The U.S. Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration recently released the 2023 National Survey on Drug Use and Health. The latest report indicates that drug abuse in the U.S. is worsening, with nearly 9 million people misusing opioids in 2023 and around 61.8 million people aged 12 and above using marijuana.
Analysts point out that although the U.S. population accounts for less than 5% of the global population, it consumes 80% of the world’s opioids. The U.S. has yet to implement permanent regulations for all fentanyl analogs, and relevant regulatory measures have been slow to be enforced. The escalating issues of drug abuse and drug proliferation pose significant threats and challenges to the physical and mental health of the public.
Rapid Growth in Drug Overdose Deaths
San Francisco’s Union Square is surrounded by luxury stores, but just a few hundred meters away in the Tenderloin district, the scene is vastly different: homeless individuals crowd the streets, many abusing opioids or other drugs, displaying erratic behavior and concerning mental states. This area is considered one of the most dangerous neighborhoods in San Francisco.
Over the past few decades, drug abuse in the U.S. has surged. According to a study by the Council on Foreign Relations, over one million Americans have died from drug overdoses since 2000, most of them due to opioids. The Centers for Disease Control and Prevention (CDC) reports that widespread use of fentanyl and other opioids is a primary cause of overdose deaths, with around 81,000 Americans dying from opioid overdoses in 2023.
The Wall Street Journal reported that “the U.S. has struggled to curb the rapid growth in drug overdose deaths.” In 1990, 8,400 people died from drug overdoses in the U.S.; from 1999 to 2017, 400,000 people died from opioid overdoses. In 2023, the number of overdose deaths exceeded 100,000 for the third consecutive year, roughly double the figure from 2015.
Magdalena Cerdá, Director of the Opioid Research and Policy Center at NYU Grossman School of Medicine, said the U.S. is facing “a massive crisis” in drug abuse, and “the situation is much worse than it was a few years ago.”
In their book What’s Wrong with America: The Deaths of Despair and the Future of Capitalism, Princeton professor Anne Case and Nobel laureate Angus Deaton wrote, “Opioids have become the anesthetic for the masses.”
Legislation Restricts Government Regulatory Power
The worsening drug abuse problem is placing a heavy burden on individuals, families, communities, and the entire healthcare system, leading to more social problems. According to Axios, substance abuse and mental illness often go hand in hand. SAMHSA’s report indicates that around 58.7 million adults in the U.S. reported having a mental illness in 2023, some of whom developed mental disorders due to drug overdoses.
A study published in The American Journal of Psychiatry revealed that from 2011 to 2021, drug overdoses caused 320,000 children to lose their parents, potentially leading to childhood trauma and influencing future substance abuse behavior in this population. Additionally, millions of children live with parents who misuse drugs or have substance use disorders, creating a concerning home environment.
In April 2016, the U.S. Congress passed the Ensuring Patient Access and Effective Drug Enforcement Act, which significantly limited the Drug Enforcement Administration’s (DEA) ability to regulate large pharmaceutical companies. Media reports disclosed that political action committees representing the pharmaceutical industry donated at least $1.5 million to the 23 lawmakers who sponsored or co-sponsored the four versions of the bill. Between 2014 and 2016, the pharmaceutical industry spent $102 million lobbying for the bill and other related legislation. A Guardian report also noted that between 2007 and 2017, major U.S. pharmaceutical companies spent nearly $2.5 billion on lobbying and contributions to U.S. lawmakers, aiming to influence legislation on issues ranging from drug costs to the approval of new drugs.
Keith Humphreys, a professor of psychiatry at Stanford, and Jonathan Caulkins, a professor of public policy at Carnegie Mellon, argue that for years, certain large pharmaceutical companies in the U.S. have supported organized campaigns to downplay the dangers of opioids, misleading the public into abusing drugs and fueling the current drug abuse and addiction crisis.
Reflecting Deep Governance Challenges in the U.S.
CNN reported that two years ago, the U.S. Department of Health and Human Services launched a national strategy to prevent drug overdoses, but the statistics show that the crisis has not been contained. CDC Chief Medical Officer Debra Houry said that many families continue to lose loved ones to drug overdoses. Former HHS Assistant Secretary for Health Elinore McCance-Katz believes that donations from opioid manufacturers to politicians will continue to influence policy decisions, adding that “this crisis represents a multi-system regulatory failure.”
Media outlets in the U.S. have reported that in pursuit of higher profits, pharmaceutical companies and related organizations have aggressively pushed for the legalization of drugs, encouraging the public to use more drugs, and physicians to overprescribe medications. This has led many patients to unknowingly abuse drugs and become addicted. A New York Times article stated that in the U.S. healthcare system, pharmaceutical representatives hold significant influence, often encouraging doctors to prescribe drugs through lectures and funding, resulting in widespread drug abuse and addiction. The lobbying efforts of various interest groups have obstructed substantive solutions to the drug abuse problem.
An article in The Atlantic noted that billboards in downtown San Francisco once suggested that people share fentanyl and other opioids with friends. The Drug Policy Alliance even praised “fentanyl dealers as harm reducers,” advising local governments not to interfere with them. Some experts have openly advocated for ending the stigma around drug use.
The article argues that the widespread drug abuse and drug epidemic in the U.S. is the result of the interplay of political systems, economic interests, lobbying efforts, and social culture, highlighting deep governance challenges in American society. It calls for the U.S. government to make significant adjustments in public policy, law enforcement, legal systems, and social culture to change the social conditions that enable drug abuse and the proliferation of drugs.
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