Here at the Cato Institute, we are marking National Health Care Quality Week by shining a light on something health-services researchers have long lamented: Medicare’s negative impact on health care quality.

Signing Medicare into law in 1965, President Lyndon Johnson vowed, “No longer will older Americans be denied the healing miracle of modern medicine.” In “Would ‘Medicare for All’ Mean Quality for All?” (forthcoming in the Quinnipiac Health Law Journal), Jacqueline Pohida and I explain that Medicare doesn’t just fail to ensure the “healing miracle” part. Medicare actually rewards low-quality and harmful care, while punishing high-quality care.

The Medicare Payment Advisory Commission explains that Medicare’s fee-for-service payment systems pay providers “more…when complications occur as the result of error” and pay providers less when they implement steps that prevent medical errors.

As a result, Medicare creates disincentives for providers to invest in cost-saving preventive services or processes that avoid misdiagnoses, iatrogenic injuries, medical errors, and other forms of low-quality care.

We tie these perverse incentives to the quality deficits health-services researchers identify in Medicare:

In the 1990s and 2000s, studies identified persistent underuse of highly effective, low-cost treatments among Medicare patients with acute myocardial infarction “even in the absence of discernible contraindications,” and underuse of dozens of other effective treatments for more than a dozen various acute and chronic conditions…

A 2003 study found Medicare fared poorly relative to the Veterans Health Administration on a series of quality indicators…

“Medicare enrollees in regions with a high-intensity pattern of practice have slightly worse access to care, no better satisfaction with care, and receive lower-quality care than those in regions with the more conservative practice patterns…In other words, when comparing identical patients in high- and low-spending regions, those in high-spending regions spent more time in the hospital and saw more physicians (more frequently) but received lower-quality care and achieved worse health outcomes [including] a higher risk of death over time.”

While technocrats claim “value-based payments” would eliminate these perverse incentives — we call this “the siren song of the perfect payment system” — we explain no single payment system can correct this problem:

One consequence of the mind-boggling complexity of medical care is that no single method of paying providers is capable of rewarding all dimensions of quality. Promoting all dimensions of quality requires open competition on a level playing field between different payment rules. Heavily favoring just one method of payment predictably and persistently rewards certain forms of low-quality care and discourages improvement on those dimensions of quality. Whereas an alternative subsidy structure could have encouraged quality improvement, Congress’ decision to tie traditional Medicare’s subsidies to a single set of payment rules undermined quality improvement.

To reverse Medicare’s negative impact on quality, we propose the novel solution of applying traditionally Democratic “public option” principles to the program.

Public-option advocates argue robust competition between government and private health plans — on a level playing field, with no favoritism toward any competitor — would deliver greater efficiency. Public-option principles would certainly promote quality by allowing open competition between different payment rules.

Advocates typically propose creating a public option to compete with private insurers in the non-Medicare market. We argue Medicare offers a better opportunity to test the concept:

Medicare already boasts an established if imperfect public option (traditional Medicare) that competes against private insurers (Medicare Advantage plans) to cover a large population of patients with experience choosing between a government-run plan and private plans. Medicare already offers “what is essentially a risk-adjusted voucher program” where enrollees choose between these options. Unlike proposals to create a public option in the non-Medicare market, applying public-option principles to Medicare would not require new government spending and could even reduce government spending…Finally, unlike creating a public option to compete in the non-Medicare market, applying public-option principles to Medicare could garner support from both major political parties.

We detail the steps Congress must take to level the playing field between traditional Medicare and private insurers. They include subsidizing enrollees directly, making enrollees fully cost-conscious, removing regulations that encourage excessive and/​or low-quality coverage, and eliminating other forms of preferentialism.

Both Republicans and Democrats will find much to like in the proposal. Republicans will appreciate that public-option principles require eliminating quality-suppressing regulations Medicare imposes on private insurers, and restrictions Medicare imposes on enrollee choice. Democrats will appreciate how public-option principles would end Medicare’s practice of offering enrollees bigger subsidies (average: 4 percent larger) if they choose private Medicare Advantage plans.

The negative impact that expanding or replicating traditional Medicare would have on quality should give the staunchest “Medicare for All” advocates pause. Applying public-option principles to Medicare, and giving enrollees a true choice between traditional Medicare and private options, can provide the quality upgrade Medicare enrollees need.

Apparently, the U.S. Department of Justice thinks the answer to the above question is “yes.” The Justice Department’s Drug Enforcement Administration sets annual quotas for manufacturing and distributing all prescription opioids—oral and parenteral—for all 330 million Americans.

