Painkillers Spark an Epidemic of Addiction
Everything about heroin addiction in America is changing. It’s not the only country to see an increase, as stronger, cheaper heroin from Afghanistan washes around the globe. But in the U.S., its spread from poor cities into affluent suburbs has reignited a debate over the four-decade war on drugs. Questions have also been raised over why it took an increase in the number of white overdose victims to switch attention from law enforcement to treatment. Another unresolved issue is whether doctors and drug companies can balance a desire to treat pain effectively with the growing evidence that prescription opioids like OxyContin and Vicodin have become gateway drugs for heroin. Four of five new U.S. heroin users report having previously misused prescription pain relievers.
Nearly half a million Americans are now estimated to be using heroin, up from 161,000 in 2007. Heroin overdoses more than tripled in four years; deaths from all opioids are now approaching the number of deaths from car crashes. In 2015, nearly every state enacted laws related to opioid abuse, including measures targeting doctors and pharmacists that prescribe or dispense too many of the pills, and offering criminal immunity to patients seeking treatment for an overdose. States and the federal government have made the opiate-antidote drug naloxone more readily available; the Centers for Disease Control says its use has reversed a documented 26,500 overdoses. President Barack Obama ordered state Medicaid programs to cover drug treatment and proposed $1.1 billion in new spending to reduce heroin deaths. Congress passed a bill to provide grants to states for treatment, but without funding; a stopgap spending bill passed in September included $37 million to fight opioid addiction. Globally, poppy cultivation reached its highest level since the 1930s in 2014. Heroin addiction in Afghanistan — the world’s largest opium producer — has soared, while its use has risen in China and in Africa, now a waystation for Afghan heroin. Between 2012 and 2014, opium poppy cultivation in Mexico increased by an estimated 60 percent, and the amount of heroin seized at the U.S.-Mexico border has more than tripled.
Extracts of the poppy plant have been a source of trouble since the 19th century Opium Wars. Heroin, first produced in 1898 by Bayer, the German pharmaceutical company, was marketed as a non-addictive substitute for morphine. By the early 1900s, widespread heroin use led states like New York to open addiction centers in hospitals. Heroin’s latest wave arose from changes in prescription opiate use. Opioid painkillers rose in popularity in the 1990s, partly in response to what was seen as widespread undertreatment of chronic pain. In 1996, Purdue Pharma introduced OxyContin as an alternative to stronger opioids reserved mainly for the dying. Its annual sales surged to $1 billion. In 2007 Purdue paid $600 million in fines and its executives pleaded guilty to federal criminal charges for misbranding the product as less addictive than other painkillers. In 2010, it released a reformulated version that was harder to crush for snorting. A May 2015 study found that while the new version reduced illicit use of the painkiller, it led more people to take up heroin, whose price was dropping. Nearly 90 percent of new heroin users in the U.S. are now white, compared with an equal mix of whites and nonwhites before 1980. Fentanyl, a powerful synthetic opioid commonly mixed with heroin, is accounting for an increasing share of overdoses — including that of Prince, whose death in April was caused by the drug.
Heroin and opiate addiction have become issues in the U.S. presidential election. Republican candidates Donald Trump and Ted Cruz have focused on cutting off the supply from Mexico, while the Democratic candidates, Hillary Clinton and Bernie Sanders, have proposed greater access to treatment. Officials from hard-hit states have chided federal regulators for not doing more to restrict opioid prescriptions, but groups that advocate for patients in chronic pain worry that the rush to solve the addiction problem will lead to needless suffering. Both the CDC and the U.S. Food and Drug Administration are encouraging doctors to reserve the strongest painkillers for patients who don’t respond to milder drugs. And some officials have turned to unorthodox approaches: Seattle announced in October that it will follow Vancouver's lead in opening supervised sites for addicts to shoot up, a plan New York is also considering.
The Reference Shelf
- A Journal of the American Medical Association article analyzing 50 years of heroin use.
- An article in the CDC’s Mortality and Morbidity Weekly Report looking at opioid abuse in recent years and another looking at patterns in opioid prescription rates by state.
- Results from the 2014 National Survey on Drug Use and Health.
- The Drug Enforcement Administration’s threat assessment for 2015.
- The National Council on State Legislature’s overview of drug legislation in 2015.
- Statistics from the National Institute on Drug Abuse on overdose deaths.
- A summary of a Congressional Research Service report on heroin production in Mexico.
- A December 2015 report by a Justice Department task force on heroin.
First published March 29, 2016
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