Morgan Dandie Hannah Interview: Part Five, Legalizing Drugs

In this part of my "deep dig" I get a short quote from Morgan Dandie Hannah where she talks about an issue that I raised: legalization. It might look like the two of us disagree about what needs to be done. I don't think that that's true, however. I suspect that no one who supports the legalization of opioids would consider that a good long term fix. Instead, I imagine that it serves to lessen the harm that we are currently seeing under the present, insanely-stupid war on drugs. If we ever did develop a holistic social policy aimed at helping addicts---including detox, counselling, assisted housing, and so on---I'd probably be opposed to it too. But, like Morgan, I suspect that we are a long, long, long way from getting to that. In the interim, I think that writing a script for legal opioids is something doctors should at least consider. Similarly, I think we are well past the point (if it ever made any sense) where we should be incarcerating people who deal small amounts of drugs because they need the money for one reason or another.  

Cloudwalking Owl · Legalizing Drugs

There are several issues that I should expand here. I raised the issue of legalizing all drugs because some of the worst problems that come from drug addiction are just as much an artifact of their being illegal as addictive. 

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The first problem with street drugs is that they vary wildly in potency. How to give you an idea of how wildly, consider the following comparisons that I found in a Washington Post article.

• Morphine is 222 times as potent a pain reliever as ibuprofen
• Morphine is 3 times as strong as codeine
• Hydrocodone is as strong as morphine
• Oxycodone 1.5 times as strong as morphine
• Methadone is 3 times as strong as morphine
• Heroin is up to 5 times (depending on how it used) as morphine
• Buprenorphine is 40 times as strong as morphine
• Fentanyl is 50 to 100 times as strong
• Carfentanil is 10,000 as strong as morphine!

Just to give people an idea of how incredibly potent carfentanil is, consider the following "factoids":

• Police officers have been warned that they should never even touch the stuff, because it is so potent
• If someone overdoses on it, naloxone often has to be administered more than once to save them
• The weight of carfentanil necessary to sedate an elephant is equivalent to 34 grains of table salt
• Carfentanil is so powerful that it can be incorporated into a gas that will almost immediately render someone unconscious. This was banned by international convention, but the Russian government used it to deal with a situation where Chechen terrorists had taken 800 people hostage at a Moscow theatre. Unfortunately---because of excessive secrecy---the rescuers refused to tell medical authorities what was in the gas, and 120 of the hostages died before doctors realized that naloxone was an effective antidote.  

The problem for addicts is that when they buy a fix on the street they have no way of knowing what it is made of, and, how powerful the dose is going to be. This makes dealing with their addiction an every-day game of Russian roulette. If, instead, they received a prescription from a doctor that a pharmacist supplied, then they would be able to take their drug without running any risk of an overdose. 

Dr. Andrea Sereda, Twitter

 

This is already happening in Canada. One example is Dr. Andrea Sereda , a family physician at the Intercommunity Health Centre in London Ontario, who prescribes hydromorphone tablets to a select number patients who are addicted to opioids, but do not respond to either methadone or suboxone treatment. Another is Dr. Scott MacDonald at the Crosstown Clinic in Vancouver's Downtown East Side neighbourhood. He deals with the same sort of patient base by prescribing medical grade heroin. In both cases, addicts have a stable, clean, affordable, and, predictable source of opioids that protect them from the problem of "accidental" (but, as they show, "preventable") overdoses.

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Dr. Scott MacDonald, Crosstown Clinic

The second issue is the cost of street drugs and effect that this has on the lives of addicts. I found a website where users can list the street price of various drugs across Canada. (Think of it as the addict's version of "gas buddy".) Here's what some of the latest figures for opioids were:

• OxyNEO (oxycondone) is $15/20 mg pill in St. Catharines
• Rivacocet (oxycondone), $10/5mg/325mg/pill Quebec (The two different numbers refer to two different medications mixed together---the first refers to the narcotic. In this case oxycondone and acetaminophen. I will just list the narcotic, but leave the second number as this is part of the official name of the drug.)
• Dilaudid (hydromorphone), $20/8mg pill in Quebec
• Heroin (powder/chunk), $200/1 g in Montreal
• Oxycondone,$1/5mg pill Hamilton
  
• Ratio-Oxycocet (oxycondone), 5mg/325mg pill Port Colborne
  
• Tylenol No. 3 (codeine), $2/30mg pill in Winnipeg
• Percocet (oxycondone), $10/5mg/325mg pill in Oakville
• OxyContin, $20/15mg pill Edmonton
• Tramadol, $5/50mg pill Vancouver
• ACT Oxycodone CR, $20/80mg pill Edmonton
• Morphine tablet, $10/100mg pill Vancouver
• Heroin, $100/1g powder Coquitlam
• Morphine tablet, $5/10mg pill Ontario
• Dilaudid (hydromorphone), $10/1mg pill British Columbia
• Hydromorphone, $15/8mg pill London
• Dilaudid (hydromorphone), $10/4mg pill Kelowna
• Fentanyl (illicit, non-heroin), other powder, $40, Orillia
• I could go on, but I think that readers have some idea of prices by now---.

Now, let's put those prices into a context. I did some more research on line and came up with the following figures:

• Hydromorphone costs $0.07 (US)/2mg table, wholesale. It was invented in 1923 and on the generic market. Compare that with the above list, where it is listed as ranging from $10 to $20/pill on the street.
• Tramadol is another generic that was invented in 1963 and it sells for $0.05 (US) per dose. It's listed above for $5/pill.
•  Oxycondone ("roxicodone") is listed online as being for sale (with coupon!) for about $0.14/pill (no dosage mentioned on website) at Costco in Saint Louis MO. But on the street, they sell for between $1 and $20/pill at various places in Canada.
  
