According to Alvin Roth, PhD, a Nobel laureate and faculty member in Stanford’s department of economics, the market for heroin in the United States can be considered "repugnant" — that is, a market involving transactions that some people engage in, but others want to ban. And understanding that market could provide some clues to help chip away at the opioid crisis.
As Roth explains in a recent Q&A, the economic concept of "repugnance" can be slippery, depending on a community's morals. For example, he said:
Kidney exchanges and surrogacy are legal in the United States, but both surrogacy and kidney exchanges are illegal in Germany. In Canada, surrogacy is legal, but you can’t pay a woman to be a surrogate, so there isn’t much of it there, while California has become a destination for 'fertility tourism.'
Another example, marijuana, “offers one of the most striking current examples of how the lack of public support has undermined the laws that prohibit it,” Roth notes.
Generally, though, his research has found that the key to eliminating a market for repugnant transactions is for a large number of people to both oppose the repugnant activity and to be willing to punish it. They must also feel strongly about it, or the market will persist.
Because society hasn't managed to stamp out the heroin market and related crisis of opioid abuse, it may be time for a different kind of solution, he writes, explaining:
It’s worth noting that many people become addicted to heroin after first being prescribed opioid painkillers. These aren’t people who we would normally consider criminals, and medical treatment is likely to be easier to organize if we stop treating them as criminals. That’s the main attraction of possibly decriminalizing heroin, as part of a shift of emphasis from incarceration to treatment.
Meanwhile, some cities already have clean-needle exchanges, to prevent the spread of HIV and other diseases. Safe-injection facilities, which can help prevent overdoses, are coming into play in Europe and Canada. In this particular market, I think it’s time to focus on harm reduction. If we’re going to have heroin addicts for a long time to come, can we come up with a way that fewer of them die?
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