 The opioid crisis this is something that I've been speaking about for I think six or seven years now and Really no matter where I go No matter what the group is or what the main presentation is that I'm giving to the economics club to the Republican Club to the Kiwanis organization church groups My own classes at Auburn University they get a miniature lecture at least on the opioid crisis and I think this is of truly vital importance that everybody get as much information on this because people are losing sons and daughters mothers and fathers all over the Country at a very alarming rate And this is something this is an issue with no quick Answers or solutions It's a very difficult and it's causing pain economic pain And pain in families all across the nation and it's a difficult talk to give On the run up to that Let me just give you a quick overview because I didn't get to speak at the summer fellows Session, but I did my dissertation on the economics of prohibition illegal drugs illegal alcohol and other things in the 1980s and I wrote extensively on that subject for Well over a decade in terms of books in terms of articles popular in academic Chapters and books on reforming drug laws And so I get a newspaper articles Of course for publications that the Institute has like the free market and I'm not today with our website and In the late 1990s, I started changing my research agenda and what I was talking about In the late 1990s, I started writing about the economics of Richard Cantillon first economic theorist I started writing about the economics of American slavery With a PhD student of mine from Auburn University And I was also writing on economic history and the history of economic thought So I really had changed my whole perspective and what I was reading about And it wasn't about drugs anymore In 2006, I noticed that Rush Limbaugh was arrested for oxy cotton and overusing he was addicted to it It was a bad scene and at the time That I remember from the late 1990s. There were about three overdose deaths In America per 100,000 people. So it was about 2.8 people per 100,000 dying from Opioid overdoses by the time Rush Limbaugh was arrested. It was over six people Per 100,000 so roughly doubling In about seven or eight years In 2012 I started the numbers were continuing to rise and that's when I started talking to groups Whether they liked it or not About the horrors and dangers and deceptions of the opioid crisis In 2014 Fentanyl, which is an artificial opioid Deaths from using that started to skyrocket in 2014 The latest reporting period 2016 there were 55,000 Overdose deaths attributed to various opioids legal and illegal so in that year more people died from Taking pills and smoking opioids then died during American soldiers died during the Vietnam War of over a dozen years so that's a 400% increase in the number of Overdose deaths due to opioids and One of the reasons I left the war on drug research was because I thought we were winning I thought there was already in place a movement Towards more freedom and less drug warring the pinnacle of the war on drugs was 1989 the late 1980s it started to decline Overdoses were declining arrests were declining death Due to violence and murder and gunfire and that sort of thing was falling rapidly mostly due to the Right to carry a weapon concealed carry permits so I basically Got back into this game and started writing about it again started talking about it again about this Massive problem and with the legal opiates what we're talking about things like oxy cotton Vicodin and there are several others, but oxy cotton and Vicodin are the most prominent Forms of legal opioids The reason I mean that's the whole purpose of this lecture is to explain why we have this crisis and what we can do about it Basically things started to change and get much much worse when pharmaceutical companies started lobbying For new guidelines for pain medication so they were arguing that Patients needed to be relieved of pain and they were putting pressure on this committee of scientists To change the guidelines so that opioids would become a regular course of Pain relief, you know So prior to this if you had dental surgery or you had an injury or broke broken bones Typically, they give you a non-opioid pain medication in the 80s and 90s But since 2000 the number of prescriptions for opioids has been Has skyrocketed So the guidelines were changed by the committee the committee on Pain Prescription drug use And physicians were encouraged to follow those guidelines So physicians who would very rarely ever Issued prescriptions for opioids Started to do so on a regular basis So just regular painful injuries and procedures So if you threw out your shoulder you broke your arm You twisted your knee you had dental surgery For a whole host of things Opioids became the standard treatment But typically those things Were only prescribed in the short run so 60 or 90 days 30 days You'd be given Maybe 30 day prescription for 60 pills or 90 pills Something like that Now as a result many people became addicted to these things And deaths now just for the legal prescription opioids is in excess of 15 000 per year So the prescription Pain guidelines changed in the year 2000 As of the year 2012 There were 250 million prescriptions written in that year Of the people who got those prescriptions 25 of the prescribed users Quote unquote misused their prescription now that can mean many things You took too many pills in a day You took too many pills in a week You didn't take your pills at all All of those things could be classified as misuse But if you had something as dangerous as opioids And The people who were supposed to be taking them Misused them in some way or another 25 of the time I would think you'd want to stop and rethink things 10 of those People with those prescriptions Got opioid use disorder Which means they became temporarily or long term addicted To the the product What as we're going to see five percent of the people in 2012 Transitioned over to heroin And we're talking about people who would never ever consider Taking heroin or buying anything on the black market So right now we're we've ended up with about two and a half million opioid addicts in our country Part of this is related to the issue of chronic pain something i'm Certainly not an expert on but i do want to mention a few Facts regarding this because that this is another epidemic That is left undiscussed and Unanalyzed and unsolved In 2003 There were 13 studies on chronic pain Of european countries And the rate of chronic pain in europe Varyed from 10 percent or 10.1 percent to 55 