Funny that this issue should come up, as I was just listening to a colleague discuss a dramatic shift away from primary heroin and towards methamphetamine among his treatment clients.

Could be a sign of change. Perhaps in his region, word is out about the dangers of fentanyl, and some users are looking around for a less risky alternative. Or perhaps, as some experts suggest, this represents a resurgence in speedballing— using a combo of stimulant and opioid to ‘smooth out’ the high.

I could see that if we were talking about a meth addict looking to reduce sleeplessness, irritability, etc., related to meth toxicity. But if you’re already dependent on heroin, you’re more likely experiencing opioid withdrawal– like a bad case of the flu, plus craving– so why would you want to stimulate your central nervous system? To more fully experience the suffering? Seems to me you might fill up on booze or Xanax and maybe try to get some sleep.

Anyway, a decline in opioids and a surge in other drug use has long been predicted. That might actually seem to some people like a good thing– as one  told me, “at least they won’t be  overdosing in the gas station bathroom anymore”– but I see two problems with that scenario.

First, samples suggest that fentanyl may have found its way into the meth and cocaine supply. There’s no real challenge in adulterating those substances, either. Which means that the risk factor for OD is probably higher than before, regardless of which drug you think you’re using.

In the absence of a heart condition or other abnormality, meth and cocaine OD is less likely to result in a fatality than heroin. But what if the meth/coke has been cut with fentanyl?

Second: Our national attention, including our drug abuse strategy, is at present almost completely focused on opioids. We’re ignoring other drugs in a valiant effort to stem the tide of fatalities. Which is necessary, of course. Still, if the ground is now shifting to other drugs, then what are we doing in response to that?

The article suggests not very damn much.

The alternative is a more comprehensive strategy to address drug problems as a whole, rather than a drug at a time. That goes against our history, where we’ve been sprinters, not marathoners.

It can’t be a slave to the political process, the way it has been for decades now, because the political process is just too destabilizing. America would have to treat its substance use problems the way it treats something like heart disease. As a human problem, common to all societies, requiring long-term strategic thinking, planning and research.

So what do you think: Any chance of that coming to pass in the near future?


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