Kicking the Habit: The Opioid Crisis and America's Addiction to Prohibition

24 Pages Posted: 28 Jul 2020

See all articles by Josh Bowers

Josh Bowers

University of Virginia School of Law

Date Written: June 29, 2020


There is no single cause of America’s opioid crisis, but overprescription of opioids has undoubtedly contributed. The federal government has responded predictably, criminally prosecuting doctors who prescribe opioids to the drug dependent. The approach may seem sensible, but it is as wrongheaded as our century‐​old drug war. Law enforcement’s recent push for punishment might succeed in limiting opioid prescriptions but only at the cost of driving drug‐​dependent individuals into more dangerous criminal markets and toward adulterated street heroin and fentanyl. For individuals addicted to opioids or suffering from chronic pain, a war on drugs has never been a prescription for improving wellness. This dominant abstinence‐​based policy model is grounded in the logic of prohibition, and it depends not upon healing but upon shame, isolation, prosecution, and penalty. The better model is “harm reduction,” grounded in connection and care, reason and rights, and human dignity and worth.

International and historical public health efforts have demonstrated that one of the best ways to confront epidemic drug use is addiction maintenance—that is, establishing medically supervised clinics to provide pharmaceutical‐​grade narcotics (often free of charge) in amounts calibrated to maintain the social and physical well‐​being of the drug dependent. In this policy analysis, we survey these international and historical efforts. We look to our own past to examine the roots of the modern American drug war and describe contemporary reforms both within and beyond the opioid crisis. We explain how meaningful change is likeliest to occur: from the ground up, as a product of underground experimentation initiated by and within the most‐​affected communities. Finally, we offer our own public health prescription: a set of pragmatic harm‐​reduction responses to prohibition and its counterproductive and often deadly effects.

Keywords: opioid, drug crisis, drug war, addict, opioid crisis, addiction, drug prohibition, prescription regulation, war on drugs,

JEL Classification: I1, I10, I11, I12, I18, H51

Suggested Citation

Bowers, Josh, Kicking the Habit: The Opioid Crisis and America's Addiction to Prohibition (June 29, 2020). Cato Institute, Policy Analysis No. 894, June 2020, Available at SSRN:

Josh Bowers (Contact Author)

University of Virginia School of Law ( email )

580 Massie Road
Charlottesville, VA 22903
United States

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