Last Saturday, October 28, the actor Matthew Perry died in his hot tub. Best known for playing Chandler Bing on the sitcom Friends, since the show ended he'd become almost as famous as a celebrity addict who very publicly struggled with substance abuse, recovery, and relapse. His untimely death offers an opportunity to think about both drug use and drug prohibition, as he took both legal and illegal substances throughout his life.
Does his life support continuing the federal drug war—a broad-based, overlapping series of policies that has given rise to high levels of incarceration over the past half-century, a $3.2 billion annual budget for the Drug Enforcement Administration (DEA), and record levels of overdose deaths?
Perry's best-selling 2022 memoir, Friends, Lovers, and the Big Terrible Thing, is a searing account of his long and difficult relationship with currently banned substances the government calls "illicit drugs," legal pharmaceuticals, and alcohol. In it, he discussed his near-death experience when his colon burst due to taking too many opioids, which have a constipating effect. (At one point, he says he was downing up to 55 Vicodins a day.) He was put into a medically induced coma, given just a 2 percent chance of survival, and spent months using a colostomy bag. He says he had his first drink at 14 and started drinking every day at age 18. He was clean and sober for only one season of Friends, which ran for a decade between 1994 and 2004. By his count, he made 15 trips to rehab, had 14 stomach surgeries, and told The New York Times that he'd "probably spent $9 million or something trying to get sober."
The cause of death for the 54-year-old is not known and an inquest and full toxicology report could take months to complete. Reportedly, the only drugs found in his house were prescription medicines for anxiety, depression, and chronic obstructive pulmonary disease, or COPD, (an artifact of his heavy smoking). But whether Perry's death was directly caused by drugs, there is no question his long history of substance abuse hastened it. Bodies just can't take the sort of punishment he gave his. Perry intuited this and noted in an interview promoting his book that he wanted to be remembered more for helping people get straight than for playing the sarcastic Chandler Bing. "When I die," he said, "as far as my so-called accomplishments go, it would be nice if Friends were listed far behind the things I did to try to help other people."
Given his personal history, it's not surprising that he was no fan of legalizing drugs. Rather, he supported drug courts and forcible treatment, as he made clear in a famous-at-the-time dust-up with British conservative Peter Hitchens. After Hitchens challenged whether addiction is a disease in the way that cancer or diabetes is, Perry responded by saying that denying the disease model of addiction was "as ludicrous as saying that Peter Pan was real." He continued: "I'm a drug addict. My life is, 'If I have a drink, I can't stop.' And so it would be following your ideology that I'm choosing to do that."
Yet while Perry's definition of an addict who has no volition is one we commonly associate with substance abuse, it should be remembered that his experience is atypical, and not simply because he had the means to pay for a level of care far beyond that of an average person, or because of the intensity and duration of his substance use.
A 2018 study of people prescribed opioids, reported Reason's Jacob Sullum, "found that just 1 percent of people who took prescription pain medication following surgery showed signs of 'opioid misuse,' a broader category than addiction." Other research shows that even people classified as "excessive drinkers"—eight drinks a week for women, 15 for men—are not "alcohol dependent." That is, they show no signs of withdrawal and report no increased tolerance for beer, wine, or spirits. Harvard psychiatrist John F. Kelly tells CNN that somewhere between 60 percent and 75 percent of people diagnosed with substance-use disorder "reach remission." One need not agree with figures such as Columbia neuroscientist Carl Hart, who has written about his "responsible" heroin use, or Sullum, whose 2003 book Saying Yes is a "defense of drug use," to understand that most people manage their legal and illegal (or illicit) substances pretty well.
In the wake of a tragic death like Perry's, it's easy to overlook how drug prohibition makes it harder for people to seek treatment by compounding shame and denial with legal issues. As a wealthy celebrity in a creative industry that is uncommonly accepting of drug problems, Perry was able to more openly deal with his issues (though as his memoir makes clear, it was still no easy task). The drug war "others" users and makes them seem less than human, which explains why it's more common that, as the Cato Institute's Trevor Burrus puts it, "heroin addicts get cages and alcoholics get treatment."
Drug prohibition also means casual users face monumentally greater risks from adulterated drugs whose potency and purity are unclear. Last year, "a record high of 109,000 Americans" died from drug overdoses, "with roughly three-quarters involving opioids and 90 percent involving illicit fentanyl."
Yet most opiate/opioid users are not trying to kill themselves. What percentage of fentanyl-related deaths involve users who don't even know they are taking fentanyl, which has been showing up in all sorts of other drugs as a cutting agent? Or who have no clear sense of how much of a substance they are taking? During alcohol prohibition, tainted liquor killed people because there were no controls on its production. That ended the minute the stuff became legal and its makers and distributors had an incentive not to poison their customers.
Legalizing drugs and regulating them similar to beer, wine, and alcohol won't end abuse or accidental deaths, but it will make those outcomes less likely. Evidence from Oregon, which decriminalized low-level drug possession in 2021, shows that reducing legal penalties had no impact on overdose deaths a year after implementation. In 2022, the director of the National Institute on Drug Abuse (NIDA) told the Senate that marijuana legalization "has not been associated with an increase in adolescents' marijuana use." That's almost certainly because legal businesses have more reason than outside-the-law dealers to follow rules.
It's better to stop spending billions of dollars a year propping up a drug war that fails most basic cost-benefit analyses (such as this one coauthored by Nobel Prize–winning economist Gary Becker) and spend more time helping people with problems and creating new cultural norms that encourage responsible living, with or without the use of intoxicants. (Drinking, for instance, has declined globally over the past 20 years.)
That may not be exactly the way that Matthew Perry thought about helping other people, but it would be a fine legacy nonetheless.
The post Matthew Perry, Drug Abuse, and Prohibition appeared first on Reason.com.
