A younger friend of mine, an immigrant like me, keeps having trouble understanding why I voted for President Trump, toward whom she drips with hatred. She produces so much hatred of the president you might think she knows him personally. He might even be an ex-husband of hers. This is a little hard for me to understand. Here is my honest reconstruction of how I came to vote for Donald Trump in 2016. May it be useful to her and, if not, to others.
During the 2016 campaign, I was mostly sad and resigned. It looked like the Dems had the wind in their sails. The Republican contest between 16 viable candidates had ended in the victory of the least viable of them, Donald Trump. For the record, my candidate was Marco Rubio, who dropped off early.
Donald Trump was loud and ignorant, and loudly ignorant. His statements about international trade were those of a lazy undergraduate who has barely skimmed the relevant chapter, and got it all wrong. His project for a southern wall struck me as the wrong solution to the wrong problem at the wrong time. Illegal immigration through the Mexican border has been dropping for years. A good wall might even end up trapping more illegal Mexicans wanting to go home than keep illegals out. Besides, no wall would stop visitors from entering legally and then overstaying their visa. Finally, I don’t even think illegal immigration is a pressing problem although it must be stopped for reasons of sovereignty. Mr Trump wanted less immigration of all kinds; I think this country needs more immigration but better regulated.
There is no doubt, (there was none then) that Mr Trump has impossibly bad manners (although that makes part of me smile). I think he has a personality disorder (as I have) which causes him to speak out of turn, to think only after he opens his mouth, and to open his mouth even when his brain tells him he shouldn’t. He gives the cultural elite heartburn. I am not sure how I feel about this though because I know the cultural elite well since I spent thirty years in academia. They are mostly a bunch of half-literate pretenders who richly deserve the occasional heartburn.
At any rate, it wasn’t obvious I would vote for Mr Trump; I kept looking over the fence. I did this in spite of the fact that the Dems keep enlarging government against civil society, the reverse of what I want to see. I did it in spite of the Democratic Party’s promotion of identity politics which are bad for America, I believe, and bad even for the Democratic Party. (As I write, even African Americans are deserting the party.)
There, on the Dem side, for a while, it looked like Sen. Sanders had a fighting chance. I don’t like socialism – whatever that means – but here was an honest man with a clear record. Sanders is my age. I feel as if we had gone to college together. He has not changed since 1968. Everything about him feels familiar, even his college president wife with the short hair. I thought that if elected, he would only attempt modest reforms that would easily be frozen out by a Republican Congress. The result would be a kind of federal immobility, not the worst scenario, in my book. If Mr Sanders had become the Dem candidate, I would at least have had a serious talk with myself about voting for him. That’s at least.
Mr Sanders was eliminated from the Dem race in a way that revived all my aversion for the Democratic Party as an organization. The thoroughly dishonest manner of his removal would have been enough to ensure that I would not vote for the actual Dem candidate, pretty much whoever that candidate was. The fact that Sanders protested but feebly the gross cheating against him makes cold sweat run down my back because of what it implies about the Dem culture.
The actual candidate was not just anyone (“whoever”). Mrs Clinton was a caricature of the bad candidate. She was a feminist previously elected on her husband’s coattails, and a career politician with no political achievements of her own. Her main contribution as Secretary of State was to get the US militarily involved in the events in Libya. (I was in favor of such involvement myself at the beginning, I must confess.) She ran for president with no economic program – which normally implies the continuation of the predecessor’s program. But Mr Obama’s economics were very bad; what was not bad could be credited to the independent Fed. I did not want more of this. Then, there was the personal issue. It’s a little difficult to explain but I developed the idea in my mind that even her supporters did not like her. So, how could I?
Mrs Clinton’s campaign was naturally an embodiment of the Dem Party’s silly identity politics which I think are bad for American democracy in ways I won’t develop here: “Vote for me,” she said, “because I am a woman.” So, what? So are 52% of the adult American population; many of those are brilliant. Mrs Clinton is not brilliant, not even close. By contrast, take Prof. Condoleeza Rice, the former Secretary of State, for example. (Plus, she is black; you get a two for one; plus, she is probably a closeted lesbian too, that’s a three for one!)
