The war on drugs needs to be fought from the demand side

Foreign cartels aren't driving our drug crisis. This is a cultural and medical war first. And the good guys are barely even fighting.

Friday, I wrote about the bipartisan morality crisis of America’s leaders.

Along the way, I criticized the Trump administration for attacking speedboats it says are moving drugs. Blowing those ships up without warning is murder, I wrote.¹

A lot of you think I’m wrong, we should destroy these boats — and their passengers.

So. Say our intelligence is correct and we haven’t blown up any fishing boats by accident. Maybe, maybe not. Even well-meaning soldiers make mistakes. But for this discussion, let’s agree we are killing cocaine traffickers, not Venezuelan fishermen.

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(Unreported Truths: less dangerous than cocaine. Cheaper, too!)

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In that case, here are two questions to consider:

1: How quickly could you legally get amphetamine if you wanted it?

2: Is there any real difference between amphetamine and cocaine?

The answers, in case you don’t know:

1: Ten minutes. Maybe less.

2: No.

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The United States is enduring the worst drug crisis in its history. Over a half-million Americans have died of overdose since 2020. Although deaths have dropped since their 2023 peak, they remain four times as high as in 2000, when the modern crisis began with the explosion of opioid prescriptions and Oxycontin.

Note I didn’t say the worst “opioid” crisis (though that’s true) or “cocaine” crisis or “meth” crisis — or even “illegal” drug crisis.

Drug decriminalizers and legalizers get almost everything wrong when they talk about drugs. But they’re right on one crucial point: the United States has erased any meaningful distinction between legal, illegal, and prescription drugs of abuse.

Cannabis and THC (the chemical in cannabis responsible for its high) fit in all three of those categories, depending on the state. Ketamine — a risky, addictive anesthetic — is offered at spas. Psychiatrists spend most of their time on “medication management,” a euphemism for writing prescriptions for amphetamines like Adderall and benzodiazepines like Valium. The amphetamines are nominally for attention-deficit disorder. The benzos are for the anxiety that the amphetamines cause.

What about our oldest and deadliest friend, opioids? Despite what legalizers claim about the crackdown on opioids, Americans still are prescribed a vastly disproportionate share of them.

But that fact shouldn’t surprise anyone. Americans are prescribed a vastly disproportionate share of all drugs of abuse.

Meanwhile, alcohol advertising is everywhere, including for “hard” alcohol, distilled spirits like vodka that are 40 percent ethanol.

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On the illegal side, public health and advocacy groups have spent decades pushing the doctrine of “harm reduction.”

Harm reduction has specific tactics, such as “supervised injection sites.” But it is above all a philosophy that views drug use as a morally neutral activity. To legalizers, drug use is part of life and society and we should not try to control it, much less eliminate it. Instead, we should simply accept it and try to handle its consequences.

Thus American public health authorities spend a good deal of time these days telling people not to “stigmatize” the users of illegal drugs.

New York state now has an entire glossary devoted to euphemisms for drug abuse and addiction. It includes such gems as: Instead of saying “non-compliant [with a drug treatment program]… consider saying “feels ambivalent regarding change.””

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(Instead of saying: High as a kite, consider saying: Enjoying the day)

(SOURCE)

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No wonder so many kids and teens and young adults believe the United States is hypocritical about drug use. They’re right. The United States is hypocritical about drug use.

The correct distinction is not between legal, illegal, and prescription drugs, but between “drugs of abuse” and everything else. How to define drugs of abuse? The simplest and to me best definition includes three points:

1: They are addictive, meaning users want to take them and typically do so at higher doses over time, even when the use is causing problems²;

2: They produce a subjective euphoria in users;

3: They have street value — meaning that they can be illegally trafficked (or diverted, in the case of prescription drugs) and sold.

It is possible to quibble over these categories, but any drug that fits in all three is surely a drug of abuse. The third point is underestimated for its predictive strength. Highs may not exist outside the walls of our skulls, but markets are as good at finding and pricing them as at everything else.