percent in these european countries In 2006 chronic pain in 15 european countries in israel averaged 19 percent 2011 chronic pain In america was 111 million people it's just kind of hard to believe And that suggests about 50 of adults claim to be in some state of chronic pain I looked on google and in 2016 there were 46 million hits for chronic pain In 2017 that rose to 163 million google hits as a result of chronic pain or related to chronic pain so One thing's for sure we got to figure that issue out eventually but for today we're going to look mostly at this opioid problem The face of heroin addicts is also changed and this is very important. It makes sense with the broader Presentation here in the 1960s in the 1970s The face of heroin addicts was young inner-city mostly minority men and vietnam veterans In the 1980s in 1990s The face of heroin addiction Transitioned to older african-american men more suburban users But there were still many young poor and minority males dominating The face of heroin addiction Today the fastest growing proportion Of the heroin population Is female older middle-class and white And it's also more rural than urban so The the kernel of the story here is that The pharmaceutical companies got the prescription guidelines changed doctors started prescribing opioids on a massive level a certain percentage of those people would become addicted And they would all subsequently or most Subsequently be cut off from their prescription. So if the reason for your prescription wasn't chronic pain, but was rather Falling down the stairs getting hurt at work having a football injury in high school With those people you'd get 30 or 60 days The leg would heal the shoulder would heal And you would get cut off and the people would go back to their doctor and say well, I need another prescription, please Nervously of course And they would be told no you can't have any your arm is no longer broken There's no need for you to be to be continuing to take opioids And so what do you do at that point? Well You can buy these pills on the black market But that tends to get very very expensive The more direct routes are you can go cold turkey, but that's extremely Hard to do and I've been told is dangerous to try to do on your own You can try drug rehabilitation treatment centers But the problem with that is is that very often you have to Give up 30 days of your time It's incredibly expensive if you don't have good insurance And it very often doesn't work So the rate of relapse of people who successfully Complete a rehab program A lot of people fall back into drug use So the rehab route is very costly and not effective in most cases The cold turkey is very very very difficult and Potentially dangerous So the third choice is to go out and buy These pills on the black market The problem with that choice is that a pill can be maybe $10 a pill it can be $25 a pill and even higher and if you're You have a habit of four or five pills a day And rush limbaugh. I think was on more than a dozen pills a day That can get very expensive you might be able to handle it at $10 for a while But if it goes up to $30 a pill not many people can afford that extra cash out of their income So one of the choices that a lot of people make that they would never ever conceivably make is To go back to the guy who sold you oxy cotton Uh, he might also be selling or know somebody who is selling heroin And heroin now Is actually much cheaper than these oxy cotton pills So if you buy a large quantity For individual consumption, you might get a a dose of heroin for three or four dollars a piece And so these fishermen these coal miners these high school teachers and football players Who would never ever consider the idea of buying heroin As their best economic alternative At least it is in the case of millions of people Okay, so we've actually pushed These people into the black market So what are the what are the causes of this problem? Well, the mainstream media will tell you it's the The cart drug cartels the smugglers and the drug dealers that are responsible They'll tell us that it's the drug addicts fault that the gateway theory that they must have been drinking or smoking pot And they ended up uh buying heroin Other people will blame the free market Uh, a lot of people nowadays want to blame china because everybody wants to blame china for everything And most of the fentanyl is made in china and shipped into the united states And most people actually agree that all of these things these are the reasons for the opioid crisis And what they're looking at is the scene frederick bastiaz the scene and the unseen Well, these are the things that are obvious and can be seen But they're not the real reasons These people who believe in these causes Want more prohibition more law enforcement locking up more and more people In government intervention to Solve the problem The real reason is what i've just given you is that the pharmaceutical industry The medical industry is really at the root of this problem that it's government intervention in various forms have basically taking The control over pain and pain treatment away from doctors and have basically set up guidelines and systems And incentives so that if patients are surveyed now by insurance companies by Medicare medicaid Are you getting sufficient pain relief? Well, it turns out no most people are not getting sufficient pain relief and so if they're not The insurance companies and medicare will actually penalize them with a lower compensation rate From the insurance companies and from medicare in other sources So it's not the free market at all in fact, it's the Polar opposite of the market that's government intervention on a massive scale And I would argue that the best way In contrast to these other people that i've mentioned Who want to lock more people up? I would argue that drug legalization Is actually the way to solve this problem So that as bait as a baby step Doctors should be able to Prescribe their patients a maintenance dose of pharmaceutical pure heroin When you do that you take the The worries away from the attic you take away the economic problem That addiction creates you give the attic time And stability in order to solve all of the other problems that come with Drug addiction family problems relationship problems job problems the whole list of problems that Are very difficult to do especially if you are a heroin addict By legalizing drugs and allowing doctors to prescribe Pharmaceutical pure Heroin or substitutes I think is the first step on the way towards reversing this terrible trend in american society Thank you very much