Donald Trump throughout his campaign was attacked for being a racist. I saw and heard many imprudent statements, some rude statements, and many goofy declarations but I did not notice racist statements. That’s if “racist” means attributing to a whole class of people negative moral qualities or objectionable behaviors based solely on their race (whatever race is, another story). My common sense also says you can’t live as a prominent New Yorker in various guises for a whole adult lifetime and not be called out for racism if you act like a racist. It’s jut a little late to do it when the man is seventy. It’s ridiculous, in fact. Or, perhaps, I have just stopped paying attention to charges of racism coming from the left. Leftists intemperate verbal habits may have trivialized racism the way they trivialized so many serious social problems, including sexual violence.
There was no doubt in my mind though that Donald Trump would be dangerous as president because he is unpredictable, does not readily listen to advice, and does not understand well how our institutions work. So, I was never enthusiastic about voting for him. I even took a detour through the Libertarian campaign. It was based on the assumption that any Dem, including Clinton, would carry California, where I vote, and that I could therefore afford the luxury of a symbolic ballot. However, after a short time, I became convinced that the Libertarian candidate was not even libertarian. So, end of story here.
During the period preceding the campaign, when Clinton was Secretary of State, and during the campaign itself, I paid increasing attention to the goings-on around the Clinton Foundation, including the pattern of donations. I came out convinced that Mrs Clinton’s eagerness to sell the Republic and her disregard for the law (30,000-plus lost emails) made her a political gangster of the same ilk and magnitude as Vladimir Putin.
So, you might say that I voted for Donald Trump because I thought he was unpredictable. Clinton, by contrast, was horribly predictable. It’s fair to add that I did not think my vote would carry the day. Like just about everyone else, I thought my side had lost until about 7 pm, Pacific Time on election day.
One year and a half later, I feel no buyer’s remorse; instead, I am pleasantly surprised. Pres. Trump has not really done any of the things I feared – such as dismantle the modern world system of fairly free world trade; he has not built a wall. When he does, I think it will be a small elegant one with viewing balconies over Mexico. Mexican tourists will gladly pay for the privilege of going up its exterior elevator. There will be a lounge and bar with overpriced drinks on the last floor.
Pres. Trump has done a couple of the things I wanted him to do, beginning with the appointment of a conservative Supreme Court Justice. He also instigated and carried out a major tax reform which will fuel good economic growth for years to come. (I am dissatisfied with the current rate. I think anything under 3.5% is not good enough. But, it’s a start.) The tax cut may even make up for the disastrous spending bill which he signed reluctantly but did sign.
Pres. Trump has also done the deliciously unexpected. I am not holding my breath (writing on 5/9/18 ) but I am amazed and delighted he has gone so far on the road to the denuclearization of North Korea. The fact that the thaw is largely a product of his bullying the North Korean bully makes this even sweeter.
After more than a year of unlimited investigation with limitless resources, the only Russian collusion in sight is that of the Clinton campaign buying from a shady international operative grotesque stories about Trump in Russia. The only shadow on this bright picture is that I am not completely sure that Mr Trump did not have sex with a porn queen several years before running for office. The horror!
- The West’s bombing of Syria meets some approval from Muslims Bruce Clark, Erasmus
- Should the Italian Prime Minister support the Democrats? Michelangelo Landgrave, NOL
- The ugliness of international politics Edwin van de Haar, NOL
- Rent-Seeking Rebels of 1776 Vincent Geloso, NOL
Last week, the Trump administration announced it would be pursuing a federalist approach to cannabis legislation, effectively allowing states to create their own rules about how the drug is classified and sold.
This is a big change in American drug policy. One common opinion of the Obama era is that the federal government took a relaxed approach toward policing states that were decriminalizing marijuana. The 2008-2016 administration shifted the financial language of the drug war from a law-and-order crackdown to a public safety effort, and placed a low priority on intervening in states with medical legality. Real reform was introduced like the Rohrabacher-Farr amendment which prohibited the Department of Justice from policing medical marijuana states with federal funds. However, DEA raids and reconnaissance missions continued — like in my home state, where counter-economizing Californians sold a whopping five times more weed than they consumed (often to states where it is illegal).
Under Obama, it looked like, with a president less enthusiastic about beating up stoners, American drug policy might start to approach the 21st century. Some skepticism was reintroduced when Senator Sessions was appointed Attorney General under President Trump. Jeff “Good People Don’t Smoke Marijuana” Sessions is explicit about supreme federal authority for drug laws, and supported overturning Rohrabacher-Farr. This, indeed, would be a return to normalcy. For the last half century, it has not been characteristic of the federal government to stay out of drug use — rather than the Trump administration being a Republican re-installation of the war on drugs, we would be witnessing a general return to the 20th century status quo. However, Trump’s announcement makes it seem like we can finally welcome the unexpected.