The agency presumes to know just how much pain medication, and what type and dose, each and every inhabitant of the country will require each year. It doesn’t determine the quotas without help. It acts after consulting the Food and Drug Administration, the Centers for Disease Control and Prevention, and the Centers for Medicare and Medicaid Services—federal agencies that also presume to divine the future pain management needs of the population. Each of the past five years the DEA has ratcheted down the quotas, seeking to prevent diversion of prescription opioids into the black market for non-medical users. The DEA announced this week a proposal to ratchet down further, for the sixth consecutive year.

In late 2019, when it proposed its fourth consecutive cutback, the DEA claimed (Federal Register page 48172):

As a result of considering the extent of diversion, DEA notes that the quantity of FDA-approved drug products that correlate to controlled substances in 2018 represents less than one percent of the total quantity of controlled substances distributed to retail purchasers.(emphasis added)

Already by 2018, a negligible amount of the drugs distributed and sold through pharmacies were getting diverted to the black market.

Opioids were implicated in over 49.000 overdose deaths in 2019, nearly three quarters of which involved illicit fentanyl. Yet the agency further reduced opioid production quotas for 2020. Of the 93,000 overdose deaths that occurred in 2020, roughly 70,000 were opioid-related, 83 percent of which involved illicit fentanyl.

Production quotas for oxycodone and hydrocodone have dropped by 69 percent and 63 percent respectively since 2013. Now the DEA seems to think reducing the supply of prescription oxycodone another 5.4 percent, hydrocodone another 3.9 percent, morphine another 19 percent, and prescription fentanyl another 5.4 percent will stem the tide of overdose deaths that are almost exclusively from drugs made and obtained on the black market. And the DEA presumes to know that these quotas, the smallest in nearly two decades, are sufficient to meet the medical needs of a population that has grown by more than 50 million over that time.

Even before this latest proposal, pain patients became the real victims of this misguided policy, with documented increases in mental anguish and suicide from untreated or under-treated pain. Suicides among veterans are skyrocketing as opioid treatments have been curtailed in the VHA system.

If your doctor continues to double down on a therapeutic regimen that is not working as intended while causing unintended harm, you should fire the doctor and get another one. Fortunately, doctors take an oath to “first do no harm,” and are unlikely to continue administering the wrong treatment in the face of such obvious harmful side effects.

Alas, the police don’t take such an oath. And that is just one reason why law enforcement should not be treating a medical problem.

Federal policymakers are finally starting to rethink their failed opioid policies that are based on the mistaken narrative that America’s overdose crisis is the direct result of doctors overtreating their pain patients with opioids, condemning them to a life of addiction. Now the streaming service Hulu comes out with a new miniseries, based on the 2018 book Dopesick, threatening to breathe new life into this false and dying narrative.

Beth Macy’s 2018 powerful book, along with 2019’s Dreamland by Sam Quinones, caused policymakers to adopt the false narrative that America’s overdose crisis is the direct result of doctors over-treating their pain patients with opioids and turning them into “addicts.”


State and federal policymakers embarked on a concerted effort to reduce opioid prescribing, hoping this would stem the rising tide of overdose deaths. Prescriptions of opioids per 100 persons have dropped nearly 50 percent since 2012. Almost simultaneously the overdose rate has surged from roughly 40,000 in 2012 to 93,000 in 2020. Meanwhile, pain patients suffer from pain and mental anguish—especially veterans—as doctors abruptly taper or deny opioids to treat their pain.

Government data show no evidence of any correlation between the number of opioids prescribed and the non-medical use of opioids or of opioid addiction. And researchers at the University of Pittsburgh provide clear evidence that overdoses from non-medical drug use have been growing exponentially since at least the 1970s, long before the Food and Drug Administration approved OxyContin in 1996, with different drugs predominating among the overdoses at different points in time.


In the late 1990s and early 2000s the drugs of choice for non-medical users were “diverted” prescription opioids like OxyContin. By 2012, as opioid prescribing started dropping, making fewer prescription pills available for diversion to the black market, non-medical users moved to heroin. In 2020, 83 percent of opioid-related overdose deaths involve fentanyl and its analogs.

