Blaming heroin addicts is easy

It’s also wrong

By Dennis Cauchon, President, Harm Reduction Ohio

On February 21, Gov. John Kasich’s administration emailed a health alert to Ohio’s 88 county health departments: more than 1,000 overdose deaths in 2017 involved fentanyl plus cocaine or methamphetamine — and these deaths were soaring.

But the governor has refused to make the warning available to the public — not on the internet, not on Facebook, not on Twitter, not in any way that the information can be shared with drug users and their families.

Harm Reduction Ohio published the warning and it’s been shared more than 600 times. We also criticized the governor’s unexplained secrecy in a letter published in The Columbus Dispatch on March 11. (See “Health department kept lid on ODs.”)

But why won’t our governor talk about deaths from fentanyl-laced meth and cocaine, or let the Ohio Health Department speak to the public?

Reporters have asked me why the state is perplexingly (and harmfully) silent. After all, the state told county health officials that preliminary data show at least 850 deaths involving cocaine and fentanyl in 2017 and 283 involving meth and fentanyl.

Kasich administration silence

The truth is, we don’t know why the governor and his health department won’t talk publicly about this health crisis. But the silence appears consistent with the political story that the administration is telling: opioid addicts, especially heroin users, are to blame for the drug overdose epidemic.

This supports the state’s strategy of arresting more people, giving out longer sentences and offering treatment to opiate addicts.

The problem is that this strategy doesn’t match the facts, as revealed in the data from autopsies or from looking at who’s dying and why. Opiate addiction has played a major role in the overdose epidemic, and the death toll among heroin users has been enormous.

However, it’s not the whole story. Most importantly, it’s a description of who’s dying, not an explanation of why.

The whole story

The reason drug users are dying in Ohio is that the entire illegal drug supply in Ohio is contaminated with fentanyl and fentanyl analogs, with the important exception of marijuana. Death came first to opioid users. But fentanyl and more dangerous fentanyl analogs starting spreading throughout the illegal drug supply about a year later.

Any illegal drug shipped through Mexico, as nearly all Ohio’s drugs are (except for cannabis) carries a risk of adulteration. Fentanyl and its analogs are attractive to drug smugglers and drug dealers because they are compact and easy to hide. These small, inexpensive, human-made products — no plants needed — now function as all-purpose potency boosts, even to stimulants.

Fentanyl is an opioid, so it’s technically correct to say that when someone dies of fentanyl-laced meth, it was an opioid-related death. But that hides the reason that fentanyl was in the drug mixture. The dealer and user weren’t selling an opioid. Indeed, they likely didn’t know the “meth” contained fentanyl. It was the adulterant that killed the user, be it arsenic or an opioid, and it’s misleading to think that opiate addiction or opioids in general explain the overdose death.

Impure illegal drugs

The drug overdose epidemic, at its core, is caused by impurities in the illegal drug supply, and impurities are an inevitable, unavoidable result of drug prohibition. The uncomfortable truth is that that the primary cause of the drug overdose epidemic that has killed thousands of Ohioans is bad government policy, a refusal to allow people access to drugs used every year by 1.8 million Ohioans.

The well-intentioned policy of trying to prevent drug use has had catastrophic unintended consequences. Many people still use banned and restricted drugs; they just have to go to the black market and Mexican cartels to get the drugs. The contents of what Ohioans get is uncertain, impure and sometimes deadly.

The government’s explanation of the drug overdose epidemic has been consistent in that it points the finger away from drug prohibition and at others: heroin addicts, doctors and drug companies. Nobody is exempt from blame (except perhaps the government). But these actors live in the economy they are given. And it’s a distorted world, of third-party payers, banned drugs, patented and profitable legal drugs, doctors as gatekeepers of what people put in their bodies, and so on.

If it turns out that the drug epidemic extends far beyond opioids, the OxyContin story becomes just a chapter in a larger story, the story of what happens when prohibition is imposed on substances that have been used for thousands of years, including by tens of millions of Americans today.

“Hi, I’m John Kasich…”

Blaming heroin addicts for their own mass death is like blaming gay men for HIV. We should not fear knowledge. Even in this imperfect world, we can take steps to reduce death. Telling people they were at risk for the HIV virus, and to use condoms during sex, reduced deaths from AIDS.

Telling meth and cocaine users they’re at risk of fentanyl overdose is the first thing Ohio health authorities must do. The failure to do so is inexplicable, and Ohio Health Department’s medical director Clint Koenig has refused repeated opportunities to explain why meth and cocaine users are being left in the dark about fentanyl risk.

Without a public admission that all drug users (except cannabis-only consumers) are at risk of fentanyl overdose, meaningful safety measures — such as drug checking, fentanyl test strips, wider distribution of naloxone, etc. — cannot begin.

The first thing Ohio must do is what Ohio has not done: Admit it has a problem. The words we need are:

“Hi, my name is John Kasich, and my state has a problem with fentanyl killing cocaine and meth users.”