Trump’s representatives have positioned this move to give up cannabis regulation to the states in a philosophy of states’ rights. Whether or not Trump cares about dual federalism, the repeal of marijuana prohibition — medical, recreational and federal — sweeping across states the last decade is a big win for individual liberty, and, since neither Party has been particularly friendly to cannabis, would seem to point to mainstream party acceptance of libertarian ideas.
What is the Party’s track record on cannabis? The Libertarian Party explicitly opposed drug laws in its first 1972 national platform. Now, in our present day, drug decriminalization is not a radical stance but something more mainstream. Failed or ex-politicians from either party have made a habit of coming out in support of legalizing marijuana the last few years, and up north, the Canadian Liberal Party may now endorse wide-scale reforms. Just yesterday, Senate Minority Leader Chuck Schumer announced he would introduce a bill to directly decriminalize marijuana as a federally classified substance. We’ll see how it goes. But it is now clear that in the same way Libertarians supported gay marriage decades before either partisan establishment now does, one doesn’t have to seek out a minarchist anymore to find someone who opposes drug laws or mass incarceration. (One mainstream policy position that hasn’t budged — war.)
So although we see radically unlibertarian moves nearly every day in Congress and the executive (e.g., FOSTA and Syria), some of the ideas of liberty have spread and reached mainstream status.
This raises some questions about the state of the philosophy and the Party, and more than just drug policy. What does it mean when our more eccentric ideas gain traction in the bigger political world? This question is tied to the purpose of an embedded libertarian political party in the first place.
Economist David Friedman made the point in the postscript to Machinery of Freedom that the purpose of the Libertarian Party is to not have a Libertarian Party. David’s argument is not the same thing as Austin Peterson’s brand slogan, to “Take over government in order to leave people alone.” Instead, David’s argument was built around a public choice understanding of political institutions, but the same conclusion follows from several different premises about the nature of third parties and especially those with a goal of mitigating or eliminating politics.
For American institutional reasons — codified in law and practice — a third party is almost certainly never going to win an election. David thinks, therefore, the purpose of a fringe political party is aspire to the legacy of the Socialist Party of the early 1900s. The Socialist platform in 1928 has succeeded in infiltrating establishment policy, even if the Party last election drew less than a tenth of 1% of the vote. Fringe parties are more successful as beacons of alternative policy than legitimate political competitors. The Party does not pursue political success but influence; hopefully, we will one day not need it to affirm liberty.
So, let’s return to cannabis decriminalization, where we are seeing a libertarian idea achieve mainstream political support.
Legalizing weed is a victory for libertarian ideas and a defeat for the Libertarian Party. Part of the simplistic draw of Libertarianism is “fiscal conservatism and social progressivism,” which, as a one-liner, allows recruitment from both the Republican and Democratic Parties. Now, however, if the progressive leaders, and the Republicans, are co-opting drug decriminalization, there is a lot less draw for social liberals to vote for Party alternatives more aligned with their radical agenda. (I know this, for instance, because drug legalization as an issue first drew me from Democratism to libertarianism in high school.) Hillary Clinton could have partially avoided her image as a crony neoliberal if she adopted more social freedoms, which would only leave her smears on the Left as an imperialist and capitalist.
A recent, rather strange video by AJ+ took aim at libertarianism (read: the Libertarian Party) as “ultra far-right” and spent seconds noting that libertarians are, on the flip side, “anti-NSA, anti-intervention and anti-drug laws.” These are not the only policies that small government people have to offer to the Left if they properly understand themselves. But, as libertarians, we should actually hope this list grows smaller and smaller; the more it shrinks, the more it means that establishment parties are appropriating libertarian positions. Pretty soon, being “anti-drug law” may disappear from the elevator pitch. Subsequently, the “worthwhile aspects” of the Libertarian Party fade to the back, and the draw of the Party (to the left, or the right) decreases until it looks heavily status quo.
So, we could expect that the influence of the Libertarian Party shrinks with the increasing influence of libertarian ideas in general society, as the general electorate pressures establishment politicians to adjust their policy space.
