The heroin and opioid epidemics


File: The U.S. Drug Enforcement Administration (DEA) of the U.S. Department of Justice released photo shows heroin seized from “Seaboard Pride” at Port of Miami, Florida on Jan. 10, 2012 and released in New York on Feb. 4, 2014. REUTERS/DEA/Handout

I’ve just posted a story online that takes a step back from the tragic death of Philip Seymour Hoffman and looks at the twinned epidemics of heroin and opioids. In many ways this is a disturbing story, because we all know people who have suffered from addiction and its often lethal consequences. This isn’t a topic I’ve written much about, so I’m learning a lot as I go. Let me add a bunch of links to the conversation.

The CDC tracks overdose deaths, and what’s striking to my eye is the very large increase in overdoses from pharmaceuticals since 1999.

“Drug overdose was the leading cause of injury death in 2010. Among people 25 to 64 years old, drug overdose caused more deaths than motor vehicle traffic crashes.”

“Of the 22,134 deaths relating to prescription drug overdose in 2010, 16,652 (75%) involved opioid analgesics (also called opioid pain relievers or prescription painkillers), and 6,497 (30%) involved benzodiazepines.”

Those are big numbers in a single year — far more than the slightly more than 3,000 deaths from heroin overdoses.

Perplexing fact: A wide government survey shows that non-medical use of pharmaceuticals is flat for the past decade — and yet the overdoses have gone way up. What’s that about? See the survey here. Here’s a thought: Pill-popping of Vicodin and OxyContin, etc., among teenagers has dropped a bit, but the Baby Boomers are using more of them. Your average 50-something person is much more likely to be a user of illicit drugs than a 50-something person of a decade ago:

“Among adults aged 50 to 64, the rate of current illicit drug use increased during the past decade. For adults aged 50 to 54, the rate increased from 3.4 percent in 2002 to 7.2 percent in 2012. Among those aged 55 to 59, the rate of current illicit drug use increased from 1.9 percent in 2002 to 6.6 percent in 2012. Among those aged 60 to 64, the rate increased from 1.1 percent in 2003 to 3.6 percent in 2012. These trends partially reflect the aging into these age groups of members of the baby boom cohort (i.e., persons born between 1946 and 1964), whose rates of illicit drug use have been higher than those of older cohorts.”

Russell Brand has a good column on addiction in The Guardian.

And here’s another one by Brand — zowie.

“…the disease of addiction is not rational. Recently, for the purposes of a documentary on this subject, I reviewed some footage of myself smoking heroin. I sit wasted and slumped with an unacceptable haircut against a wall in another Hackney flat (Hackney is starting to seem like part of the problem), inhaling fizzy black snakes of smack off a scrap of crumpled foil. When I saw the tape a month or so ago, what was surprising was that my reaction was not one of gratitude for the positive changes I’ve experienced. Instead I felt envious of this earlier version of myself, unencumbered by the burden of abstinence. I sat in a suite at the Savoy hotel, in privilege, resenting the woeful ratbag I once was who, for all his problems, had drugs.

That is obviously irrational, but the mentality and behaviour of drug addicts and alcoholics is wholly irrational until you understand that they are completely powerless over their addiction and, unless they have structured help, they have no hope.”

Which brings up another terrific essay on addiction, by Seth Mnookin, in Slate:

“Most adults with jobs and mortgages and spouses and kids can have a glass of wine after work. For me, a glass of wine is a gateway to my past—and that past provides a pretty robust pool of evidence that there’s not much separation between my having a drink and my ending up alone in an apartment with a needle in my arm.”

At the Knight Science Journalism Tracker, a guest post discusses media coverage of the Hoffman case.

Here’s the top of my story:

The death last Sunday of Oscar-winning actor Philip Seymour Hoffman at age 46 focused media attention on the nationwide surge in heroin use and overdoses. But the very real heroin epidemic is framed by an even more dramatic increase since the beginning of the century in overdoses from pharmaceutical drugs known as opioids.

These are, in effect, tandem epidemics — an addiction crisis driven by the powerful effects on the human brain of drugs derived from morphine.

Prescription opioids are killing Americans at more than five times the rate that heroin is, according to the most recent numbers from the Centers for Disease Control and Prevention. These drugs are sold under such familiar brand names as OxyContin, Vicodin and Percocet and can be found in medicine cabinets in every precinct of American society. They’re also sold illicitly on the street or crushed and laced into heroin.

