On Opioids: America's Drug Addictions and the Wacky Laws that Perpetuate Them
Two years ago, a little silver car sat parked outside our home. As the sun was going down an ambulance, police cruiser, and firetruck suddenly arrived to pull an unconscious young woman with a bobbing ponytail out from the driver side of the car. A bottle of heroin had been found next to her. I never saw that young woman again, and the police came to impound her car a few days later.
Last July, I sat in the small chapel at a local funeral home staring at the body of my husband's cousin. Only 29 years old, living less than a mile from our house, married and a daddy-to-be, and there he lay in an open coffin looking sound asleep. After months of staying clean he had found a dealer in the apartment complex he and his wife had just moved in to. That night he took heroin for the last time.
In 2013, Ohio Senator Mike DeWine decried heroin use as "a statewide epidemic." (1) A rising tide of heroin-related deaths totaled over 900 for Ohio in 2013, a sharp increase from previous years that showed no signs of leveling off or decreasing (1). Heroin is cheap, easy to get, and often deadly (1). Heroin use is also directly linked to prescription narcotics, which studies (2) show has decreased in rates of abuse in my area, ostensibly due to tougher federal and state laws (3) implemented last year that limit their prescription by practitioners.
Many times a person will experience legitimate pain, be prescribed a narcotic, get hooked on the high, and then turn to heroin when their prescription is over and they can't get a refill (2). Heroin is essentially morphine, a drug commonly used in emergency rooms for severe pain (5). It is one of the strongest opioids available (5) and it is a major problem that people are taking the leap from prescriptions like Vicodin and Percocet (hydrocodone and oxycodone) to street heroin. While lawmakers are right to be concerned about prescription opioid abuse, they are not focusing efforts on the much larger problem of heroin abuse, and the sad results are astounding.
Last May 2014, The National Institute on Drug Abuse, a component of The National Institutes of Health, presented the following information at the Senate Caucus on International Narcotics Control (4).
"To illustrate this point, the total number of opioid pain relievers prescribed in the United States has skyrocketed in the past 25 years (Fig. 1). The number of prescriptions for opioids (like hydrocodone and oxycodone products) have escalated from around 76 million in 1991 to nearly 207 million in 2013, with the United States their biggest consumer globally, accounting for almost 100 percent of the world total for hydrocodone (e.g., Vicodin) and 81 percent for oxycodone (e.g., Percocet).
This greater availability of opioid (and other) prescribed drugs has been accompanied by alarming increases in the negative consequences related to their abuse. For example, the estimated number of emergency department visits involving nonmedical use of opioid analgesics increased from 144,600 in 2004 to 305,900 in 2008; treatment admissions for primary abuse of opiates other than heroin increased from one percent of all admissions in 1997 to five percent in 2007; and overdose deaths due to prescription opioid pain relievers have more than tripled in the past 20 years, escalating to 16,651 deaths in the United States in 2010.
Pretty scary-sounding stuff, but notice in the argument above words like "opiates other than heroin" which may or may not include prescription narcotics, and may in fact include Suboxone (more on that in minute). Although the number of prescription opioids has increased over 10 years, the percentage of abuse represents only a fraction of the number of people taking these medicines, 305,900 to 207 million. Compare that to the numbers of heroin users which is double the amount of prescription narcotics abusers, "The number of past-year heroin users in the United States nearly doubled between 2005 and 2012, from 380,000 to 670,000" (4). Policymakers have put the emphasis on the wrong syllable and no one is being helped.
Indeed, the recent laws our country and states have implemented to purportedly alleviate the "problem" of prescription opioid abuse, has only exasperated the very real problem of heroin abuse, which is reaching epic proportions around the nation (4). I recently spoke with a local 25-year veteran chemical dependency counselor that I'll call "Glinda" (not her real name). Poor Glinda was very frustrated with the current system of treatment for drug abusers, telling me quite frankly, "People are dying because of this new policy!" What policy was she referring to?
Glinda informed me that up until 5-6 years ago, the standard form of treatment for heroin users who wanted to be free was a very selective residential treatment program. After being selected for treatment, the heroin addict was admitted to a local hospital that partnered with the chemical dependency clinic. The patient stayed in the hospital for 3-4 days, being observed and weaned off all drugs. By the end of those 3-4 days, the patient was completely drug-free and then sent to a residential treatment facility for another 28 days, at least. Although it was not 100% fool-proof, Glinda admitted, "We had a pretty high success rate." This program had been in place since 1960 in Dayton, Ohio, until about 5 years ago when drug companies came out with Suboxone (also known as buprenorphine), a drug created to help users stop their opiate addictions. A slightly less intense form of synthesized heroin, Suboxone is still a powerful narcotic with the same potential for addiction.
Chemical dependency counselors hate it."
What went on behind the scenes one can only guess at, but, Glinda told me, lawyers, policymakers, lobbyists, and state and city medical boards all jumped on the Suboxone bandwagon (6) as a cheaper alternative to hospital detox programs. Laws were passed to ensure medicaid would pay for new Suboxone and methadone clinics, which popped up over the city of Dayton and state of Ohio like daffodils in spring. According to Glinda, these clinics simply hand out free Suboxone or methadone (an opiate drug even stronger than heroin) to any user who comes in asking. They are limited to one round a day or week depending on the clinic. Users are supposed to go through counseling before they can have the drugs, but Glinda said, "Many times this 'counseling' is nothing more than an hour-long video."
Glinda told me that Suboxone users sometimes take an additional anti-anxiety medicine with benzodiazepines like Xanax, Valium, or Ativan, to get back the extra high suboxone purposely leaves out, often resulting in the user's death. However, many other times users will take their free drugs and just sell them on the street for heroin. "It may be a cheaper 'solution'", Glinda said, "but no one is getting clean. Chemical dependency councilors hate it." The article, The Misguided Obsession with Heroin / Opiate Maintenance Drugs (Suboxone, Subutex, Buprenorphine, Methadone) (7), from The Clean Slate Addiction Site, echoes Glinda's concerns,
"Most of the research on drugs like Suboxone (a popular formulation of Buprenorphine and Naloxone) checks the effectiveness of the drug over a 12 week period. That’s it. And as stated above, long term results are essentially unknown. Also, most of the “success” that’s found with drugs like Bupe and Methadone is that people who take it stay engaged in treatment programs longer than those who just receive counseling (without drugs).
If the NESARC results from heroin and prescription opiate users are to be factored into the equation, we might decide less treatment is better. After all, those opiate and heroin addicts who received treatment had MUCH longer periods of abuse and dependence before actually remitting. Which in itself means more occasions of use, which means more opportunity to overdose."
At the same time safer (compared with street heroin) and documented prescription narcotics are being locked down, marijuana (8) is becoming legalized in various forms around the nation and addicts get their stronger-than-prescription-narcotics Suboxone or methadone free, allegedly to help them get off of narcotics. By severely limiting the prescription of legitimate narcotics, not only have policymakers been contradictory, they have effectively tied the hands of America's doctors and punished law-abiding citizens in real pain, in order to prevent them from potentially becoming law-breakers. But we also have laws in place that essentially reward law-breakers by giving them free drugs, as a way of trying to make them law-abiding citizens. We are making more heroin addicts with these policies, not fewer, and the numbers sadly corroborate.
After speaking with Glinda for over an hour, my final question was simply, "What can we do to change this?" Her response, "Activism is the key. Contacting policymakers including county commissioners and boards of health (these links are for Montgomery County and Ohio), and pointing out the facts that these [Suboxone and methadone] clinics just are not working. Then maybe we can help save some lives." Or, in the words of one of my favorite films...
Sources (in order of appearance)