However, a lot of things are being taken for granted here. Do politicians actually respond to the general public consensus and public desire? Is it the case that “libertarian” ideas are spreading to the mainstream, or is it more “progressive” or “traditionalist” ones that are moving it in ostensibly similar directions? Can the ideas alone move policy positions without backing money?
We also know that the power of the Libertarian Party has greatly increased since its humble beginnings (whether or not its reputation has improved). My hypothesis is that the influence of libertarian ideas in society at large pressures the estabishment parties to adjust their positions, which in turn makes the Libertarian Party more irrelevant. This is not disproved by an increase in Libertarian Party power. The ideas, even if libertarian, still need to be seen as “libertarian” for it to hurt the Party. For instance, Chuck Schumer said “Looking at the numbers” guided him toward decriminalizing cannabis at the federal level and cited the ACLU. These “numbers” have been available for decades, from a potpourri of alternative political thinktanks. Citing them from the ACLU will not embed the bill — also faux-embedded in a philosophy of states’ rights — in libertarianism, but in the context of mass incarceration, criminal justice racial disparity and THC research opportunity. These are all good contexts. But the individual freedom element key to libertarianism will be missing, and of course it is, because Schumer says nothing about the other plethora of federal drug laws which prohibit freedom. Recognition of the libertarian aspect of ideas which are libertarian, I think, is essential for them to harm a Party which bases itself around the philosophy.
All of this means that there will be perverse incentives in third-party leadership. Politicians want job security like the next guy, and organizations in some sense want to “survive,” so the interests of libertarianism and the Libertarian Party are in one way opposed (or environmentalism and the Green Party). Liberty is more advanced by incumbent politicians (who are liberty-advancing, of course) than defeated politicians. And the mainstream parties are successful, the fringe parties are not. Thus, liberty is better spread when our ideas take off and get mainstream acceptance, but this will only serve to weaken the Libertarian Party itself, as its attraction as a political outlier fades. This must be obvious: no Libertarian Party candidate is going to claim the White House in our lifetime, and the best hopes of libertarian success are in influencing other parties. So, even when we gain more percent of the vote, the success is in getting people to hear about libertarianism, not in actually convincing people to vote Libertarian.
Conflicting incentives (working in the Party and advancing liberty) means that the Party could be taken over by bad actors like any other political organization, and indeed David predicts this with the increase of political clout. Parties with political power have plenty of favors to dish out, and it only takes a few non-ideological Party members to break ranks. As some of the ideas become more mainstream, this is one possibility. Another is disintegration: there might be no reason for the Libertarian Party to continue, given that its unique draw has suffused into larger bases. A third option is that more radical contingents, like the Mises Caucus, achieve ideological supremacy as the moderate libertarians leave for the newly-libertized Democrat and Republican parties.
In any case, libertarianism faces a conundrum in its Party format. Much of the problems apply to other third parties, but some are unique to libertarianism. One brutal confrontation is the acknowledgement that legalizing cannabis will advance liberty and simultaneously hurt the liberty movement. To this end, Saul Alinsky’s reflection in Rules for Radicals is potent.
The Woodlawn Organization in Chicago is trying to stop the University from bulldozing the black ghetto. The activists issued five demands for the city council, grew in power, and defeated the construction project. Eight months later, the city crafts a new policy on urban renewal to the frustration of the Woodlawn Organization, who barge into Alinsky’s office denouncing the policy statement. But “Through the tirade it never occurred to any of the angry leaders that the city’s new policy granted all the five demands for which the Woodlawn Organization began. Then they were fighting for hamburger; now they wanted filet mignon; so it goes. And why not?”
The solution to one problem creates a new problem, and there are always future problems to work on. Liberty will just have to keep trucking through the victories, and learn from our friends the Socialists of 1928 and Saul Alinsky, who never joined a political party.
With stocks plummeting this week upon an announcement of retaliatory tariffs by China in response to a recent spate of steel and aluminum tariffs from the Trump administration, it seems a midweek reader on the situation is appropriate.
- At the Washington Post, Rick Noack explains how Trump is going into unprecedented territory since the WTO was founded, and why existing trade norms probably can’t stem a trade war. A slice:
But while China has used the WTO to accuse the United States of unfairly imposing trade restrictions over the last months, Trump does not appear interested in being dragged into the dispute settlement process. In fact, Trump appears to be deliberately undermining the legitimacy of that process by saying that his tariffs plan was based on “national security” concerns. WTO rules mandate that a member state can claim exceptions from its trade obligations if the member’s national security is at stake.
