Coming Soon: Drug Test Nation?

Over the ages, classical liberal thinkers have produced a lot of dense prose attempting to explain that socialism is incompatible with freedom. In order to truly appreciate the point, however, most people require vivid examples. To that end, consider the proposal of Wisconsin Governor Scott Walker to force a wide range of recipients of government assistance to submit to drug tests.

Under the proposal, the state’s Medicaid program, called BadgerCare, would require beneficiaries to be assessed for substance abuse and undergo a drug test “if indicated.” People would not become ineligible for Medicaid if they tested positive for drugs, but would be referred to a treatment program or otherwise have benefits delayed for six months. Anyone who refuses testing or assessment would not be eligible to receive Medicaid.

A drug test is a pretty intrusive invasion of personal privacy, but this is the sort of rollback of freedom that normies and standard-issue conservatives love because it applies only to welfare recipients, people whom conservatives resent. A true lover of freedom, however, cares about everyone’s freedom, not just the freedom of those of whom we approve.

Furthermore, if drug testing Medicaid recipients becomes the norm, a lot of people outside the stereotypical welfare class are going to end up getting tested. That’s because most states (though not Wisconsin) under Obamacare have expanded Medicaid to include many people in the working class and lower middle-class.

Governor Walker has also proposed testing people other than those receiving Medicaid.

Walker recently has also proposed drug testing able-bodied adults who are on food assistance and people who receive unemployment benefits.

Unemployment compensation is not even a welfare program. What’s next, testing student loan recipients? Oh wait, that was already proposed at least as far back as the Clinton Administration.

So, everybody on Medicaid, expanded Medicaid, food stamps, unemployment compensation, student loans…that’s a helluva lot of people potentially getting drug tested.

You may not think drug testing is intrusive, but if the government tried to mandate it for everyone, the courts would almost certainly strike down the policy. But if the government limits the testing to recipients of government benefits, then it’s considered acceptable because government can set conditions on giving out money. He who pays the piper, calls the tune.

But what happens when the government is paying for nearly everybody? A lot of people believe that ‘single-payer’ or ‘Medicare for all’ health insurance is inevitable in America. Once the government is paying for nearly everybody, will everybody have to take a drug test?

That’s something people who love liberty should be worried about, but sad to say, it won’t worry too many suburban normies. Governor Walker is already a hero to many conservatives and libertarians for taking on the labor unions, and his drug policies, unfortunately, won’t cost him much support.

The War on Drugs is a War on America

If a foreign power killed ten thousand Americans, it would rightly be considered an act of war several times worse than 9-11, Pearl Harbor, Lusitania, or Maine. And yet, that’s the number of Americans killed every year by their own government in the War on Drugs. As the New York Post reports, since the government’s crackdown on prescription opiods, overdose deaths from opiods have increased by 10,000 per year.

Consider OxyContin — a major drug of choice for addicts that in 2010 was reformulated to make it far harder to abuse.

Illegal OxyContin use did indeed plummet immediately — but abusers then switched in droves to heroin, which is far more dangerous, and deaths from heroin overdose soared from 3,000 in 2009 to 13,000 in 2015.

Worse still, black-marketeers are now blending fentanyl — a highly potent, synthetic version of heroin — with heroin itself, or substituting it outright for the “natural” drug. That’s responsible for much of the soaring ODs.

The Department of Health in Ohio — which has the highest number of opioid deaths in the nation — reported in 2015 that more than 80 percent of opioid deaths arose from heroin or fentanyl, up from 20 percent in 2010. Health agencies in Florida and Massachusetts report similar trends. It’s now indisputable that most recent opioid deaths result from heroin/fentanyl, not pain pills.

If the choice is between people taking OxyContin pills or deadly junk like fentanyl, let them have the OxyContin.

Furthermore, the federal crackdown is inhibiting the use of opiods for people who legitimately need them for pain relief.

