April 24, 2022

Good morning. We answer a common reader question about the opioid crisis and legalizing drugs.

Youngstown, Ohio, has struggled with addictions during the opioid crisis.Spencer Platt/Getty Images

A cautionary tale

Drug overdose deaths in the U.S. reached their highest point ever recorded last year, with more than 100,000 deaths over 12 months. Deaths are up nearly 50 percent since the start of the Covid pandemic.

Whenever I write about deadly overdoses, some readers ask: Why not legalize and regulate drugs? They argue that the government causes more harm by outlawing drugs and enforcing those bans through policing and incarceration. They suggest that legalization and regulation could better minimize the risks involved.

So today I want to explain why that argument goes only so far — and why many experts are skeptical.

"Drug warriors said we should have a drug-free nation, which was totally bogus," Jonathan Caulkins, a drug policy expert at Carnegie Mellon University, told me. "But it is totally bogus on the other side to say we can legalize and all the problems will go away."

In fact, we are living through a crisis that shows the risks of legalization: the opioid epidemic.

The problem began with a legal, regulated drug: prescription painkillers. Pharmaceutical companies promised the drugs would help address pain, a major public health issue. But when the pills were made widely available in the 1990s, their use skyrocketed — along with addiction and overdoses. And instead of carefully regulating the drugs, officials consistently gave in to profit-minded pharmaceutical companies, which sold opioids to millions of people.

Chart shows provisional figures. | Source: Centers for Disease Control and Prevention

The crisis has evolved from its origins, with street drugs like heroin and fentanyl — and, increasingly, stimulants like cocaine and meth — behind most overdose deaths. But as I previously wrote in this newsletter, opioid painkillers are at the root: Many of the people now using heroin or fentanyl began with painkillers. And drug cartels started to more aggressively ship heroin and fentanyl to the U.S. once they saw a promising customer base in the growing number of painkiller users.

Instead of constraining addiction and overdoses, U.S. regulators enabled the current crisis.

Bad regulation

America is poorly poised to legalize and regulate drugs, some experts said. It tends to resist regulation and favor free-market solutions more than other developed nations. It is one of two countries to allow direct-to-consumer pharmaceutical ads. The First Amendment protects some commercial speech, making drug marketing hard to regulate.

"The policy has to match the culture," Caulkins said. And "we are not good at having bureaucracies that view their mission as defending the people against the industry."

The painkiller saga illustrates this. Aggressive marketing and messaging from companies like Purdue Pharma persuaded not just doctors but also regulators of the drugs' safety and effectiveness. That enabled the approval of Purdue's OxyContin in 1995.

As we now know, those opioids were not as safe or as effective as claimed.

But federal agencies consistently failed to act as painkiller overdose deaths quadrupled, the drug policy historian Kathleen Frydl argued:

After approving OxyContin with faulty data, the Food and Drug Administration did not explicitly restrict its use until the 2010s.
The Drug Enforcement Administration sets limits on how many opioids can be produced, but it increased those limits for years, until the mid-2010s. The quota for oxycodone was nearly 13 times higher at its peak in 2013 compared with 1998. Without higher quotas, "we wouldn't have an opioid crisis," Frydl told me.
The Centers for Disease Control and Prevention did not publish guidelines calling for stricter prescription of opioids until 2016, more than two decades after OxyContin was approved.

A spokeswoman said the F.D.A. is using "a comprehensive, science-based approach" to limit painkiller misuse and expand addiction services. An official said the D.E.A. is changing its process for setting quotas with advances in data and information technology. The C.D.C. did not respond to a request for comment.

But federal regulators have done too little, Frydl said: "None of these agencies have been asked to perform any sort of introspection and accountability process such that we could be confident in their decision making going forward."

The Missouri Network for Opiate Reform and Recovery uses a retrofitted ambulance to help opioid users.Whitney Curtis for The New York Times

A policy spectrum

Experts widely agree that the U.S. government failed to properly regulate opioids. But that does not justify the prohibition and criminalization of drugs, argued Kassandra Frederique, the executive director of the Drug Policy Alliance, an advocacy group. "That's a false binary," she told me.

Many options exist between commercialized legalization and criminalized prohibition, experts said. Portugal decriminalized the personal possession of all drugs in 2001, but not manufacturing and distribution. Canada prohibits drugs, but allows for facilities where trained staff supervise drug users and may even provide substances to use.

Different drugs can also warrant different approaches. Marijuana is much safer than cocaine and heroin, and laws can reflect that.

And while the opioid crisis has shown the perils of legalization, it has also exposed the risks of prohibition. People who die from a fentanyl overdose often believe they are consuming heroin, cocaine or some other drug, not knowing it is actually fentanyl or contaminated with fentanyl. That is a problem of unregulated supply.

