Never mind the ‘war on drugs’ or laying all blame with pharmas, this epidemic exists because millions live in a world without hope, certainty and structure
• Marc Lewis is a neuroscientist and author of The Biology of Desire: Why Addiction Is Not a Disease
Most drug-related deaths result from the use of opioids, the molecules that are marketed as painkillers by pharmaceutical companies and heroin by drug lords. Opioids, whatever their source, bond with receptors all over our bodies. Opioid receptors evolved to protect us from panic, anxiety and pain – a considerate move by the oft-callous forces of evolution. But the gentle impact of natural opioids, produced by our own bodies, resembles a summer breeze compared to the hurricane of physiological disruption caused by drugs designed to mimic their function.
Most street opiates (including heroin) are now laced or replaced with fentanyl – the drug that killed the singer Prince – and its analogues, far more powerful than heroin and so cheap that drug-dealing profits are skyrocketing at about the same rate as overdose deaths. The UK’s National Crime Agency said that traces of fentanyl have been found in 46 people who died this year. Users don’t know what they’re getting and they take too much. Fentanyl is recognised as a primary driver of the overdose epidemic.
Dozens of UK drug deaths linked to opioid that killed singer Prince
Society’s response has been understandably desperate but generally wrongheaded. We start by blaming addicts. Then we blame the pharmaceutical companies for developing and marketing painkillers. We blame doctors, for overprescribing opiates, which pressures them to underprescribe, which drives patients to street drugs – cheaper, home delivery via the internet, and zero quality control. We say we’re going to reignite the war on drugs, recognised by experts as a colossal failure from the 1930s onward. We also continue to view addiction as a chronic brain disease, so the benefits of education, social support, psychological intervention, and personal empowerment receive far too little attention. Yes, addiction involves brain change, but ongoing medicalisation does little to combat it.There has been some progress: There are pockets of activity here and there where prescribed opiates – like methadone and Suboxone – are made more easily available to addicts. That’s a good thing, because increasingly desperate addicts are often driven to the street, where they’re most likely die. The availability of naloxone, which works as an antidote, is slowly wending its way through the drug policy jungle, providing a simple resource to deal with an overdose on the spot. But in most segments of most communities in the US and elsewhere, it is still too difficult to obtain.
There are smarter answers at hand – but also smarter questions to be asked. The overdose epidemic compels us to face one of the darkest corners of modern human experience head on, to stop wasting time blaming the players and start looking directly at the source of the problem. What does it feel like to be a youngish human growing up in the early 21st century? Why are we so stressed out that our internal supply of opioids isn’t enough?
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