Another side of the equation is the cruel and needless suffering inflicted on blameless Americans who can no longer easily get pain medications. Just as addicts will do almost anything to feed their addiction, people in severe pain will do what is needed to escape it — even suicide.

Indeed, escaping pain is becoming increasingly difficult. People who have been treated appropriately and responsibly for years are now finding it difficult to obtain the relief they need, even from the same doctors. And you can’t blame the doctors.

Physicians rightly view the CDC “advice” as anything but voluntary. With the DEA looking over their shoulders, they fear losing their licenses for overprescribing. This creates just another wall between doctors and patients, many of whom are now forced to cope with their pain by using non-opioid, over-the-counter drugs such as Advil and Tylenol. These drugs are less effective and also carry their own risks, chiefly liver, kidney, stomach and heart toxicity.

Stop the madness. End the drug war now.

Does Drug Enforcement Cause Overdose Deaths?

A plausible economic theory states that prohibition of drugs or alcohol will increase the potency of the drugs that people consume illegally. More potent drugs are more economical for both users and dealers because they pack a bigger punch into a smaller volume, making them easier to transport and to conceal. Potent drugs can sometimes also deliver the required dose more quickly, which can help users to evade detection. There is evidence, for example, that alcohol prohibition during the 1920s caused an increase in the consumption of hard liquor relative to beer and wine. After all, there’s no point risking arrest at a speakeasy just to nurse a lite beer; the point is to get smashed.

The other problem with illegal drugs is the lack of quality control. So at the same time that the drugs are more potent, the lack of transparency and quality control makes the level of potency difficult for the user to determine. This uncertainty regarding potency dramatically increases the likelihood of overdose.

The conclusion is that the War on Drugs actually causes users to resort to drugs that are more dangerous than they might otherwise consume. Perhaps not so coincidentally, America’s current heroin epidemic took off right after authorities cracked down on prescription opioids like OxyContin. Abusing prescription opioids is bad; but at least OxyContin is produced by a reputable pharmaceutical company and not cooked up by gangsters in a Mexican hideout.

Now the New York Times reports that potency on the illicit market has ratcheted up to the point where people are using synthetic opioids up to 5,000 times more potent than heroin. The stuff is so dangerous that a tiny speck can kill, and cops are refusing to field test samples for fear of coming in contact with the stuff. The synthetic opioids are largely responsible for a record 200 overdoses in Cincinnati in just a two-week period.

Addiction specialists said the sharp increases in overdoses were a grim symptom of America’s heroin epidemic, and of the growing prevalence of powerful synthetic opiates like fentanyl. The synthetics are often mixed into batches of heroin, or sprinkled into mixtures of caffeine, antihistamines and other fillers.
In Cincinnati, some medical and law enforcement officials said they believed the overdoses were largely caused by a synthetic drug called carfentanil, an animal tranquilizer used on livestock and elephants with no practical uses for humans. Fentanyl can be 50 times stronger than heroin, and carfentanil is as much as 100 times more potent than fentanyl. Experts said an amount smaller than a snowflake could kill a person.

Around Cincinnati, police officers and sheriff’s deputies are so concerned about the potency of carfentanil and other synthetic opioids that they carry overdose-reversing naloxone sprays for themselves, in case they accidentally inhale or touch the tiniest flake.

The problem is growing so fast that overdose deaths in Hamilton County have doubled since 2012, and in the overall Cincinnati area overdose reports have more than doubled in just the past six months.

Meanwhile, the only response to the problem seems to be to send more and more people to jail. That’s the response in particular from the ‘law and order’ types in the rural and suburban counties. The New York Times published another fascinating report about how the Drug War is filling up jails in rural and suburban counties. Dearborn County, Indiana, just a bit west of Cincinnati, now sends more people to prison per capita than nearly any county in America.

By 2014, Dearborn County sentenced more people to prison than San Francisco or Westchester County, N.Y., which each have at least 13 times as many people.