• The best retail price for codeine pills in Saint Louis is $0.28/pill at Walgreens. In contrast, Tylenol 3 pills are selling for $2/pill in Winnipeg.
• Morphine pills are pretty much the same everywhere in Saint Louis, $0.28/pill (with coupon). But on the street in Canada they cost between $5 and $10/pill.
• According to the CBC in Switzerland, where it is legal to purchase heroin, it only costs $3.80/gram---which seems like one heck of a deal compared to between $100 and $200/gram on the streets. 
  

The point of the above exercise is to show that the drugs people end up addicted to are actually very inexpensive and easy to find---if you can do so legally. But if you can't, then you end up paying an extraordinary amount of money for narcotics that could very well kill you. That's a big reason why there is so much petty crime in Guelph. One additional part of the problem is that for many addicts, the only way they can afford to pay for their habit is by selling to others, which just adds to the problem.

I tend to agree with Morgan Dandie Hannah that legalizing all drugs isn't the solution we need. But given the context we find ourselves in, it might be the case that it could be part of temporary harm reduction strategy if somehow people who simply can't---for one reason or another---get off the stuff to simply have MDs give them a prescription for it. Then they wouldn't burn through all the money they have in order to buy street drugs and play Russian roulette. 

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Digging up all this info is tedious work. That's the nature of anything worthwhile. Scientists do enormous amounts of repetitive "scutwork". Academics in the humanities do too. Detectives, engineers, most blue collar jobs---pretty much anything worthwhile is 95% perspiration and only 5% inspiration. That's why people get paid to do this sort of thing. That's why I keep posting these blue-print appeals for readers to subscribe. If you can afford it, why not? It's easy to do with  Patreon and Pay Pal.

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Hannah said that she is opposed to "decriminalization", but I think that what she really meant was "legalization". Cannabis was recently legalized in Canada, but if it had been decrminalized, no one would be busted for possession while at the same time there would be no legal way for someone to purchase it. My understanding is that that is how Portugal treats narcotics. 

Having said that, there are subtleties to this sort of thing that should be understood. For example, look at these charts that describe the population of American federal prisons. They come from a 2016 Brookings report and do a good job of illustrating why we should be very careful about the idea that all "drug dealers" are monsters of one sort or another. 

First of all, let's look at the composition of the federal prison population. (Don't forget that there are also local jails and state penitentiaries, where people who are presumably less dangerous reside.)

As you can see, one half of the people in US federal prisons as of 2009 were described as being there for "drug offences", but not for "violent crime". Please don't forget that what we see in this graph is just the recorded crime. The American criminal justice system is rife with plea bargaining. It might be---for all I know---that a certain percentage of these criminals are violent, but prosecutors have allowed them to plead to a lessor charge just to get the conviction and speed up the process. Still, 50% of people in prison for non-violent drug charges is a startling figure!

As you can see in this breakdown of that 50% of the federal prison population in jail for drug offences, only 0.8% are identified as being there for simple possession. This is where it's important to remember that this is a report about federal prisoners---presumably the majority of people incarcerated for just possession would be in a municipal jail or a state penitentiary. (One interesting thing to think about is that sliver of the pie titled "other drug offences". What is there about drugs besides making, importing, selling, and, using drugs? What could the "other" category include?)

 

 

Let's look at the above figures. Each of the titles for those numbers could be parsed-out in more detail than they are (for example, is a "street-level dealer" an addict who sells just a enough to pay for their own habit? or, are they someone who makes a lot of money off encouraging naive young people to "chase the dragon"?) But I do think that they at least introduce readers to the complexity involved in the manufacture and distribution of illegal drugs.

I've led a "marginal enough" life to have known a few convicted drug dealers in my day. And they bore no resemblance in any way-shape-or-form to the stereotypes that popular media presents. They weren't twisted, evil scum living in palatial mansions like Al Pacino's depiction of Scarface. Instead, they were guys just trying to pay the bills like everyone else. The following short video from the American non-profit The Drug Policy Alliance explains the disconnect.

 

If that isn't enough to raise the idea that we should be very cautious about deciding that it's OK to go after dealers with full force of the law while leaving users alone, here's another video from the same organization that adds to the above arguments.

While the materials I quote above mostly come from the American experience, the fact of the matter is that we have a crazy bad opioid epidemic too. And that suggests to me that we should also look for the same sort of systemic failure in criminalizing all levels of the drug trade. 

With that in mind, I'd say that it would be useful to emphasize and expand on Morgan's concern that we not go after seller's who are also "users" by saying that we should be quite clear about only going after the real kingpins and them alone with the criminal justice system. I suspect that this would be very difficult, however, since the same sort of system that protects people like the tax-evaders identified in the Panama Papers would also make it really hard to go after high-level drug kingpins. It just stands to reason that local police forces who want to pump up their "numbers" would go after the local guys selling on the street rather than pursue a Quixotic attempt to find and arrest some guy in a three-piece suit who might even live in another country. 

 

Anyway. I think that that is enough detail for readers to process for one week. I'm planning on dealing with the Portuguese model that Hannah talked about in my next post.  

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Furthermore I say unto you, we must deal with the Climate Emergency!