NOT EVEN the federal government can solve the nation’s growing heroin epidemic on its own, but it could always do more. That’s probably the best way to think about the new anti-heroin initiative unveiled by the White House on Monday. A one-year, $2.5 million plan to track the flow of drugs through the Northeastern states and other “high-intensity” regions certainly can’t hurt; but the White House isn’t pretending that its new initiative will conquer the problem and nor should anyone else.
Two out of every 1,000 Americans were addicted to heroin in 2013, according to the Centers for Disease Control and Prevention, double the rate in 2002. There were 8,200 heroin-related overdose deaths in 2013; the number of such deaths per 100,000 people nearly quadrupled between 2002 and 2013, the CDC reports. These figures are especially troubling given that heroin abuse increased at a time when the United States made significant progress against so many other stubborn social ills — including drunken driving and teen pregnancy.
Even more frustrating, the heroin epidemic is itself an unintended consequence of what had previously been thought to be a great medical advance: the rise of prescription opioid pain medications. Massively prescribed, often for routine ailments rather than cancer or other excruciating diseases, these painkillers addicted hundreds of thousands of people, many of whom eventually turned to chemically similar, but cheaper, heroin. Prescription-opioid addicts are the highest-risk group for heroin addiction, according to the CDC, and controlling the flow of prescription opioids is, accordingly, the most important thing that government — federal and state — can do to prevent it.
One key program is the use of state-level electronic databases to track the dispensing of opioids; additional federal funds for these prescription drug monitoring programs were part of $133 million in new spending to curb opioid overprescription in President Obama’s fiscal 2016 budget, and those dollars would probably do as much or more to fight heroin abuse than anything specifically targeted at heroin.
It would also help if the federal government could find a way to speak with a single voice on this issue. In 2013, the Food and Drug Administration baffled many officials in heroin-ravaged states by approving a new opioid despite a negative recommendation from its own expert advisory panel. And on Aug. 13, just days before the White House rolled out its latest anti-heroin plan, the FDA approved the powerful opioid OxyContin for use in patients as young as 11. Sen. Joe Manchin III (D-W.Va.) denounced this as a “reckless act.” The FDA noted, defensibly, that the approval may actually inhibit overprescription because it provides more definitive guidance on dosing and efficacy to physicians who were already free to give opioids to young patients “off-label.” Nevertheless, Mr. Manchin was understandably worried that the FDA did not appoint an advisory panel to screen the proposal and that its decision could be seen as a green light for wider pediatric use by doctors lacking the time or inclination to educate themselves on best practices.
The last thing this country needs is more conflict and confusion about how and when the gateway drugs for heroin enter the marketplace.