The DEA is screwing all of us over.
Maybe having the shock troops of America’s racist drug war regulating critical, essential medicines is a bad idea.
So much of the fentanyl epidemic seems intractable. The dynamics of black markets mean there’s no likely ebb in the near future. The demand is high and the supply is cheap and seemingly infinite. How is it possible to stop the flow of illicit fentanyl?
The DEA, as always, clings to a delusion that a more robust drug war is going to do the trick. Somehow.
The Washington Post is treating Milgram like a pitiful bureaucrat rather than the director of a federal agency with a $3 billion budget who is demonstrably failing at their job in every way possible. First, to suggest fentanyl is “new” is absurd. Overdose deaths involving fentanyl have steadily climbed upward since 2012. The level of mortality today is shocking, but it also demonstrates a staggering level of incompetence by the DEA. It’s bizarre that the Washington Post isn’t more critical of the entire law enforcement, DEA, supply-side approach. For more on that, read Zach’s 2019 piece in The New Republic: "How the Drug War Blob Took Over the Washington Post.”
The Post seems to paper over the fact that the DEA is a big reason why the market for illicit fentanyl is so massive in the first place. After cutting production of pharmaceutical opioids like oxycodone, shutting down pain clinics, leaving thousands upon thousands of patients with no pain relief, no wonder the market for counterfeit meds pressed into familiar oxycodone pills is booming. If the DEA truly wanted to save lives, they would put a stop to their crusade against doctors treating pain.
The people who can’t get prescription drugs in legal markets resort to illegal markets. This isn’t rocket science, it’s basic economic principles. Between the Adderall shortage to the impossibility of getting legal painkillers, the DEA is involved and a huge player at every level of this total disaster. If the DEA’s goal is to push more and more people into deadly black markets, and enrich criminal drug trafficking organizations, congratulations, they’re killing it.
Let’s take a look at Xanax, a benzodiazepine primarily used for treatment of acute anxiety. In the early aughts, when I was panicking my way through grad school, doctors used to hand out Xanax like candy. When I went to the school clinic with what I wrongly thought was asthma, the doctor took one look at my scrunched-up torso and and terrified face and said, “Oh sweetie are you a little high strung?” He explained that rather than not getting enough air, I was over breathing. The sensation that caused me to gasp like a grounded guppy? That was my body’s way of achieving homeostasis.
He wrote me a Xanax script with instructions to take a pill any time I felt like I couldn't breathe. That didn’t sit right with me. Here I was, the lucky owner of young, healthy lungs, having to take a pill to breathe? I never took them. Regretfully, I think this precious Xanax script went down the gullet of some ex-boyfriend.
Years later I developed a debilitating fear of flying and could only plan a trip or get on a plane after taking a Xanax. Somewhere around that time studies linked high-dose daily intake of benzos to late-life dementia. They also found the drug was very “habit forming,” and also caused brutal (and possibly deadly) withdrawal symptoms after abruptly stopping use. Interestingly, Xanax works on the same receptors in the brain as alcohol (called GABA). Alcohol and Xanax are therefore similar, and both drugs used over extended lengths of time can cause dependence and addiction. Though alcohol, a drug that’s widely advertised and embedded in American culture, go figure, seems way harsher on the body.
I used to never had trouble getting Xanax prescriptions. My doctor tracked that I was, in fact, pretty much only taking it to fly and so there was little risk of me growing addicted. I’ve never built up a tolerance and it effects me the same way every time (my brain is basic AF), which is that instead of screaming “We’re all going to die!” every time the plane hits a bump, I’m pretty chill.
What’s not chill is our medical system’s outsized over-reaction to concerns about addiction. The pendulum on benzos swung far in the other direction from the free-for-all days of the early aughts, when nervous college kids could get a script. When my doctor eventually retired I went to another woman at the clinic for a Xanax re-fill. I told her why I was there and her demeanor abruptly changed. She sized me up and down for signs that, I don’t know, that I was about to pretend my finger was a gun and demand her prescription pad. “Have you tried yoga?” Internal eyeroll. “What about deep breathing?” She said, demonstrating with a dramatic “wooooosh.”
After running my name through a database to make sure I wasn’t hitting clinics all over the tri-state area she reluctantly agreed. I knew it’d be the only time from her. She was just not comfortable treating me with a medicine that truly works and makes my life better because of a hypothetical risk of future addiction. Today I have an actual mental health professional who monitors my use to make sure it stays rare.
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