How the government promotes deaths from drug poisoning

See Heroin and Prohibition Are a Lethal Combination by Jacob Sullum of Reason. Excerpt:

"A lot of those new heroin users switched from prescription opioids such a hydrocodone and oxycodone after a government crackdown made those drugs more expensive and harder to get. In recent years, as heroin use has been rising, nonmedical use of opioids has been declining. Trends in poisoning deaths involving the two kinds of drugs also have been moving in opposite directions. According to a 2014 JAMA Psychiatry study, younger heroin addicts entering treatment generally started with prescription opioids, a pattern that is much less common among older addicts. More than nine out of 10 addicts who switched from painkillers to heroin reported that they did so because heroin was cheaper and easier to obtain.

Polydrug use may be even more common among prescription opioid users than it is among heroin users. In 2013, according to the CDC's data, 77 percent of deaths related to prescription painkillers involved mixtures, compared to 67 percent of heroin-related deaths. As with heroin, increases in prescription opioid deaths have far exceeded increases in use. The number of opioid-related deaths more than doubled between 2002 and 2011 (from 7,456 to 16,917), even as the number of past-month users remained about the same. Anderson thinks that disparity may be partly due to an increase in the average size or frequency of the doses that opioid users take.

Opioid users who tend to mix drugs face a greater hazard when they switch to heroin because the purity of the latter drug is so unpredictable. While prescription painkillers come in carefully measured doses, heroin potency varies widely over time, across dealers, and from city to city. That variation, a familiar feature of the black market created by prohibition, can be deadly, whether heroin is combined with other drugs or consumed by itself. A heroin user who comes across a batch that's more potent than he expected, whether because it is purer than usual or because it is spiked with something like fentanyl, can easily take too much, especially if he is consuming another depressant at the same time. Novice heroin users accustomed to legally produced drugs sold in standard doses are apt to be less aware of this danger. Another hazard for switchers: The difference between an effective dose and a lethal dose is smaller for heroin than for prescription painkillers.

The war on drugs magnifies the risk of drug poisoning by making heroin purity inconsistent, by pushing prescription opioid users toward heroin, by making friends and acquaintances of users who need medical attention reluctant to call for help, and by discouraging harm reduction measures as simple as cautioning people against mixing heroin or painkillers with other depressants. By design or not, these effects of prohibition presumably discourage drug use by making it more dangerous, but only by sacrificing the lives of those who are undeterred."