysteria

Drug use has been a cause of multiple moral panics over the past fifty years; now and then, a drug turns up that somehow captures the public imagination and becomes a focus for policy and law enforcement. Fentanyl has, for a few years, been one of those drugs.

Part of the wider opioid crisis, fentanyl has a legitimate clinical use and is frequently prescribed to help manage cancer pain. It is a powerful painkiller, about 100 times more powerful than morphine. There is also no doubt that fentanyl can be a dangerous drug. Opioids produce euphoric highs for users, but carry the risk of side effects which include respiratory depression. Fentanyl users can find themselves effectively suffocating to death because their central nervous system slows their breathing to dangerous levels.

The problem is when the pressure to ‘do something’ about drugs results in policies and enforcement actions that make little difference and may actually cause more harm. The fundamental problem is that drug use, and the drug trade, is a complex issue. It cannot be addressed with knee-jerk responses designed to catch headlines. And the result is different levels and branches of government taking actions that contradict each other.

There are many drug liberalization measures but these will frequently run counter to policies that mandate the prosecution of drug users. The Department of Justice, for example, will prosecute every case involving fentanyl, regardless of amount, even while federal laws, like the First Step Act, are being passed to shift the focus of drug sentencing away from punishment and towards rehabilitation. In 2017, North Carolina even started the reform of opioid sentencing in the very same bill that they created harsher sentencing for fentanyl.

This mixed messaging does nothing to help those who might be struggling with addiction to come forward, and undermines useful initiatives like Good Samaritan laws, where people are discouraged from coming forward because they are fearful of the consequences for themselves.

And the tragedy is that these measures have little effect. People use drugs for a variety of reasons, but no-one starts using drugs because they think the sentencing policy is weak. By focusing on headlines, policymakers generate heat, but no light. Drug seizures account for less than 1% of a US drug market estimated to be worth at least $100 billion a year. And while the number of adults incarcerated in the US, at nearly two-and-a-half million people, is over five times the amount since the war on drugs started, demand and supply has not been affected. For every dealer sentenced, another takes their place.

Taking drugs can be deadly, but so can everyday activities like a walk along the street or a drive to the store. Most drug users will grow out of their drug use without committing any other crime, and the biggest risk for most is from adulterated drugs or risky usage. Rather than trying to fight an unwinnable war on drugs, policymakers and law enforcement might do better if they focused instead on the causes of drug use, practical measures to reduce risk, and practical pathways away from drugs.

Previous: Polypharmacy in the Elderly

Next: Isotonitazene vs Fentanyl