It’s the drugs, stupid. (Cory Clark/NurPhoto via Getty Images)

It’s tempting to think about America’s opioid crisis in the past tense. The Sackler name — which belongs to the family that owned and ran Purdue, the pharmaceutical company that flooded America with addictive painkillers — has long been removed from the walls of the art galleries and museums they showered with money. Lawsuits have been settled. Dozens more are ongoing. Stories of addiction in Appalachia and rustbelt overdose deaths fill bookshop shelves. You can watch the same tale play out on Hulu’s TV series Dopesick.
But America’s lethal addiction crisis is far from over. In fact, it’s worse than ever. According to data published by the Centers for Disease Control published this week, more than 100,000 Americans died of a drug overdose in the 12 months between April 2020 an April 2021. It is the first time the figure has reached six figures over a year-long period and represents a 28% jump on the previous 12 months.
As I have reported before for UnHerd, the pandemic quickly undid what limited progress had been made in the fight against opioids before 2020. Lockdowns left recovering addicts alone and starved of the human contact that is so central to staying sober. Relapses spiked, and with them deaths. “Isolation is the opposite of what you need for recovery,” one pastor in West Virginia told me.
But the pandemic is only one dimension of what amounts to a serious public health emergency. And the prescription pills peddled by Big Pharma that most people think of when they hear the words “opioid crisis” aren’t the biggest problem. Today’s battle is against two synthetic drugs: one that kills with terrifying ease, another that creates zombified and desperate addicts almost overnight. These have transformed America’s drug landscape, and rendered obsolete a lot of conventional wisdom about drug use, addiction and the proper policy responses. They are not the drugs fondly remembered by ex-hippie Boomers.
“I don’t know any longtime fentanyl users,” one addict-turned-counselor tells the journalist Sam Quinones in The Least Of Us, his new book on America’s metastasising addiction crisis and the two drugs at its heart. “They all die.”
Today, fentanyl is responsible for the majority of drug deaths in America. In tiny doses it gives users a high that resembles the blissed-out pain relief delivered by heroin or prescription pills. But it is far stronger and more deadly. In anything other than those microscopic quantities, it will kill you. The other drug central to the latest phase of the addiction crisis is methamphetamine, in particular a kind cooked up using a method known as P2P, which uses phenyl-2-propanone.
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