As deaths from illegal drugs rise, many people recommend more stringent law enforcement. The basic thrust of this argument is simple. In the last few years, we have seen overdose deaths rise from sixty-odd thousand to over a hundred thousand per year. The drugs they die from are brought into the US illegally and typically contain fentanyl. We need more cops and so on to stop the flow.

Full disclosure: I am a retired anesthesiologist who administered fentanyl extensively throughout most of my thirty-six years in medicine. I have literally given gallons of the stuff, so I’m intimately familiar with it. I’m also intimately familiar with its chemical relatives (alfentanyl, sufentanyl, remifentanil, carfentanyl, and so on). Three of those had prominent places on my drug shelf in the operating room. Add to that the old drugs morphine and Dilaudid, and you can see that I know a bit more than the average bear about this.

I included all that to make a simple point. If I mixed up a dose of any of those drugs to ultimately equal potency and then gave it to a patient, once it reached full effect, you would not be able to tell which one I gave. The patient wouldn’t either unless he’d had a bad side effect (such as nausea) in the past from the one he happened to get. Every one of those drugs is functionally the same as every other one. Don’t get me wrong. There are reasons why one is more useful in some circumstances than another, but the basic point holds.

Image: Drug addicts in Philadelphia. Twitter screen grab.

If I take you into the manufacturing process, you’ll discover that these drugs cost almost nothing to manufacture. That’s right, they are no more expensive to make than aspirin, and you can buy that cheap. So why are we seeing inexpensive safe drugs killing people and criminals like El Chapo becoming as rich as Croesus? I’ll give you a hint. It’s not the drugs.

I discussed this in print here and here and on video here and here. Because I’ve discussed this at such length, I’ll cut directly to the chase. Someone who ingests a large amount of fentanyl and then dies demonstrates that fentanyl was the proximate cause of death.

This is what people in law enforcement see, and their background leads them to look at law enforcement as the solution. Therefore, understandably, they want more officers, more enforcement, and more punishment for offenders.

This approach is doomed to failure. A police state addresses only the final common pathway of death. It does nothing for the root cause. More drugs will keep coming in, with more deaths and more drug lords who are so rich that they run Mexico. As Einstein is supposed to have said, “Insanity is doing the same thing over and over and expecting a different result.” We must look for the ultimate cause. And to illustrate what I mean, let’s look at something less controversial than substance abuse: Type II Diabetes.

T2D is a result of overeating carbohydrates. If you eat a lot of carbs, your body must store them, producing insulin which stores those carbs as fat. Keep eating carbs, and your waistline gets really large. This is totally preventable just by limiting the number of carbs you take in.

At this point, the fat cells scream “Uncle” and resist the insulin. Your blood sugar goes up and, now, your doctor has you inject more insulin because high blood sugar is deadly. That may protect your kidneys and eyes for a while, but it does nothing for the root cause of T2D.

That insulin shot isn’t fixing the problem; it’s actually making it worse. The problem was the dinner table, with all the pasta, sugary drinks, and desserts. Until you fix those, your T2D will only get worse. (For more details, check this out). This same issue applies to drugs. We must back up and look at the root of the problem.

I’m only going to scratch the surface here. For more, read work by the Cato Institute Senior Fellow Jeffrey Singer MD. The rap goes something like this.

• I want to relax or get a little high, who cares why?
• I will find something that suits my need, who cares where?
• It wasn’t in the liquor store, I found it at a party.
• It took away my troubles, so I kept a bit for Tuesday.
• It worked for a while, but troubles kept coming.
• And then it stopped working, but I couldn’t quit.
• Stopping made me sick, so I found another source.

Those curbside sources pharmacists provided an illegal boost for a price. It wasn’t the price of production that affected that price; it was the price of distribution because it was illegal. Drug dealers got a subsidy from the risk premium created by prohibition. And the user wanted quality for his money, so the seller boosted with fentanyl for a more potent hit. Ultimately, the underground economy led to a lethal combination. Overdoses are an economic consequence of prohibition, not an inherent problem with an otherwise safe drug.

It wasn’t the drugs that were responsible for the patient’s death. It was the drug laws that created the economic incentive for criminals to supply the illicit need. Until we address this issue, we will see our good people dying in larger and larger numbers. If we do address it, we won’t be plowing new ground.

Portugal has essentially decriminalized opiates. It has coupled this with completely free (to the patient) maintenance programs and various rehab approaches. The country has done this for decades and has the lowest overdose rate in Europe at a cost of about ten dollars a day per addict. The Portuguese have even discovered that about half of the addicts completely detox without any intervention other than maintenance. Their answer may not be perfect, but it’s a damn sight better than more policing.

Freedom works whenever it’s tried. What a concept!

Ted Noel MD is a retired Anesthesiologist/Intensivist who podcasts and posts on social media as DoctorTed and @vidzette. His DoctorTed podcasts are available on many podcast channels