The bottom line

No one drug policy is perfect, and all involve trade-offs. "We've got freedom, pleasure, health, crime and public safety," the Stanford drug policy expert Keith Humphreys has told me. "You can push on one and two of those — maybe even three with different drugs — but you can't get rid of all of them. You have to pay the piper somewhere."

For more

Lethal batches of fentanyl have caused at least two mass-casualty events in Washington, D.C., this year.
Portugal's decriminalization strategy shows one way to win the war on drugs.

NEWS

War in Ukraine

Ukrainian President Volodymyr Zelensky yesterday.David Guttenfelder for The New York Times

Russian missiles struck the port city of Odesa, killing at least eight. Odesa had largely been spared attacks with high civilian casualties.
The U.S. secretaries of state and defense will visit Kyiv today, President Volodymyr Zelensky said.
Russian troops resumed attacks on the Mariupol steel plant that is housing the last of Ukrainian resistance there.
Germany's former chancellor Gerhard Schröder has become a pariah because of his work for Russian-controlled energy companies.

FROM OPINION

The idea that only people with personal experience can create art about it is a miserly take on living, the new Times columnist Pamela Paul writes.
Is Putin committing genocide? That's the wrong question right now, Ross Douthat argues.

The Sunday question: Should Finland and Sweden join NATO?

Both are strong democracies that would bolster the alliance's military, Foreign Policy's Elisabeth Braw argues. Sara Bjerg Moller notes the risks, including that NATO would have to defend Finland's 800-mile border with Russia if Moscow responded aggressively.

Your support makes The Morning possible.

Help our journalists continue to bring you the facts. Subscribe today with this special offer.

MORNING READS

A rescued kangaroo in India.North Bengal Wild Animals Park

Exotic fauna: Why are kangaroos turning up in India?

Allergy season: It's about to get worse. You can prepare.

Gut health: Those TikTok hacks are usually too good to be true.

Advice from Wirecutter: 5 cheap(ish) things for a lovely front porch.

A Times classic: How to substitute flours.

BOOKS

Laughing it off: Randy Rainbow set political commentary to Broadway tunes. His memoir traces his rise from theater kid to YouTube star.

By the Book: For Viola Davis, recording a memoir was a "vulnerable experience" of reliving certain moments.

Times best sellers: The lives of Molly Shannon and Delia Ephron are detailed in new hardcover nonfiction best sellers. See all our lists here.

THE SUNDAY TIMES MAGAZINE

Hiking in Iraqi Kurdistan.Photograph by Andrea Frazzetta for The New York Times.

Step inside the magazine's annual voyages issue. Can you tell the plastic life-size food models from the real in Japan? Or maybe you've fantasized about roadtripping out of a van — Caity Weaver (hilariously) advises against it. Hike along the mountains of Kurdistan, or escape to Greece with the novelist Rachel Cusk.

Eat: A coveted Jamaican recipe — crispy fish doused with hot vinegar and wicked Scotch bonnets.

Read the full issue.

THE WEEK AHEAD

What to watch for

French voters head to the polls today in a runoff between President Emmanuel Macron and the far-right leader Marine Le Pen. Follow our live updates.
President Biden is expected to ask Congress this week to approve more funds to aid Ukrainian forces.
The Supreme Court will hear a case tomorrow about a football coach's prayers. Its ruling could make a major statement about religion in public life.
Texas has scheduled its first execution of a Hispanic woman for Wednesday. But new evidence cast doubt on her conviction.
The N.F.L. draft begins on Thursday. The Jacksonville Jaguars have the first pick.

What to Cook This Week

Mushroom chicharrón tacos.Linda Xiao for The New York Times. Food Stylist: Hadas Smirnoff.

Genevieve Ko's one constant lately in weeknight cooking? "The meals have to come together quickly," she writes. "The longer days are lovely, but the later-setting sun makes me lose track of time." Her suggestions for this week include mushroom chicharrón tacos, green masala chicken and shrimp and tomato pasta.

NOW TIME TO PLAY

Here's a clue from the Sunday crossword:

105 Down: Name that's "all the beautiful sounds of the world in a single word," on Broadway

Take the news quiz to see how well you followed this week's headlines.

Here's today's Wordle. Here's today's Spelling Bee. If you're in the mood to play more, find all our games here.

Thanks for spending part of your weekend with The Times. — German

Claire Moses, Ian Prasad Philbrick, Tom Wright-Piersanti, Ashley Wu and Sanam Yar contributed to The Morning. You can reach the team at themorning@nytimes.com.