As my co-authors and I pointed out in the Journal of Pain Research in 2019:

Americans increasingly have been engaging in the non-medical use of licit and illicit drugs since the late 1970s. Some of this drug use may represent self-medication in response to anxiety, depression, alienation, and despair. The rising incidence of drug-related deaths among nonmedical users also indicates that they are facing bigger risks today, probably because potency has become more difficult to predict and possibly because doses have increased and drug mixtures have become more reckless. However, policymakers and the media tend to favor simple explanations and solutions for complex problems, and the opioid overprescribing narrative is no exception. However, as Mencken observed, “There is always a well-known solution to every human problem” that is “neat, plausible, and wrong”. The standard explanation of the overdose crisis is wrong, and the policies it has inspired are not only ineffective, but harmful.

The standard explanation of the overdose crisis is also based upon a tendency to conflate physical dependency on a drug with drug addiction. There is a big difference, as I point out here.

Physical dependence represents an adaptation to the drug such that abrupt cessation or tapering off too rapidly can precipitate a withdrawal syndrome, which in some cases can be life‐​threatening. Physical dependence is seen with many categories of drugs besides drugs commonly abused. It is seen for example with many antidepressants, such as fluoxetine (Prozac) and sertraline (Zoloft), and with beta blockers like atenolol and propranolol, used to treat a variety of conditions including hypertension and migraines. Once a patient is properly tapered off of the drug on which they have become physically dependent, they do not feel a craving or compulsion to return to the drug.



Some also confuse tolerance with addiction. Similar to dependency, tolerance is another example of physical adaptation. Tolerance refers to the decrease in one or more effects a drug has on a person after repeated exposure, requiring increases in the dose.

On the other hand, addiction is defined as compulsive behavior despite harmful consequences. Many experts view it as a behavioral or learning disorder as opposed to an organic brain disease. Regardless of the etiology, as Drs. Nora Volkow and Thomas McLellan of the National Institute on Drug Abuse pointed out in this New England Journal of Medicine article, when people are placed on opioids for the treatment of pain, addiction is very uncommon, “even among those with preexisting vulnerabilities.”

Based upon a “neat, plausible, and wrong” narrative, policymakers cast in stone the then-controversial Centers for Disease Control Guideline for Prescribing Opioids for Chronic Pain—United States, 2016, etching into policy what the CDC explicitly stated was not “settled science,” but what were meant to be general rules of thumb to aid practitioners, and would be:

[V]oluntary, rather than prescriptive standards. They are based on emerging evidence, including observational studies or randomized clinical trials with notable limitations. Clinicians should consider the circumstances and unique needs of each patient when providing care.

Most of the CDC guidelines were based on “type 4 evidence,” which the CDC defined as, “clinical experience and observations, observational studies with important limitations, or randomized clinical trials with several major limitations.”

Policymakers have gradually become aware that their ham-handed approach to the overdose crisis, based upon a flawed and simplistic narrative, is doing more harm than good. Patient advocacy groups increasingly object to the undertreatment of their pain, and the way in which the flawed narrative stigmatizes them as people with “addictive personalities” who are “drug seekers.” They plead with policymakers to drop the narrative and follow the science.

Aware of the misinterpretation and misapplication of its 2016 guidelines, the CDC issued an advisory in April 2019. The agency announced in December 2019 that it planned to update its guidelines. And the FDA held a “public workshop” last August entitled, “Morphine Milligram Equivalents: Current Applications and Knowledge Gaps, Research Opportunities, and Future Directions.”


Daily morphine milligram equivalent caps are a part of the guidelines that states codified. The stated purpose of the workshop is to “provide an understanding of the science and data underlying existing MME calculations for opioid analgesics, discussing the gaps in these data, and discussing future directions to refine and improve the scientific basis of MME applications.” (emphasis added)

Purdue Pharma and other drug makers may have been untruthful and overly aggressive in marketing prescription opioids. I am not here to defend their practices or absolve them of any guilt. But if the last 20 months of the COVID-19 pandemic have taught us anything, it should be that biological science is rarely settled, it is usually nuanced, and that neat and simple explanations are usually wrong. Just when those responsible for our misguided opioid policy are coming to this realization and reevaluating their approach, Hulu releases a miniseries that is sure to fuel the passions and might cause them to backslide.

The most important health care right is the right to make one’s own health decisions. To restore that right, the Cato Institute is launching an initiative to make health savings accounts (HSAs) work for everyone.

How do HSAs restore health care rights? Read on…

An essential part of the right to make one’s own health decisions is the right to control one’s income. Every individual has a right to make use of their earnings according to their values. Any other principle would create inequalities between citizens and government officials who could impose their values on others. The right to control one’s earnings includes the right to choose whether, how much, and how to spend one’s money on health insurance and medical care. If you don’t control the money that purchases your health care, you don’t control your health care.

