US Pill Abuse may not make Cartels Completely Irrelevant

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The drugs of choice for an increasing number of Americans are prescription painkillers which are now thought to constitute the second most widely consumed drug in the country after marijuana. Baker Institute Postdoctoral Fellow Nathan Jones assesses the scope for Mexican gangs involving themselves in the trade.

The federal government has identified prescription drug abuse in the United States as a significant portion of the US drug problem. As director of the Office of National Drug Control Policy, R. Gil Kerlikowske described at a Center for Strategic and International Studies (CSIS) event, “prescription drugs, not coming across any border, take more lives than cocaine and heroin each year combined. And it is a bit of an unrecognized problem.”

This has important implications for a “drug war” that has hitherto involved a supply-side strategy, which focused on preventing the illicit importation of narcotics into the United States from foreign countries, in particular Latin America. Because prescription drug abuse is a largely domestic problem, one might think that Mexican drug cartels, often identified as a national security threat, seem less relevant. This trend begs an important question:

What will the rise in prescription drug abuse mean for “the drug war” as we know it?

Unfortunately, we should not write off Mexican drug cartels as an irrelevant actor in this market. Just as Mexican cartel cells have grown marijuana in US national parks in an attempt to undercut medical and US cultivated marijuana domestically, there are conceivable positions for Mexican drug cartels to enter the US pill market.

The meth story

The methamphetamine pattern may be a useful analogy. In the 1990s and 2000s, US state legislatures passed a series of control laws to tighten the supply of pseudoephedrine, an over-the-counter decongestant, which could be used to make methamphetamine. Individuals referred to as “smurfs” purchased small quantities of pseudoephedrine at many locations and sold them to “cooks” to convert into methamphetamine. When these controls became sufficiently tight — individuals had to show ID and were limited in how much pseudoephedrine they could purchase — methamphetamine production in Mexico skyrocketed. The US meth market is now supplied by Mexican cartels that, in turn, purchased chemical precursors from India and China. A similar pattern could emerge in the prescription drug market, where Mexican cartels buy or produce prescription pills and transport them to the United States to satisfy the US market, utilizing existing distribution networks.

Cartel resilience

Mexican cartels will also continue to sell other drugs that are prohibited in the US market, including marijuana, cocaine, meth, ecstasy and heroin. Further, some cartels particularly, Los Zetas, make significant profits from extortion, kidnapping and human trafficking. Thus, they will not be going out of business even if prescription drug abuse is rising and states like Colorado and Washington are in the process of legalizing marijuana. Legalization does have the salubrious effect of denying organized crime significant profits, which, when combined with increased state capacity in Mexico, hastens the moment organized crime will be a more manageable problem.

Survey results on prescription Drug abuse using pain relievers as a proxy

Counter-intuitively, the 2011 National Survey on Drug Use and Health indicated a statistically significant decline in people who had abused prescription drugs in the month prior to the survey. However, prescription drug abuse is still the second-most common form of drug abuse after marijuana.

The majority (54.2 percent) of those who abused prescription drugs got them “free from a friend or relative.” This would suggest education about the dangers of prescription drug abuse and programs to reclaim unused medications would be the most effective strategies for reducing prescription drug abuse.

According to the National Drug Abuse Survey 2011 results, only 1.9 percent of those surveyed who abused prescription drugs obtained the drugs from “more than one doctor,” suggesting that “doctor shopping” is a limited part of the problem. Only 3.9 percent of those who abused prescription pain relievers got them from a drug dealer or stranger. If the aforementioned medication reclamation and education programs are successful, buying prescription medications from drug dealers will likely increase as an overall percentage of pain reliever abuse, allowing an opening for established organized crime groups to enter the market as wholesalers.

However, predictions about drug abuse trends are always difficult and may be complicated by the fact that Colorado and Washington have legalized marijuana for recreational use. With marijuana now recreationally legal in some states, it is possible that it will serve as an alternative to prescription drug abuse. As a softer drug, the health consequences of marijuana use may be less than the abuse of many prescription drugs.

While I have painted a picture of the potential entry of Mexican organized crime in the prescription pill market, it remains unlikely in the near future. The more likely scenario is that this market will be supplied almost entirely domestically and “suppliers” will likely continue to be family and friends. Given the nature of prescription drug abuse, it is best addressed where it often begins, within the health system.

*Nathan Jones is the Alfred C. Glassell III Postdoctoral Fellow in Drug Policy at the Baker Institute. Baker Institute Viewpoints is a regular series produced by Rice University’s Baker Institute for Public Policy that brings together Institute scholars and relevant experts to respond to timely public policy questions.

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