Chasing the Scream: The First and Last Days of the War on Drugs

by Johann Hari

again is: When do the worst problems associated with Oxycontin and Vicodin, the ones you see on the news, start? When do the addicts start to hold up pharmacies to get their next batch, or prostitute themselves, or start overdosing on a massive scale? Meghan Ralston, one of the leading experts on this crisis, explained to me: They don’t begin when the drugs are prescribed. They begin when the prescriptions are cut off.

The United States, she explained, doesn’t have a Swiss-style policy of prescribing Oxycontin or Vicodin or other opiates to addicts. In fact, it has the precisely opposite policy. If I am an American who has developed an Oxycontin addiction, as soon as my doctor realizes I’m an addict, she has to cut me off. She is allowed to prescribe to treat only my physical pain—not my addiction. Indeed, if she prescribes just to meet my addiction, she will face being stripped of her license and up to twenty-five years in jail as a common drug dealer—just like Henry Smith Williams’s brother at the birth of the drug war.

Nobody, she explained to me, swallows 80 mg of Oxycontin prescribed by their doctor and goes out to commit a crime, or dies of an overdose. No: it’s when the doctor realizes the patient is an addict and cuts them off that all the trouble begins.

when I began to think about it in relation to the last time drugs were sold freely in the United States—before 1914—that I started to understand. Remember the transformation Henry Smith Williams lived through. Before the ban, almost all opiate users would buy a mild form of the drug at their corner store for a small price. A few did become addicts, and that meant their lives were depleted, in the same way that an alcoholic’s life is depleted today.

The same pattern is playing out today with prescription drugs. If I am a young man with a legal Oxycontin prescription that I am using compulsively to deal with my psychological pain, my life will be depleted, and sluggish, and incomplete. If I am cut off from that prescription—if my own personal 1914 hits me—my life will become disastrous, and I will start acting in all the chaotic ways associated with the prescription drug crisis today. It is when the legal routes are cut off that the worst begins. So, Meghan says, the prescription drug crisis doesn’t discredit legalization—it shows the need for it.

you can prescribe opiates for back pain, why can’t you prescribe them for psychological pain? Imagine if a woman addicted to Oxy in Oklahoma City wasn’t abruptly told to stop using, with directions to the nearest Narcotics Anonymous group and a brisk “Good luck.” Imagine if, instead, she was told exactly what the patients in Geneva are told: you will be given a safe, legal dose for as long as you need it, and while you receive it, we will give you support and care to help you to rebuild your life, get secure housing, and keep your job. It seems reasonable to expect that the results would be the same in Vermont or Alabama as they were in Switzerland—that most people would, over time, choose to reduce their dose and eventually give up their drugs as their pain abated. But that’s only the first step: it’s the bandage that stops the hemorrhaging. Then you need to have a deeper strategy—one that stops these wounds from forming in the first place. To do that, you need to change the culture so people find life less unbearable. We have to build a society that looks more like Rat Park and less like a rat race. If that sounds like pie in the sky, remember the alternative: addiction outbreaks that only swell, like an Oxy slick forming across the sky.

This leads to the second question: Why did the prescription drug crisis radically accelerate in the past decade? There are two possible explanations. The first is the only one any of us have ever heard. It says that doctors—urged on by the greed of Big Pharma—have been handing out these legal opiates for conditions such as back pain without properly warning their patients about the risk of addiction,

But there’s a crucial piece of evidence that has been omitted from this picture. As we saw earlier, in hospitals across the West, people are given much more powerful opiates than Oxycontin and Vicodin day in, day out.

This suggests we should look at the other possible explanation—a story taught to me by Bruce Alexander back on the streets of the Downtown Eastside. Bruce showed that at any given time, you and I and everyone around us has access to a huge array of chemicals that could drive away our pain for a while, from vodka to valium. Almost all of the time, we leave them on the shelf, unused. So the question is: Why are there sudden moments when large numbers of people, scattered across different bathrooms and barrooms, suddenly pick them up and swallow them compulsively, all at once? The answer doesn’t lie in access. It lies in agony. Outbreaks of drug addiction have always taken place, he proved, when there was a sudden rise is isolation and distress—from the gin-soaked slums of London in the eighteenth century to the terrified troops in Vietnam.

This raises the question: Has anything happened in the United States in the past decade that could be the deep driver of the prescription drug crisis? It’s not hard to find the answer. The American middle class had been painfully crumbling even before the Great Crash produced the worst economic crisis since the Great Depression. Ordinary Americans are finding themselves flooded with stress and fear.

This insight puts the prescription drug crisis in a different light. All those stressed-out moms hooked on Vicodin and all those truck drivers hooked on Oxycontin have been seeing their incomes shrink and their abilities to look after their families wither for years as their status and security in American society shrivel away.

It is not that the specific drug plays no effect—clearly it does. Vicodin and Oxycontin do contain chemical hooks, and those do play some role in the addiction. Remember the evidence from earlier, about how just 17 percent of tobacco addiction is caused by the chemical hooks in the drug?

kept bumping up against the third question thrown up by this crisis: Why are so many people starting with Oxycontin and Vicodin and ending up using heroin?

Again, I discovered there are two stories about why this has happened. The first story is that this epidemic proves that the crisis is driven by chemicals. As your body becomes hooked, it clearly needs more and more powerful drugs to hit the same sweet spot. So your Oxy doesn’t do it for you anymore, and you turn to heroin.

This will sound weird at first—it did to me, at least—but it is a well-proven effect. In fact, if you want to see it in action, you can go to any college football game in the United States, any weekend of the year, and watch it with your own eyes. This effect is called “the iron law of prohibition.”

The day before alcohol prohibition was introduced, the most popular drink in the United States was beer, but as soon as alcohol was banned, hard liquor soared from 40 percent of all drinks that were sold to 90 percent. People responded to a change in the law by shifting from a milder drink to a stronger drink. This

It turns out it didn’t change their tastes. It changed something else: the range of drinks that were offered to them. The reason is surprisingly simple. One of the best analysts of the drug war, the writer Mike Gray, explains it in his book Drug Crazy. When you are smuggling a substance into a country, and transporting it in secret, “you have to put the maximum bang in the smallest possible package,” he writes.

Imagine secretly transporting a trunkload of beer across the United States. You will be able to get, say, a hundred people their drink for the night. But load the same trunk with whisky, and you will be able to get a thousand people their drink for the night. So