“Jake Leg” and a Modern Tragedy of the Marketplace

Well-intentioned but ultimately misguided actions over recent decades have contributed to today’s opioid epidemic. Pain was promoted as the “fifth vital sign” as pharmaceutical manufacturers encouraged more liberal prescriptions of new and supposedly safer formulations. When addiction issues became apparent, the pendulum swung toward restricting prescriptions, constraining “street” supply of pharmaceutical opioids. The unintended consequence was creation of new and highly efficient drug distribution pipelines with synthetic opioids to fill market demand. The result has been an epidemic of opioid fatalities, which worsened during the COVID-19 pandemic. This article draws parallels between the current opioid epidemic and a previous tragedy of the marketplace created by Prohibition in the 1920s.