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Yet for far too long we have pretended that medically prescribed drugs somehow do not count as drugs of abuse. That cycle began with opioids and cocaine in the 1800s, moved to barbiturates and amphetamines after World War 2, and now encompasses the laundry list of narcotics I mentioned above.

In each case, physicians and the medical establishment aggressively offered these pills. Some doctors (and patients) may have been genuinely naive about the risks they ran, at least at first. Others were not.

In any case, figuring out the real appeal of these chemicals shouldn’t have taken long for either side. In Drug Dealer, MD: How Doctors Were Duped, Patients Got Hooked, and Why It’s So Hard to Stop, Dr. Anna Lembke — a Stanford University psychiatrist — describes the cat-and-mouse game that goes on between drug-seeking patients and physicians who want to trust them but are aware they may be lying.

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(Though she’s not really ill, there’s a little yellow pill…)

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The generation-long explosion in amphetamine prescriptions for the dubious disease called attention-deficit hyperactivity disorder is particularly problematic.

No biological markers for ADHD exist. Like so many illnesses created in the last 75 years, it is defined primarily by its symptoms — and those symptoms can change from person to person. In April, the New York Times ran a long magazine piece [paywall dropped] about ADHD that argues powerfully that it is massively overtreated.

In Dopesick, Beth Macy tells the stories of a half-dozen young opioid addicts in southwestern Virginia. Without exception, they were prescribed amphetamine or amphetamine-like drugs — in the form of Adderall or other stimulants — as kids.

The lesson is clear: Drug use breeds drug use. The people who insist Americans need these stimulants have to explain why children (and adults) in other major developed countries do just fine without them.

Instead, we have made getting amphetamines almost comically easy. Answer a quick online questionnaire, get a prescription, and you’re off to the races, no sleep required.

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(Pills fo’ cheap!)

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Your biggest problem may actually be filling the prescription.

The never-ending American appetite for amphetamine has led to years of spot shortages at pharmacies that can force speed addicts — I mean ADHD patients — to spend days chasing their fixes, I mean filling their prescriptions.

The endless quest for amphetamine be would be comic, if it weren’t tragic.

Nobody’s suggesting drone strikes on CVS trucks, though.

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(The truths - and perspective - you don’t get anywhere else. For pennies a day.)

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Medicalizing, promoting, and commercializing drug use drives drug use.

Drug use drives addiction, neighborhood and family destruction, and death.

Blowing up a few speedboats may feel good, but it doesn’t fix the underlying problem — which comes from the powerful American appetite from drugs of abuse, an appetite that pharmaceutical companies and our culture stoke together.

Meanwhile, the harm reducers use our voracious appetite for prescribed drugs to argue that anyone who standards against illegal drug use is a hypocrite. They have the answer backwards: the answer is not to decriminalize and legalize the use of drugs like cocaine, but to demedicalize and stop promoting the use of drugs like Adderall.

Our leaders and physicians need to stand against the use of drugs of abuse of all kinds - whether illegal or medical. This is not to say that these drugs do not sometimes have limited medical use. No one would deny opioids to someone dying of cancer.

But doctors need to stop offering addictive and psychoactive drugs to treat American “diseases” that exist almost nowhere else in the world. And we need to crack down on dealers of all kinds, including the ones in white coats.

We don’t have to average 100,000 overdose deaths a year, as we have recently. We have grown to tolerate a level of misery from drug abuse that no country should.

But before we can solve this crisis, we have to accept that its roots are in the United States - not the Caribbean Sea.

1. My exact words were: “The Trump administration’s answer to the crisis of drug use has been to blow up civilian ships in international waters… This is murder, plain and simple. It is also precisely the wrong response, for many reasons, including the most basic: the answer to lawbreaking is not more lawbreaking.”

2. The question of physical withdrawal is less important. Drugs like cocaine and cannabis are very hard for heavy users to quit, though they produce only mild physical withdrawal.