That reasoning has long been a no-go among WTO member states, because they understand that triggering trade disputes under a “national security” framework could eventually render the WTO meaningless.
- Last month at the Chicago Tribune, Steve Chapman had a good op-ed showing why Trump’s justification of steel and aluminum tariffs on national security grounds is bogus:
But putting tariffs on all imports to prevent dependence on China or Russia is like throwing away your library card to avoid bad books. It would make more sense to focus on the guilty countries rather than deploy a sprayer that also soaks the innocent.
The national security risk is minuscule, though. Imports make up only one-third of the steel we use, and the Pentagon requires less than 3 percent of our domestic output. No enemy has us over a barrel, because we buy steel from 110 different countries.
Most of what we import comes from allies and friends, including Canada, South Korea and Mexico, which would have no reason to cut us off in a crisis. If China stopped shipping to us, friendlier countries would leap to grab the business.
- Also at the Washington Post last month, historian Marc-William Palen gives numerous historical examples of how nobody wins in trade wars and how they can threaten our national security by arousing populist resentment of the US abroad. A slice:
The trade wars that followed the Republican passage of the protectionist Smoot-Hawley Tariff Act of 1930, which raised duties on hundreds of imports, similarly contain illustrative lessons for today. Canada responded with tariff increases of its own, for example, as did Europe.
In a widely cited study from 1934, political economist Joseph M. Jones Jr. explored Europe’s retaliation. His study provided a warning about the trade wars that can arise when a single nation’s tariff policy “threatens with ruin” specialized industries in other countries, arousing “bitterness” throughout their populations.
- At Cato’s At Liberty, Daniel Ikeson explains how Trump’s tariffs establish a dangerous international precedent that will threaten US interests elsewhere:
By signing these tariffs into law, President Trump has substantially lowered the bar for discretionary protectionism, inviting governments around the world to erect trade barriers on behalf of favored industries. Ongoing efforts to dissuade China from continuing to force U.S. technology companies to share source code and trade secrets as the cost of entering the Chinese market will likely end in failure, as Beijing will be unabashed about defending its Cybersecurity Law and National Security Law as measures necessary to protect national security. That would be especially incendiary, given that the Trump administration is pursuing resolution of these issues through another statute—Section 301 of the Trade act of 1974—which could also lead the president to impose tariffs on China unilaterally.
- The Independent Institute’s Robert Higgs reminds us that citing trade deficits is misleading:
In reality, individuals, firms and other organizations, and governments trade with other such entities, some of which are located in the same country and others of which are located in other countries. The location of the trading partners has no economic significance whatsoever. Trading entities enter into exchanges voluntarily, each one in each transaction anticipating a gain from the trade. Hence, in expectational terms, every such trade entails a gain from trade, or in other words an addition to the trader’s wealth.
- At American Greatness, Henry Olsen tries to give a communitarian justification of protectionism:
So-called populist movements around the world are gaining strength because their voters no longer feel like valued members of their nations. They do not believe their worth should decline because the owners of capital say so, nor do they think their life dreams or values should be denigrated simply because the most educated have different visions.
Populists like Trump address this spiritual yearning and fulfill the deepest need every human has, to be valued and to belong to a group that values you. In this, and perhaps in this need alone, all men are truly created equal. Tariffs are simply an economic means to fulfill this spiritual need. Tariff opponents can only win if they first recognize this need and promise a more effective way to fulfill it.
- At Bleeding Heart Libertarians, Jason Brennan explains why communitarianism cannot justify protectionist policies:
Second, if tariffs don’t actually succeed in helping these workers, then the symbolic argument falls flat. Imagine an artist said, “I’m so concerned about the plight of people living in tenements, I’m going to do a performance art project where I burn down all their homes and leave them on the street. Sure, that will make them even worse off, but my heart is in the right place, and I thereby express my concern for them.” This artist would be…a contemptible asshole.
- Finally, given its relevance at the moment, it’s worth revisiting Paul Krugman’s classic essay “Ricardo’s Difficult Idea” which remains the best account of why non-economist intellectuals have a hard understanding free trade:
(i) At the shallowest level, some intellectuals reject comparative advantage simply out of a desire to be intellectually fashionable. Free trade, they are aware, has some sort of iconic status among economists; so, in a culture that always prizes the avant-garde, attacking that icon is seen as a way to seem daring and unconventional.