Government exists to protect these rights. Yet governments routinely violate health care rights with excessive taxes and coercive tax penalties that deprive Americans of control over their health care decisions and leave them with worse health care.

For more than 100 years, Congress has let workers avoid paying tax on income they receive in the form of employer-provided health insurance. The flip side of this “tax exclusion” is that if workers elect to take that same income as cash—so they can use it to choose their health insurance themselves—Congress taxes it. The effect is to threaten workers with higher taxes unless they let an employer control a large portion of their income and choose their health insurance. Intentionally or not, Congress penalizes workers for exercising their rights to control their income and to choose their health insurance.

Some call the “tax exclusion” for employer-sponsored health insurance a tax cut or a tax break. In fact, it operates as a tax because it uses coercion to deny workers control of roughly $1 trillion of their earnings each year.

Economists agree employers pay for health benefits by reducing employees’ wages—a lot. To finance employer-sponsored health insurance, employers reduce wages for workers with self-only coverage by an average of $6,227 and for those with family coverage by an average of $15,754. When employers purchase health insurance for their employees, they are therefore assuming control of a huge chunk of those employees’ earnings. A new Cato Institute/​YouGov poll shows U.S. adults do not grasp how much control over their earnings this tax “break” costs them.

Workers do not freely choose to let employers control that money. When employers take that money out of wages, the government no longer taxes it. This reduces the amount of tax workers must pay to the government. But if workers demand that employers let them control that $15,754, the government taxes it. On average, workers with family coverage would have to pay an average $4,300 of that money to the government in additional taxes. In effect, the U.S. tax code penalizes workers who exercise their right to control their earnings and choose their health insurance: either you let an employer control $15,754 of your earnings and those decisions, or the government will tax you an additional $4,300.

In total, this tax “break” coerces workers into letting employers control some $1 trillion of their earnings each year. That’s roughly 4 percent of GDP. It is the second-largest source of health spending (21 percent) after government spending (47 percent). It’s an odd tax break whose effect is to offer taxpayers the option of losing control of even more of their income than the government threatens to take.

This tax penalty does enormous harm to workers. It reduces the quality of their coverage and care. It makes the problem of pre-existing conditions worse by stripping coverage from sick patients when their spouse dies, when they lose their jobs, or when they divorce, move, or retire. It disrupts access to care. It makes health care and health insurance less affordable. It encourages outrageous charges, surprise medical bills, wasteful spending, and higher health premiums. It forces workers to accept and stay in jobs they hate, just for the health insurance.

Government should not bestow preferential tax treatment on any uses of income. Workers have a right to control that money and to make their own health care decisions without government penalizing them.

In 1993, the Cato Institute took a step toward eliminating those preferences and penalties when it published Patient Power: Solving America’s Healthcare Crisis, which brought the idea of health savings accounts to the national stage.

Twenty-five years ago, in 1996, Congress took a step toward eliminating those preferences and penalties. On a bipartisan basis, it let some workers take a portion of that income as cash without penalty through tax-free Archer medical savings accounts (MSAs), a precursor to health savings accounts.

In 2003, Congress took another bipartisan step toward restoring patient rights when it created tax-free health savings accounts. HSAs let workers control a portion of that $1 trillion and make more of their own health care decisions without government penalizing them.

Yet HSAs are not enough. They have returned to workers only 4 percent of that $1 trillion. Unnecessary restrictions prevent HSAs from restoring the health care rights of more Americans. Congress requires HSA holders to enroll in high-deductible health plans, which many consumers dislike. It forbids workers to take all of the money their employer pays toward health coverage (e.g., $16,000 for workers with family coverage) as a tax-free HSA contribution. Congress forbids workers to enjoy the full benefits of HSAs unless they have their employer’s assent and enroll in their employer’s plan; otherwise, Congress penalizes them.

In 2005, I proposed making HSAs work for everyone with three changes that would further restore workers’ rights to control their earnings and health care decisions:

• Increase HSA contribution limits so nearly all workers could deposit 100 percent of what their employer pays toward health benefits tax-free into an HSA;
• Free workers with all types of health plans or no health plan to use HSAs; and
• Free workers to purchase health insurance from any source with tax-free HSA funds.