A collection of small, quiet towns near the Ohio River, Dearborn County does not look like a prison capital. Violent crime is rare. There are few empty storefronts. And local officials, flush with money brought in by a popular local casino, have built a convention center and a high school football field fit for a movie set.
But the extraordinarily high incarceration rate here — about one in 10 adults is in prison, jail or probation — is driven less by crime and poverty than by a powerful prosecutor, hard-line judges and a growing heroin epidemic.
Opioid addiction spread early here. Mr. Negangard, the prosecutor, has fought the heroin crisis by aggressively going after drug crimes.
“If you’re not prosecuting, then you’re de facto legalizing it,” Mr. Negangard said.

But maybe legalizing would stop people from overdosing because they wouldn’t have to resort to taking elephant drugs smuggled from Mexico.

If legalization, de facto or otherwise, seems too risky, then we can at least halt the crackdown on prescription pills and focus just on the really dangerous opioids.

Donnie Gaddis picked the wrong county to sell 15 oxycodone pills to an undercover officer.

If Mr. Gaddis had been caught 20 miles to the east, in Cincinnati, he would have received a maximum of six months in prison, court records show. In San Francisco or Brooklyn, he would probably have received drug treatment or probation, lawyers say.

But Mr. Gaddis lived in Dearborn County, Ind., which sends more people to prison per capita than nearly any other county in the United States. After agreeing to a plea deal, he was sentenced to serve 12 years in prison.

“Years? Holy Toledo — I’ve settled murders for a lot less than that,” said Philip Stephens, a public defender in Cincinnati.

If we’re punishing people more for prescription pills than for murder, and the drug problem only gets worse, maybe it’s time to try a different approach.

Another FDA Triumph: OTC Decongestants

It’s bad enough that Americans aren’t allowed to take a drug without the approval of bureaucrats at the Food and Drug Administration. But in 1962, the Kefauver-Harris Amendment made things even worse by requiring drug companies to convince the FDA that a product was not only safe, but also effective. Requiring effectiveness causes huge delays in approval of new drugs and, in the end, the FDA cannot even be trusted to make the correct decision.

We wrote previously about how antidepressants taken by millions of Americans, including as many as one out of five women, are no more effective than placebos. Those antidepressants were affirmed by the FDA to be effective.

Now comes word that the leading over-the-counter decongestant, phenylephrine, is no better than a placebo, even though the drug was certified by the FDA.

Phenylephrine got the FDA’s green light as an OTC decongestant in the 1970s, mostly hinging on a few small-scale studies. In 2006, Hatton and Hendeles reviewed those studies, finding conflicting and questionable data sets. In total, they concluded, only four studies supported efficacy of phenylephrine at the approved dosage of 10 milligrams, while seven found no difference between the drug and placebo. “Thus, in our view, the panel reached a specious conclusion that was not based on a systematic review of the available data,” they wrote.

Now the latest and largest study confirms that the drug does not work.

In a new study of more than 500 adult allergy sufferers, researchers found that the common, over-the-counter(OTC) decongestant, phenylephrine, was no better at unclogging noses than placebo—even when given at higher doses than those currently approved. The study’s authors called on the Food and Drug administration to strike phenylephrine from its list of effective nasal decongestants.

But wait, the story gets better. The primary reason most people are using phenylephrine is that its rival pseudoephedrine, a decongestant that actually works, and that happens to be the active ingredient in Sudafed, got pulled from shelves because authorities didn’t want people using it to cook up methamphetamine. So that left no effective decongestant on the shelves.

Let’s therefore review the awesome 100-years of decision making by American authorities.

Step 1. Outlaw relatively safe drugs like laudanum and other opiates that people had been using for ages prior to 1914.

Step 2. Because of step 1, people resort to using more potent and dangerous drugs produced and sold on the black market.

Step 3. Require drug manufacturers to demonstrate efficacy to the FDA.

Step 4. Screw up step 3 by certifying as effective a decongestant that does not work.