(ii) At a deeper level, comparative advantage is a harder concept than it seems, because like any scientific concept it is actually part of a dense web of linked ideas. A trained economist looks at the simple Ricardian model and sees a story that can be told in a few minutes; but in fact to tell that story so quickly one must presume that one’s audience understands a number of other stories involving how competitive markets work, what determines wages, how the balance of payments adds up, and so on.
During her recent visit to China, a Democratic Senator from Massachusetts, Elizabeth Warren (perceived by many as a potential Presidential Candidate of the Democratic Party in 2020), came down heavily on US President Donald Trump’s approach towards foreign policy, arguing that it lacks substance, is unpredictable, and does not pay much attention to liberal values and human rights, which according to her has been the cornerstone of US foreign policy for a long time.
Commenting on Trump’s unpredictable approach towards Asia, Warren stated:
This has been a chaotic foreign policy in the region, and that makes it hard to keep the allies that we need to accomplish our objectives closely stitched-in.
Critical of US approach towards China
Warren met with senior Chinese officials including Liu He, vice-premier for economic policy, Yang Jiechi, a top diplomat, and the minister of defense, Wei Fenghe, and discussed a number of important issues including trade and the North Korea issue.
Warren criticised China for being relatively closed, and stated that the US needed to have a more realistic approach towards Beijing. She also spoke of the need for the US to remain committed to raising Human Rights issues, and not skirt the issue, while dealing with China.
Here’s the second half of an abridged essay I wrote for a public policy course. First half is here, and next week I’ll write about the FDA’s new enemy, kratom.
The DEA’s 2015 declaration of an opioid epidemic was the first sign of large-scale federal attention to prescription analgesics, to my knowledge. On the CDC’s official glossary, “outbreak” and “epidemic” are interchangeable: “the occurrence of more cases of disease than expected in a given area or among a specific group of people over a particular period of time.”
The classification of addiction as a disease is sometimes controversial. (See also Adam Alter’s Irresistible for a popularized form of the psychological takes on addiction.) For the opioid problem to be an epidemic, the focus must be the addition rate, and not the overdose or death rate alone. The federal government usually refers to the opioid situation as an epidemic or emergency (which presupposes a value judgment), and when media has covered it (as with the deaths of Philip Seymour Hoffman, Heath Ledger and Prince) they use the same language. One definitive media moment might have been last year, when John Oliver announced for a young progressive crowd that “America is facing an epidemic of addiction to opioids.”
Oliver was referring specifically to addiction — criticizing companies like Purdue Pharma (creator of OxyContin) for misleading or misinformative advertising about addictiveness. But usually it does not seem like the focus is on addiction. As stated, nonmedical usage of opioids is generally down or stabilized from the last couple years, and the problem is mostly overdoses. (True, these are intimately connected.) This might indicate that cutting the pills with other drugs or general inexperienced use are greater problems than general addiction. So, there is an epidemic in the colloquial usage — extensive usage of something which can be harmful — but only questionably in the CDC’s medical definition, as the usage rates are expected to be up as synthesized morphine-, codeine- or thebaine-based pain relievers diversified, and these have mostly stabilized except for heroin (thought as often beyond opioid status) and fully synthetic derivatives which get less attention (fentanyl, tramadol).
Why the standard of abuse fails
John Oliver — worthy to talk about because much of the public plausibly started paying attention after his episode — noted that the pills are assigned to patients and then, even if the patient doesn’t develop an addiction, they end up in the “wrong hands.” What happens at this point? The Commission recommends that companies design their prescription drugs for “abuse-deterrent” formulations (ADF). After spikes in opioid abuse, Purdue Pharma and other companies began researching mechanisms to prevent abusers from easily obtaining a recreational high by tampering with the pill or capsule. In a public statement, FDA commissioner Scott Gottlieb asserted that the administration’s focus is on “decreasing unnecessary exposure to opioids,” but, recognizing the real role that prescription opioids play in pain relief, Gottlieb continues that “until we’re able to find new nonopioid forms of pain management … it’s critical that that we also continue to promote the development of opioids that are harder to manipulate and abuse, and take steps to encourage their use over opioids that don’t offer any form of deterrence.” Some of these abuse-deterrent options are crush resistance or wax coating to make dissolving more difficult.
