Photo Jonathan Blair

Saturday, December 31, 2016

Overdoses are a problem for dealers too

[The little crocodile is not abandoning Latin America, but while home in Canada, it keeps an eye on local drug markets. Comments are most welcome.]

The overdose epidemic risks killing--literally--the customer base of drug dealers, and they have to know it.

Drug sellers have a vested interest in keeping their customers heavily dependent but also alive. Irresponsible legal prescriptions of opioids have enormously broadened their client base: when doctors end up refusing prescriptions as it becomes clear that their client's requests are driven by addiction, dependent users move to the black market. Hence the quick increase of recent years, which may get even quicker as legal prescriptions are likely to get reigned in given media attention and the public outcry that develops as a result of it.

Cheap, powerful and hard to detect synthetic opioids imported illegally from China make it easy for dealers to satisfy demand. With a high much stronger than heroin or good old oxycontin,  synthetic fentanyl and carfentanyl quickly hooks people, for whom heroin becomes , All this is obviously good for business. Concentration, however, is also a problem as it becomes extremely difficult to get a grip on the strength of particular doses, especially once opioids are mixed with other substances. There lies the root of the current crisis, which will have killed about 800 people in British Columbia alone in 2016.

At that speed, unless doctors keep feeding the addiction pipeline--which at last, they may stop doing, in the face of the disaster that they have wrought--many dealers will run out of clients in a few short years.

So, from their standpoint, what is to be done?

One solution would be to find a way to get a grip on the doses that they hand out. "Safe" products would quickly give their dealers a competitive edge. The technical requirements of doing so in an illegal environment, and the power of the products currently entering the market, however, make this unfeasible.

Another solution is to bet that the public health effort will be ramped up substantially, keeping users alive. Better still would be to piggy back on it, basically exploiting the availability of emergency services to ensure that the essentially unavoidable overdoses become less lethal, ideally not lethal at all. The world-famous Insite supervised injection site delivers just that, with no overdose death since it opened its doors in 2003. It can't keep up anymore with increased use, however, and emergency injection sites have been set up in tents right by the alleys where people procure and inject the drug. With more resources--and they should be coming soon--public policy would basically solve the dealers' problem...

In the meantime they appear to bet on the compromise solution that results from underfunded and desperate efforts of volunteers and overworked emergency workers, setting up shop right by both their customers and the people who can keep them alive: "Outside the tent, street-level dealers sell various drugs to dozens of people injecting in the alley. More than 200 people will access the tent before the last group is hustled out at 10 p.m."

Moral hazard, in sum, meets health hazard...

Now, normalizing overdoses cannot be an acceptable solution from a public health perspective. At the same time, framing Insite and the current desperate effort to keep thousands of dependent users alive as simply abetting--if not encouraging--heavy use and trafficking takes one down a narrow, cruel and ultimately ineffective policy path.

In other words the main implication of the argument just developed is that dealers have a vested interest in getting a grip on the epidemic and, consequently that they can be part of the solution.