The Washington PostDemocracy Dies in Darkness

The color of heroin addiction — why war then, treatment now?

Heroin deaths have almost tripled since 2010, a Drug Enforcement Administration official told a House committee. (Studio shot)

The nation’s heroin epidemic found its way from the shadows of America to Capitol Hill on Tuesday as lawmakers and experts struggled with a raging disease that is leaving an increasing number of bodies behind.

Heroin deaths have almost tripled since 2010, Louis J. Milione, a Drug Enforcement Administration deputy assistant administrator, told the House Oversight and Government Reform Committee hearing. “Today’s heroin at the retail level costs less and is more potent than the heroin that DEA encountered two decades ago,” he said.

The surge in overdose deaths is one reason Congress now is examining heroin addiction. Another reason is the complexion of the addicted.

Rep. Elijah E. Cummings (D-Md.), who has seen the effects of drug abuse in his Madison Park neighborhood in West Baltimore, pointed to the difference in the way heroin addiction is dealt with now compared with years ago.

The difference between a war on drugs and drug treatment is like the difference between black and white.

“In Baltimore, where many of the victims were poor and black … our nation treated this issue like a war rather than a public health emergency,” said Cummings, the ranking Democrat on the panel. “We incarcerated a generation rather than giving them the treatment they needed.”

“Now, things are changing,” he noted. “Between 2006 and 2013, the number of first-time heroin users nearly doubled, and about 90 percent of these first-time users were white.”

While the hearing heard from knowledgeable medical, law enforcement and policy experts, it lacked the testimony of those who reek of the poison in their arms, those who have tried to kick only to relapse, those who have stolen from their families to feed a deadly habit.

Leana Wen, Baltimore’s health commissioner, made heroin addiction real with a story from her emergency-room experiences.

“I remember well my patient, a 24-year-old mother of two who came to the ER nearly every week requesting addiction treatment,” Wen recalled. “She would be told there was nowhere for her to go that day or the next, and would be offered an appointment in three weeks time. Because she lacked housing and other supportive services, she would relapse. One day, her family found her unresponsive and not breathing. By the time she arrived in the ER, it was too late for us to save her, and she died.”

Stories like that repeat, increasingly in places not like Baltimore, whose many troubles are well chronicled.

Take Orange County, Fla., which includes Orlando. It’s becoming known for more than Mickey Mouse at Walt Disney World.

The county’s mayor, Teresa Jacobs, told the hearing that heroin-related deaths in the county jumped almost six times from 2011 to 2015.

“Despite Central Florida’s strengthening economy, extraordinary quality of life, and soaring reputation,” she said, “heroin use has exploded.”

Cummings called on Congress to take action.

“Congress should not leave town until we take emergency action to increase funding to help states combat this epidemic,” he said. “We must also fully fund President Obama’s budget request for $1.1 billion for 2017.  This crisis will not be ended in a day.  It will take our sustained commitment, and every one of us owes it to our constituents to make that a priority.”

For Republicans, however, one item on their list of “takeaways” from the hearing indicates their hesitation on spending more. “In 2015, $400 million was appropriated to address the opioid epidemic – an increase of $100 million,” it said. “To date, none of the money has been spent.”

With an almost unanimous vote, the Senate approved legislation earlier this month designed to fight opiod, including heroin, abuse. The bill, which still must be considered by the House, would encourage the use of naloxone, a drug that can reverse heroin overdoses.

Cummings directed some of his fire toward Amphastar Pharmaceuticals, which makes naloxone. The drug was praised at the hearing for its effectiveness.

But it’s getting very expensive.

Cummings accused Amphastar of “corporate greed,” saying it raised the price as more first responders turned to naloxone. The price of the 10-dose pack used by the Baltimore City Health Department jumped from $190 in May 2014 to more than $400 today, according to Cummings.

Bill Peters, Amphastar’s senior vice president and chief financial officer, said by email “this is definitely NOT” (his emphasis) what the company charges and could reflect a middle-man markup.

“We have negotiated rebates with various entities for lower pricing,” he said. “For example, we entered into a rebate agreement with the following states: New York, Ohio, Delaware, Wisconsin, Vermont, Rhode Island and New Jersey. We have offered rebates to Maryland, but as of today, they have not accepted our offer.”

Joe Davidson is columnist.

Read more:

[CDC warns doctors about the dangers of prescribing opioid painkillers]

[Few doctors sign up to treat opioid addiction]

[Senate passes bill to combat heroin, painkiller abuse]