There have been numerous efforts by law enforcement agencies to crack down on “pill mills” that dispense massive amounts of the pharmaceuticals, as well as regulations aimed at preventing users from “doctor shopping” to find someone who will write a prescription.

Those efforts have had the unintended effect, officials say, of driving some people to heroin in recent years as their pill supply dries up.

The latest government survey of drug abuse shows a drop since 2010 in first-time users of illegally obtained OxyContin. But heroin use is up. It’s akin to pushing on a beanbag chair. Health officials in Maryland, for example, reported that in the first seven months of 2012, a 15 percent drop in pharmaceutical opioid overdoses was accompanied by a 41 percent increase in heroin overdoses.

Market forces play a role in this drug substitution, as do the brutal realities of addiction and the need for a fix. Street heroin is much cheaper than a pharmaceutical — typically $10 a packet for heroin, compared with perhaps $80 on the street for an 80-milligram OxyContin, public health officials say.

The stigma and lethality of street heroin — long viewed much more negatively than drugs such as cocaine, according to government surveys — are no deterrent to someone facing the agony of withdrawal from an opioid.

“In the storm of narcotic withdrawal, any opiate port will do,” said Jim Hall, an epidemiologist at Nova Southeastern University who studies addiction.

Prescription painkillers may also grease a slippery slope toward a relapse for former heroin addicts. Hoffman appears to be a case in point. He was found with a needle in his arm and dozens of heroin packets in his Manhattan apartment. The autopsy and initial toxicology tests were inconclusive, and so the precise cause of Hoffman’s death — whether he overdosed on heroin alone, for example, or in combination with one or more other drugs — is pending further investigation.

But the actor revealed last year that, after being clean for two decades, he suffered a relapse into heroin use after first taking prescription pills.

“The main driver of overdoses right now in our country is from opioid medications, more than from heroin,” said Nora Volkow, director of the National Institute on Drug Abuse.

In 2010, according to the CDC, 3,036 people died in the United States from heroin overdoses, up from 1,960 in 1999.

But 22,134 people died in 2010 from pharmaceutical drug overdoses, nearly triple the 7,523 deaths reported in 1999, according to the CDC. About three out of four of those overdoses — 16,652 — were from opioids. Most of the rest of the overdoses came from such drugs as Xanax, Valium and Ativan, which are used for anxiety or sleeplessness and are categorized scientifically as benzodiazepines.

Most people who abuse pills don’t have legal prescriptions for them. They get them from family and friends, and sometimes from drug dealers. Young people may view them as safer than street drugs like heroin because they are manufactured as medicine and originate with doctors.

“We have tried to shatter the myth that these are safe,” Volkow said.

Young people are often the victim of chemical combinations they don’t understand, said Karen Hacker, director of the Allegheny County Health Department, which includes the city of Pittsburgh. They combine the pills with alcohol and other drugs. They may feel that snorting or smoking certain drugs is safer than injecting them. And they may not realize that slow-release opioid painkillers have long-lasting effects.

“We had people going to sleep kind of drunk and literally not waking up in the morning,” Hacker said.

Her county had a rash of 16 deaths between Jan. 17 and Jan. 30 from heroin laced with the opioid painkiller fentanyl, which is many times stronger than heroin. The chief medical examiner, Karl Williams, said that in the 1980s and 1990s Allegheny County would typically have about 100 overdoses annually, but in the late ’90s the numbers began steadily rising, and now there are about 250 overdoses each year.

Even that huge rate of overdoses didn’t prepare the coroner for what he saw on Friday, Jan. 17, when three bodies were brought in with signs of heroin overdoses. The next day, Saturday, he saw four more cases, and then Sunday brought three more — 10 deaths in just three days. Laboratory tests showed that all had taken a lethal 50-50 mixture of cocaine and fentanyl.

The overdoses from the fentanyl-laced heroin apparently have stopped, said Williams and Hacker — presumably because word got to users that they were in grave peril from heroin sold in plastic envelopes stamped “Theraflu” and “Bud Ice.”

 

 

 

Joel Achenbach writes on science and politics for the Post's national desk and on the "Achenblog."
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