Step. 5. Due to step 2, take the decongestant that does work off the store shelves leaving only the one that doesn’t.

The end result is worse than having nothing at all on the shelf because now you part with your hard earned money to buy a worthless drug that you expect will work and then it doesn’t.

All the people who got cheated by purchasing phenylephrine should be paid compensation out of the FDA pension fund.

FDA to boys with deadly disease: Drop dead

Yesterday, an advisory panel of the U.S. Food and Drug Administration announced its verdict regarding Eteplirsen, an experimental drug used to treat a deadly degenerative disease that mostly afflicts boys.

Duchenne’s is a rare genetic disorder characterized by progressive muscular weakness. The disease is caused by a lack of dystrophin, a protein needed to keep muscles healthy. Eteplirsen is designed to increase the production of dystrophin.

The disease typically emerges in boyhood, causing weakness in the arms and legs and eventually the lungs and heart. Patients typically lose the ability to walk during adolescence and frequently die in their 20s or 30s, according to the National Institutes of Health.

Hundreds of patients and family members pleaded with the panel to approve the drug.

“FDA, please don’t let me die early,” urged 15-year-old Billy Ellsworth, who has the disease.

The panelists said they were moved by the patients’ testimony and that in some cases, it swayed their votes.

But all that pleading did not sway enough votes, as the panel voted against approving the drug.

The panel voted 7-3, with three abstentions, that the clinical trial of 12 patients did not provide substantial evidence the drug was effective for muscular dystrophy patients with a specific genetic mutation.

The vote followed a skeptical presentation by FDA reviewers, who questioned the validity of the data. They said the results were hard to interpret and there was no clear evidence the drug slowed progression of the disease…

The panel’s decision reflects the malign influence of the 1962 Kefauver-Harris Amendments which required drug companies to demonstrate not just safety, but also efficacy. Failure to demonstrate efficacy was the FDA panel’s justification for voting down the Duchenne’s drug this week.

The drug may or may not be effective, but we fail to see how patients who are facing death are better off not being able to try the drug at all. The decision to take this drug, it seems to us, should rest in the hands of the patients and their doctors, not panels of bureaucrats.

In any event, the panel’s vote was only ‘advisory’ and the FDA has not yet reached a final decision. Although it seems unlikely, the FDA might still be persuaded to approve the drug. Maybe the company that produces the drug just needs to make the right political contributions.

FDA delenda est

FDA Delenda Est

Since the Kefauver-Harris Amendments of 1962, the Food and Drug Administration has been tasked with approving for sale only drugs proven to be both safe and effective. Medical research, however, is an imperfect science. And FDA bureaucrats can make poor decisions due to incompetence, or because they are unduly influenced by political considerations. As a result, two types of errors can occur. First the FDA can mistakenly approve a drug that is not safe and effective. Second, the FDA can fail to approve a drug that is, in fact, safe and effective.

The first type of error imposes greater costs on the FDA than does the second. If the FDA approves a drug, and then people are harmed or die from taking the drug, the incident will generate very bad publicity, and the FDA bureaucrats will come under fire from elected officials and the public. The second type of error generally creates much less controversy. We rarely hear about drugs that never make it to market, even if people die who could have been saved by those drugs.

In order to avoid the backlash from approving a harmful drug, the FDA has the incentive to err on the side of excessive strictness, so that the FDA ends up delaying or deterring beneficial drugs. That’s why it takes something like 10 years and $1 billion to bring a new drug to market. In many cases, people die waiting for drugs to be approved. Or the high costs deter the pharmaceutical companies from developing the drug in the first place. As a result, people die.

But this arrangement serves the interests of the FDA bureaucrats. They get in trouble only for mistakenly approving drugs, not for rejecting them. That’s right; people die so that bureaucrats can have an easier life. Remind us again how socialism is ‘compassionate.’

Writing at the website of the Hoover Institution, law professor Richard Epstein offers just the latest story of the FDA’s obstructionism and interference with personal autonomy.

