Why the opioid epidemic is making a libertarian rethink drug legalization

One of the biggest debates in drug policy is whether legalizing drugs, and therefore increasing access to them, would actually lead to more use and abuse — or whether people would be rational enough to stay away from dangerous drugs. Supporters of legalizing all drugs tend to believe the latter, while opponents of legalization tend to believe the former.

In comes the opioid painkiller and heroin epidemic. After doctors loosened access to opioid painkillers by prescribing them at tremendous levels, use very clearly rose — and Americans have been suffering the results of that greater use through tens of thousands of deaths since 2000. In 2014 alone, more Americans died of drug overdoses than any other year on record: more than 47,000 deaths in just one year, nearly two-thirds of which were opioid-related, according to federal data.

Over at RealClearPolicy, Robert VerBruggen wrote that this has him reconsidering his support for drug legalization:

I was never so naive as to think there would be no increase in drug use or abuse if drugs were legal. But I did think legalization would easily pass a practical cost-benefit test: reduce incarceration, if perhaps not as much as some might think; end an illegal market whose violence spills far beyond our borders; and expand personal freedom, all for the acceptable price of an extra overdose or other health problem here and there, plus maybe some extra property crimes by addicts stealing to feed their habit.

Drug addiction couldn’t go up that much. The War on Drugs is an utter failure and drugs are widely and cheaply available anyway. Everyone knows that.

Well, reality is not lining up with this view of the world. In 1999, Americans had fatal drug overdoses at a rate of 6 per 100,000. In 2014, that number stood at 14.8 per 100,000 — a rise of 8.8 per 100,000. To put this in perspective, America’s famously high homicide rate is about 5 per 100,000. And the overdose spike is apparently driven by a policy change much gentler than full legalization.

One wrench I would throw in this: Maybe opioid use only rose because doctors were telling Americans that these painkillers were safe, and Americans tend to trust their doctors, rightly or wrongly, as health experts. In some ways, patients were in fact being encouraged to use a dangerous, addictive substance, because doctors — who were lobbied by pharmaceutical companies that wanted to sell more opioids — gave out the drugs under the (very false) idea that they were a great, safe way to treat chronic pain.

That’s a vastly different scenario from one in which opioids or other drugs are legally available for recreational use but are marked with big, scary warning labels, sort of like how cigarettes are handled. Yes, the drugs would be legally available. But their use would still be discouraged — a key distinction that may be enough to suppress a rise in use, abuse, and overdoses.

Still, VerBruggen’s take is refreshing because it’s a rare example of someone showing he’s willing to adjust his position as new evidence comes in. It certainly provides something to think about, even for hard-line supporters or opponents of the drug war.