April 10, 2017    8 minute read

Drug Addiction Is a Problem of Supply and Demand, and the Solution is Treatment Plans

Sowing Afghanistan' Poppy Fields    April 10, 2017    8 minute read

Drug Addiction Is a Problem of Supply and Demand, and the Solution is Treatment Plans

The road to hell is paved with good intentions, according to a popular aphorism. One example is the United States’ past attempts to rid Afghanistan of the twin scourges of the Taliban and its poppy/opium/heroin crop. But have they done anything meaningful to tackle drug addiction, or do such measures ignore the realities of the opioid market?

Now that the US is in the midst of an opioid epidemic, doctors and government officials again have attempted to restrict access to and production of opioids, resulting in a greater black market. Most addicts prefer something more potent, such as fentanyl. Many of all ages and incomes have moved to heroin as a cheaper and more easily available substitute. Destroying some or all of Afghanistan’s poppy fields won’t decrease the demand unless America is prepared to deal with the resulting hordes of addicts undergoing ‘cold turkey’ withdrawal.

Good Intentions

The US went into the oft-invaded country with the intention not only of avenging the September 11th terrorist attack by al-Qaeda, but also freeing the Afghan people from the extreme Islamic rule of the Taliban. In addition to protecting al-Qaeda terrorists, the Taliban oppressed Afghanistan’s women and other civilians with a severe interpretation of sharia law, and destroyed the culturally and historically important Buddhas of Bamiyan, giant 6th-century statues carved into the side of a cliff.

To be fair, the United States was much more interested in getting rid of al-Qaeda and its Taliban protectors – specifically Osama bin Laden, and anyone else involved in the collapse of the World Trade Center and the attack on the Pentagon – but it also was aware that its failure to support the Afghans after the Soviets pulled out in 1989 left a vacuum for the Taliban to fill and exploit. And the US government is always more interested in stopping drug traffic than creating treatment plans for addicts.

It’s been expensive, with the Afghanistan war alone costing the US $800bn, according to the Huffington Post. And Breitbart says that Afghan opium production has increased 25-fold since the U.S. invaded Afghanistan, accounting for about 4% of all the heroin in the US.

Although the US doesn’t rank among the top 10 countries for abuse of poppy-derived opiates, such as morphine – an essential medicine according to the World Health Organization – and heroin, it’s in first place for opioids, which includes both opiates and synthetic/semi-synthetic substances that similarly affect the body’s opioid receptors, as well as prescription opioids (oxycodone, hydrocodone, fentanyl). In the US, “heroin deaths shot up from 1,779 in 2001 to 10,574 in 2014,” said Dissident Voice’s William Edstrom.

US employers are bearing a large part of the cost in healthcare dollars and lost productivity. According to a National Safety Council report on Marketwatch, alcoholic and drug abusing workers miss up to six weeks of work every year. Left untreated, such substance abuse costs employers from $2,600 (in the agriculture sector) to $13,000 (in the information and communications sector) per affected employee.

Ironically, the Taliban already outlawed the poppy crop in Afghanistan in 2000, believing it to be “un-Islamic“.“[W]ithin a year it was all but gone,” Edstrom added. Less than 19,000 acres of the poppy crop remained. And since the Taliban retreated, poppy production has resumed and increased.

Unintended Consequences

The resurgent Taliban has learned to see the financial benefits of more poppies, too, and has learned to live with its “un-Islamic” aspects. In 2014 poppy cultivation occupied more than 553,000 acres – up 10% from just the previous year, according to the United Nations – and with more yield per acre. Afghanistan now produces 85% of the world’s illegal opium and heroin.

Drug traffic is a problem of supply and demand. If there’s demand, then there’s incentive to increase that supply to match it. Poppies are much more profitable than conventional and legal crops, so even a death penalty for poppy cultivation isn’t enough to stop money-strapped farmers from growing it.

Attempts are being made to steer farmers to other crops, but it’s hard. According to the New York Times, startup Rumi Spice was expected to make $500,000 from Afghan saffron last year – the pricey and coveted culinary ingredient sells for between $2500 and $30,000 per kilogram – but that pales in significance compared to opium’s annual profits of $100m to $700m.

It doesn’t help that Afghanistan is rated as one of the most corrupt governments in the world, with both police and government officials taking bribes. It shouldn’t come as too much of a surprise that Afghanistan is also one of the most addicted countries in the world, and that heroin is its most popular drug – with per capita use of 6.9%, according to “deep research from different verified sources” by Wh?ch country in 2012.

There is a worldwide shortage of medical morphine, which is probably about to get worse. In October 2016, “The DEA announced… that it is reducing production quotas for almost every Schedule II opioid pain medication next year by 25 percent or more,” said the Pain News Network’s Pat Anson, “many of which are used to give pain relief to patients in palliative and hospice care,” including morphine.

Edstrom argues that the fact that the Taliban eliminated poppy production once before proves “that Afghan opium can be eradicated quickly for any administration that chooses to do so.” Maybe, but by what means? Philippine president Rodrigo Duterte has drastically decreased drug use in the past year, but it’s doubtful Edstrom approves of his methods. In five months, more than 4700 alleged drug dealers and users have been killed without due process by both official law enforcement and extra-legal vigilantes, with Duterte’s blessing and encouragement. So many drug users have been arrested or turned themselves in rather than risking summary execution —more than 730,000— that the inmates have to sleep in shifts.

The increased demand for heroin is partly due to the law of unintended consequences. At one time, doctors too gingerly prescribed morphine and other potentially addictive but painkilling opioids. Then the pendulum swung too far in the other direction, and people were receiving prescriptions too easily, generously, and for too long a period of time. Most opioid prescription medicines lose their efficacy over time, but some doctors kept the prescriptions going. Their now-addicted patients required larger doses to stave off withdrawal, regardless of whether or not they were still in pain.

Reducing Demand: Reducing Drug Addiction

No one wants to become an addict. Some, who remain high-functioning and can afford to feed their habit while maintaining a job, home, and family, prefer to remain addicts rather than risk withdrawal while undergoing treatment plans. Warnings of ‘once an addict, always an addict’ might even encourage that attitude: if someone can’t be cured, why try to quit? That’s why some in the US advocate for harm-reduction programmes, such as safe, medically-supervised public places to shoot up and needle exchanges. They minimise harm not just to the addict but also to society as a whole.

Incarcerating addicts isn’t a real deterrent. Addiction is a type of mental illness, and threatening prison time doesn’t make someone less mentally ill. Rather than concentrating on the supply, demand needs to be curbed. Even conservative US politicians such as Newt Gingrich say it’s a medical problem, not a character problem. His organisation, Advocates for Opioid Recovery, wants more and better treatment plans instead of jail time, shorter waiting times to get into drug addiction treatment programs, and the use of replacement drugs to help addicts safely withdraw.

What’s needed is a massive investment in drug addiction rehab programs; better education among primary care physicians to help them look for the signs of opioid addiction; new treatment plans, including drug delivery implants, in order to administer a daily maintenance level of a replacement drug such as buprenorphine without the risk of diversion to the black market; and research into potential new treatments such as ibogaine and other psychedelics.

Prohibition alone never works, however good the intentions behind it are. Nor does burning poppy fields and threatening to execute farmers and addicts, unless they are offered hope and an alternative.

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