Earlier this month, the Food and Drug Administration rejected the application of Biomarin Pharmaceutical to market its drug Kyndrisa (drisapersen) for use in the treatment of Duchenne muscular dystrophy. The FDA, as is often the case when it rejects a drug application, listed all sorts of technical reasons why the data presented was not sufficient to establish by respectable scientific means that the drug in question was safe and effective in its intended use. Without question, much evidence from the clinical trials revealed serious complications from the drug’s use, including blood-platelet shortages that were potentially fatal, kidney damage, and severe injection-site reactions. But the no-treatment alternative could prove far worse.

Duchenne is a rare but fatal genetic disorder that attacks only young boys, roughly 1 in 3,500 to 5,000. Typically, it first manifests itself between two and five years of age. With time, it relentlessly weakens the skeletal muscles that control movement in the arms, legs, and trunk. Most of its victims are wheelchair-bound between the ages of seven and 13. By 20, many have died.

The source of the problem is the absence from the cell of the key chemical dystrophin, which is needed to control muscular movement. The proposed treatment is known as “exon-skipping,” which allows the body to produce the needed quantities of dystrophin. At present no drugs are on the market to fix the genetic defect. But other drugs are also under investigation. If the door is closed for drisapersen, it remains ajar for an unnamed drug produced by Sarepta Therapeutics, which will be reviewed by the FDA shortly. But, based on early rumblings from the FDA, it is likely that this drug too will be kept from the marketplace.

As might be expected, the decision by the FDA has left parent groups and their physicians tied up in knots. You can get a sense of their frustration by looking at the desperate petition of a mother whose son has the disease. Tonya Carlone wrote a public letter to the FDA pleading for the drug to be allowed on the market: “This medication has allowed my son, Gavin, to be able to ride a 2 wheel bike, to play on a soccer team, to run and play with his healthy 10 year old peers. Dr. Craig McDonald of UC Davis Medical Center and a Duchenne expert of over 30 years, has stated that he has never seen a boy with Duchenne at the age of 10 have as much function as Gavin.”

All irrelevant, says the FDA.

In a free society, no mother of a child with a deadly disease should ever have to write a desperate letter begging government bureaucrats to allow access to a drug that might save the child. The decision on which drugs free citizens will use should be made by those citizens and their doctors. No government bureaucrat should have anything to do with that decision. The FDA’s drug approval process is incompatible with basic principles of human freedom and personal autonomy, and should be completely abolished.

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Time to Lower the Drinking Age

Until about 30 years ago, most states set their legal drinking age at 18. Then the federal government used constitutionally-dubious extortion–threatening to withhold highway funds–to coerce the states to raise the drinking age to 21. Despite the higher drinking age, 18-20 year olds who want to drink can always find a way to obtain alcohol.

But the problem with the drinking age is not just that it’s ineffective at reducing consumption. Perversely, the drinking age creates incentives that make alcohol consumption by young people less responsible. Specifically, the drinking age incentivizes binge drinking, and drives youth drinking underground, out of sight of older, more responsible adults.

In a recent article in Commentary magazine, John Steele Gordon provides a concise summary of the issue.

[T]he main consequence of this law has been to drive college-age alcohol consumption underground, which has in all likelihood increased that consumption and probably actually increased drunk driving. Unable to drink in public at bars and restaurants, where the owners and the other patrons would exert a restraining influence, college-age people drink in dorm rooms, basements, and fraternity houses. The result has been a marked increase in binge drinking. U.S. News and World Report reported that, “The CDC… found that young people between the ages of 12 and 20 drink 11 percent of all the alcohol consumed in the U.S., and more than 90 percent of this alcohol is consumed during binge drinking.”

That last statistic is quite remarkable. Not a lot of casual drinking among the young. They drink to get shit-faced. The reason is that prohibition, whether of drugs or alcohol, always increases the intensity of consumption. That’s because there’s no point to breaking the law just to nurse a light beer for an hour. If you’re going to run the legal risk, might as well make it worthwhile by getting hammered. That explains binge drinking, and also why Prohibition during the 1920s increased the consumption of hard liquor relative to beer and wine.