However, opioid abuse comes in two forms which are conflated by the legal language. The first is when a patient takes more than their recommended allocation or takes it in the wrong way. The second is when someone with or without a prescription consumes them purely for recreation. Many drug savvy abusers of the second variety have adapted methods to get a recreational high but avoid potential health risks, the most popular method being “cold water extraction” (CWE). Most opioid pills contain both a synthesized opium alkaloid (from morphine, codeine or thebaine) and acetaminophen: Percocet contains oxycodone and paracetamol; Vicodin contains hydrocodone and paracetamol. The acetaminophen or APAP has no recreational benefits (a pure pain reliever/fever reducer) and can cause severe liver problems in large quantities, so recreational users will extract the opium alkaloid by crushing the pill, dissolving it in distilled water, chilling it to just above freezing, and filtering out the uncrystallized APAP from the synthesized opium. This way a greater quantity of the opioid can be ingested without needlessly consuming acetaminophen. Other recreational users that want less of the opium derivative can proceed without CWE and insufflate or orally ingest the particular pills.
ADFs might be able to dent the amount of abusers of the second variety. If the pills are harder to crush (the route of Purdue’s 2010 OxyContin release) or, for capsules, the interior balls are harder to dissolve (the route of Collegium Pharmaceutical’s Xtampza), amateur or moderately determined oxycodone enthusiasts may find the buzz is not worth the labor. As the Commission observes, more than 50% of prescription analgesic misusers get them from friends and family (p. 41) — these are not hardcore aficionados, but opportunists who might be dissuaded by simple anti-abuse mechanisms. Abusers of the first variety, though, are unaffected: at least in the short term, their abuse rests on slightly-over-the-recommended doses or a natural tendency to develop an addiction or non-medical physical dependency. And, if the political core of the opioid emergency is patients that develop an addiction accidentally (those that stay addicted to pharmaceuticals and those that graduate to heroin), abuse-deterrent focuses are unlikely to create real change in addiction rates. It could even have the unintended consequence of higher overdose deaths for amateur narcotics recreationalists, who aren’t skilled enough to perform extractions and opt to consume more pills in one sitting instead.
And furthermore, ADFs can be incorporated into the naturals and synthetics that are usually bonded with APAP like codeine, oxycodone, hydrocodone and tramadol, but cannot for the drugs that come in pure form like heroin or fentanyl. And those are the problem drugs. The NIDA research on drugs involved in overdose deaths across the board, for one, shows that overdose deaths are on the rise as a whole (except for methadone), and also that the synthetic opioids are much more deadly than the naturals and semi-synthetics: fentanyl is the biggest prescription analgesic killer (it’s much more potent than morphine, and tramadol is not very good for recreation).
(This graph also shows, however, that the natural/semi-synthetic usage rate was possibly leveling out but resuscitated in 2015.) So ADFs are useless for the drugs most massively causing the “opioid epidemic.” Making them harder to abuse only dents the second category of abuser, and does not limit their addictiveness for those prescribed them for postsurgical pain or otherwise.
Moreover, from a libertarian standpoint, the second category of abuser does not really belong in the “public health crisis” discussion. Those who knowingly consume opioids for recreation are not a problem, they are participants in a pleasure-seeking activity that doesn’t tread on others. So long as their costs are not imposed on other people, it might be better to separate them from the “epidemic” status. Blurring the lines between the groups that fall under “abusive” means that those with a side-interest in OxyContin on Friday nights are lumped in with addicts suffering from physical dependency. Someone who has a glass of wine each night is not “abusing” alcohol, but we can recognize someone who is an alcoholic; the same distinction should be applied medically to opioid users. By painting all consumers outside of direct medical usage as “abusers,” there can be no standard for misuse, and thus no way for a recreationalist to know how much is too much, when health problems might set in, if they are really trapped in their recreation, etc. Research and knowledge are threatened by the legal treatment and classification.
To summarize, the government terminology of “abuse” obscures a legitimate distinction that is justified on both medical-political and civil liberty grounds. Some of the approaches in the Commission report, like the market-based CMS package recommendation, will likely succeed at quelling opioid exposure (and thus addiction and overdoses), while other maneuvers like an education campaign or ADFs should be treated with cautious skepticism. The trends show that heroin and fentanyl are actually the biggest contributors to the opioid epidemic, although semi-synthetics are climbing again in overdose deaths after leaning toward stabilization two years ago. Evidence that prescription abuse and street use are linked, as well as testimony from former addicts, indicates that drug users easily swing between the legal and black market.