USA: Drug Crises Over the Horizon

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Two important aspects of the drug epidemic are at the forefront of national attention. The first is the legalization of the production, sale, and use of marijuana. The second is the explosion of drug overdose deaths that has resulted in overdose becoming the leading cause of death for Americans age 50 and younger[1] and has led to a remarkable decline in U.S. life expectancy for the third consecutive year.[2] These are the poles of drug policy: efforts to relax and even eliminate prohibition of marijuana on the one hand and increasing restrictions on opioids to discourage use and to reduce overdose deaths on the other. As we consider present and future drug crises, we can learn useful lessons both from expanding the focus beyond marijuana and opioids and from exploring the path that has led the nation to the current drug epidemic.


While ending the modern drug epidemic is impossible, there are many good and practical ways to limit the damage caused by commercialized recreational drug use. The first crucial step is widespread recognition that recreational pharmacology–especially polydrug recreational pharmacology–is unhealthy and dangerous. A public health corollary is that national policy must aim to reduce the use of intensely brain-stimulating chemicals for personal pleasure.

Just as the human brain’s vulnerability to addiction is not limited to any particular subset of the population, the drug epidemic is not limited to any one nation. Drug-using behaviors and drug supply, both legal and illegal, also are global issues. Therefore, solutions to this modern public health threat must be global, based on the recognition of our shared vulnerability.

Recreational pharmacology, sadly, will claim many more victims. Heightened commercialization of recreational pharmacology must be avoided in the interests of the public health. This modern, rapidly evolving drug epidemic will reshape our political decisions. Our nation’s ability to deal successfully with commercialized recreational pharmacology will be tested for generations to come–as it has been tested for generations past. May we think clearly and act wisely to prevent the harms that we bring upon ourselves.

Robert L. DuPont, MD, is President of the Institute for Behavior and Health, Inc., and former Director of the National Institute on Drug Abuse.

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