These changes would increase wages for workers with family coverage by an average $16,000 per year. They would return $1 trillion each year to the workers who earned it. Doing so would constitute the largest effective tax cut voters have ever seen. It would deliver better, more affordable, and more secure health care. And it would restore the rights of working Americans to control their health care dollars and decisions.

The time has come for Congress to restore those rights to all taxpayers. Congress needs to make health savings accounts work for everyone.

Today, the Cato Institute releases a poll of public attitudes toward health care financing and health savings accounts (HSAs). From September 2 to September 13, Cato and YouGov fielded an internet survey of 2,000 adults age 18 and older.

The results (toplines, tabs) reveal U.S. adults do not grasp the extent to which the U.S. tax code violates their health care rights, but do support restoring those rights by improving HSAs to make them work for everyone.

The most important health care right is the right to make one’s own health decisions, including the right to choose one’s health insurance plan. An essential component of those rights is the right to control one’s income. The U.S. tax code violates health care rights by threatening workers with higher taxes unless they let an employer control a large portion of their income and choose their health plan.

Many call the “tax exclusion” for employer-paid health insurance premiums a tax “break.” In fact, it denies workers control over an enormous share of their earnings. It coerces workers into letting employers control roughly $1 trillion of their earnings each year as well as their health insurance. Along the way, it leaves workers vulnerable to losing coverage when they change jobs, divorce, or retire. Economists agree employers fund those payments by reducing workers’ wages. Firms that offer health insurance reduce wages an average $16,000 for each worker with family coverage and $6,000 for each worker with self-only coverage.

The Cato/​YouGov poll results demonstrate U.S. adults do not grasp how much control over their earnings they lose due to this tax penalty:

• Half of U.S. adults (49 percent) do not know employers fund employee health insurance by reducing wages. A third (36 percent) incorrectly believe employers fund those payments by reducing company profits or executive compensation.
• More Democrats than Republicans know employers fund those payments by reducing wages (56 percent vs. 46 percent).
• A majority (78 percent) incorrectly believe employers pay less than $16,000 toward family coverage.
• Nine out of 10 U.S. adults (91 percent) underestimate by an order of magnitude how much employers pay toward employee health benefits.

In the United States, half of health care spending comes from government. When one includes government-compelled private spending, the OECD reports 83 percent of health spending in the United States is compulsory—among the highest levels in advanced nations. U.S. adults are unaware that government controls more health spending in the United States than in most other advanced nations:

• A majority of respondents (78 percent) incorrectly believe that in Canada, Denmark, and/​or the United Kingdom, government controls a larger share of health spending than in the United States.

If U.S. adults understood how much health spending government controls, they would describe the United States as having a government-run health system.

• A majority (61 percent) indicated that when government controls 50 percent of a country’s health spending, that country has a government-run health system.
• Five out of six (84 percent) indicated that when government controls 75 percent of a country’s health spending, the country has a government-run health system.

U.S. adults are broadly in agreement that workers have a right to control those earnings and to make their own health care decisions without government penalizing them:

• Two thirds (69 percent) adults favor eliminating the additional tax workers must pay if they want to control their health care dollars.
• Four fifths (80 percent) support removing this tax on workers whose employers do not offer health insurance.

Health savings accounts allow workers to control their health care dollars without penalty and have broad bipartisan support:

• Significant shares of Democrats (16 percent), Republicans (14 percent), and independents (11 percent) report having an HSA.
• Large majorities of Democrats (73 percent), Republicans (74 percent), and independents (65 percent) view HSAs favorably.

U.S. adults support eliminating restrictions that limit HSA eligibility to just a small share of workers and that limit HSAs to allowing workers to control just 4 percent of those trillion dollars of their earnings:

• Large majorities of Democrats, Republicans, and independents (76 percent, 80 percent, and 72 percent) support letting workers put all $16,000 in an HSA tax-free.
• Among low-income households, 78 percent favor the idea.

Government should not bestow preferential tax treatment on any particular uses of income. Congress can restore health care rights and improve health care by making health savings accounts work for everyone.

Last summer I wrote an essay about what science can and cannot do and the role it can play in public policy decisions including those pertaining to the COVID-19 pandemic. I concluded that science explains relationships between cause and effect: no more and no less. No normative conclusions about individual or collective decisions follow directly from science. Instead, costs, benefits, and other values properly enter both individual and collective decisions.

I have written twice since then about gradual recognition of this argument among medical professionals as well as journalists. I am writing again to recommend a recent column in the Washington Post by Leana S. Wen, a medical doctor as well as former health commissioner for the city of Baltimore. The title itself is striking in its clarity: “Public health is not only about science. It’s about values.”

