The existentialist philosopher Soren Kierkegaard wrote, “Life can only be understood backwards; but it must be lived forwards.” Or maybe, as William James remembered it, “We live forwards but we understand backwards”.

The point is that life is not a mathematical equation or, if it is, we don’t understand the math. Social policy — such as drug abuse treatment, addiction and overdose death prevention — is not an exact science. We can’t predict the future results of our present actions with any accuracy.

If we’re lucky, we can see the connections after the fact, looking backwards, and can extrapolate to other situations. If we’re lucky. More often we seem to fall back on that definition of insanity (often misattributed to Einstein, but probably from a Narcotics Anonymous pamphlet): Doing the same thing over and over, but expecting different results.

The solution to the opioid epidemic eludes us. Sometimes actions have unwanted and unexpected consequences. Although we have cut the number of prescriptions for the drugs that caused or at least exacerbated the problem, the number of opioid overdose deaths continues to rise.

The reason seems to be that when people are prevented from getting the OxyContin, Percocet, Vicodin and other prescription medicines to which they have become dependent — in part because the pharmaceutical companies claimed they were less or non-addictive and therefore could be prescribed without fear to people with chronic pain as well as short-term pain — those with addictions don’t conclude, “Oh well, I guess I’ll just have to go through withdrawal cold turkey and then live with the pain”.

Instead, they turn to whatever other painkillers they can find, legal or illicit, such as heroin and the synthetic super-opioid fentanyl. These drugs can be unintentionally lethal, especially if you’re accustomed to taking a standard dose of a prescription medicine. The anti-drug slogan “Heroin Kills” is not wrong, and fentanyl can be 50 times as powerful as heroin.

Worse, even if the black market drugs look like the same prescription pills you could get at the pharmacy, they might not be. Suppliers press fentanyl into pills that look like OxyContin because customers want Oxy, but fentanyl is cheaper and easier to obtain.

That’s just the result of one action: cutting down on suspect prescriptions. It’s kind of obvious in retrospect, but few seemed to anticipate it. We won’t know what will stop the epidemic until long after the fact, but we must learn from our missteps and keep trying.

There is no single or simple solution to addiction. Behavior, genetic predisposition, environment all contribute to why one person becomes an addict and another doesn’t. Proper substance abuse treatment incorporates several elements, including medically monitored detox, sometimes medication-assisted treatment (MAT) such as buprenorphine, cognitive behavioral therapy, learning coping skills, a support group, and aftercare to reduce the risk of relapse.

Addicts may relapse anyway. That’s common, but it’s not necessarily a failure. Keep on trying, maybe try some other method. That’s sanity.

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