The same holds true for drugs. People often argue that we can’t legalize drugs because hard drugs like heroin are too dangerous. What they don’t understand is that hard drugs are themselves the product of prohibition. If drugs were decriminalized, people could meet their needs with milder opiates rather than resorting to heroin. Indeed, a major contributor to America’s current heroin epidemic is the government’s counterproductive crackdown on opioid painkillers.

For years, treatment centers saw few heroin addicts. But that started changing in the mid-2000s and took off a few years later after a government crackdown on opioid painkiller abuse. Unable to get pills, many addicts turned to heroin, the painkillers’ chemical cousin.

As usual, the better policy involves more freedom, not less. Time to bring the drinking age back down to 18, or preferably, eliminate it altogether.

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How the Drug War Kills

An article in the Washington Post calls Dayton “an epicenter of the heroin problem.” In the lengthy article, two paragraphs caught our attention.

First,

For years, treatment centers saw few heroin addicts. But that started changing in the mid-2000s and took off a few years later after a government crackdown on opioid painkiller abuse. Unable to get pills, many addicts turned to heroin, the painkillers’ chemical cousin.

Second,

In Montgomery County, home to Dayton, heroin-related deaths have skyrocketed 225 percent since 2011. Last year, this county of 540,000 residents reported 127 fatal heroin overdoses — among the highest rates in the nation, according to statistics from the U.S. Centers for Disease Control and Prevention.

Well, maybe if the police state hadn’t launched its crackdown on painkillers, those users would not have “turned to heroin, the painkillers’ chemical cousin,” and many if not most of those 127 fatal overdoses wouldn’t have occurred.

This is exactly how prohibition kills–by driving users to less standardized and more toxic substances. Instead of popping pills manufactured by reputable pharmaceutical companies, people end up shooting junk produced in some Mexican hideout.

A similar phenomenon occurred during alcohol prohibition, when thousands died or went blind from drinking methanol.

But when most people hear that 127 people died from heroin overdose in just a single Midwestern county, they take that as evidence that drugs are far too dangerous to decriminalize, and they become even more resolved to prosecute the War on Drugs. What they don’t understand is that the drug war itself is what makes the drugs that people take so dangerous.

But hey, at least the drug war creates good jobs and benefits for law enforcement.

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Ohio to Vote on Legalizing Marijuana

The pro-marijuana group ResponsibleOhio has collected enough signatures to put a constitutional amendment on the November ballot.

The amendment would legalize medical marijuana and the use of up to one ounce for adults 21 years or older. Limited amounts of home growing would also be allowed.

[…]

The measure would also establish a marijuana control commission to regulate growth, distribution and sales in the state. Ten locations across the state would be selected for licensed growing operations.

The measure would tax 15% of gross revenues for growing operations and 5% of gross revenues for retail marijuana stores, plus annual licensing fees.

Fifty-five percent of the taxes would be distributed to cities and townships and 30% to counties for infrastructure and public safety purposes, and the remaining 15% would go to the marijuana commission.

Let’s hope that Ohio voters have the wisdom to approve this measure. The way we see it, legalization of marijuana isn’t just about enabling people to lawfully smoke dope. It’s about putting an end to police abuses such as launching dangerous SWAT raids, replete with armored cars, grenades, and battering rams, because some guy might have a few plants under a fluorescent light in his basement. Or seizing somebody’s vehicle because a cop at a traffic stop spies a roach clip or because a sniffer dog allegedly catches a whiff of weed.

We’ll watch with interest to see what position the police unions take on the amendment. Is the amendment’s earmarking of 30% of tax revenue “to counties for infrastructure and public safety purposes” a way of buying off the unions? A savvy move, if it works.

Now if we can only think of some way to win the Clueless Soccer Mom vote.

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