The column describes the CDC and FDA scientific advisory committee discussions about the appropriate recommendation for COVID-19 booster shots. The data were not in question. “The coronavirus vaccines, though they still do well to protect against hospitalization and death, have waning immunity against symptomatic disease, especially in older and more vulnerable individuals. A third dose, given at least six months after the initial series, increases antibody response and reduces the likelihood of breakthrough infections.”

What was in dispute was the goal of vaccination: reduction of disease severity or prevention of symptomatic infection. Many medical professionals argue that only the former is the appropriate goal: “If you really use infection as an outcome, you probably need a booster every six months, which is unrealistic and unattainable,” said Dr. Peter Chin-Hong, an infectious disease expert at the University of California, San Francisco. “I don’t care about symptomatic disease — I care about severe disease.”

Dr. Wen responded as follows: “This is not a scientific question as much as one of personal values. Should academics and bureaucrats really be the sole arbiters in making such sweeping societal policy as to deny boosters to people who want to better protect themselves? Similarly, scientists shouldn’t be the only people to weigh in on whether the United States should be prioritizing boosters to our own citizens vs. vaccinating people in other countries. Who should decide, then? I believe it should be the American people.”

I could not have said it any better myself.

Today the Drug Enforcement Administration released a Public Safety Alert warning the public about “the alarming increase in the lethality and availability of fake prescription pills containing fentanyl and methamphetamine.”

International and domestic criminal drug networks are mass-producing fake pills, falsely marketing them as legitimate prescription pills, and killing unsuspecting Americans. These counterfeit pills are easy to purchase, widely available, and often contain deadly doses of fentanyl. Pills purchased outside of a licensed pharmacy are illegal, dangerous, and potentially lethal. This alert does not apply to legitimate pharmaceutical medications prescribed by medical professionals and dispensed by pharmacists.

A press release accompanying the Alert, stated fentanyl and methamphetamine are primarily made in labs south of the border with China supplying the chemicals to make fentanyl and its analogs. Drug dealers and cartels use pill presses to convert the products into counterfeit prescription opioids pills, as well as counterfeit Adderall (amphetamine mixed with dextroamphetamine) and Xanax (a benzodiazepine tranquilizer).

Non-medical drug users purchase these drugs on the black market believing they are buying “diverted” legal products with which they are familiar, and succumb to overdoses from much more potent illicit fentanyl or methamphetamine. The DEA announced a new campaign called One Pill Can Kill that includes a website to help black market customers distinguish between counterfeit and authentic prescription pills.

What’s odd about the DEA issuing the Public Safety Alert today is that this is old news. The agency has been talking about this in the mainstream press for a number of years. I discussed it in a commentary in the Cincinnati Enquirer in 2018, a few months after a Minnesota prosecutor announced that the music artist Prince died by ingesting a counterfeit Vicodin pill that was made from fentanyl.

Another interesting feature of the Public Safety Alert is that, perhaps unintentionally, it informs the public that the war on drugs is an abysmal failure:

DEA and its law enforcement partners are seizing deadly fake pills at record rates. More than 9.5 million counterfeit pills were seized so far this year, which is more than the last two years combined. Officials report a dramatic rise in the number of counterfeit pills containing at least two milligrams of fentanyl, which is considered a deadly dose. The number of DEA-seized counterfeit pills with fentanyl has jumped nearly 430 percent since 2019, a staggering increase. DEA laboratory testing further reveals that today, two out of every five pills with fentanyl contain a potentially lethal dose. Additionally, methamphetamine is increasingly being pressed into counterfeit pills.

And it also points the way to reducing overdose deaths: drug legalization.

According to the Centers for Disease Control and Prevention, last year more than 93,000 people died of drug overdoses in the United States, marking the largest number of drug-related deaths ever recorded in a year. Fentanyl, the synthetic opioid most commonly found in counterfeit pills, is the primary driver of this alarming increase in overdose deaths…The only safe medications are ones prescribed by a trusted medical professional and dispensed by a licensed pharmacist. Any pills that do not meet this standard are unsafe and potentially deadly.

While I take issue with the Alert’s contention that the only safe medications are those prescribed by a trusted medical professional, I think the DEA is not being subtle when it points out that legal drugs are safer than those obtained in the black market.

The DEA also makes it clear in the Alert that the overdose crisis is not caused by doctors prescribing opioids to their patients in pain.

Now if only lawmakers would seize upon the obvious.