As Prescription Opiate Abuse Slows, Heroin OD’s Rise
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As Prescription Opiate Abuse Slows, Heroin OD’s Rise


In a classic case of Good News/Bad News, a recent report released by the Massachusetts Health Council indicated that while murder in the Bay State had dropped by 34 percent (from 184 to 121) in 2012, the number of deaths by heroin overdose continued to increase, with 674 recorded for the year. The state’s rate of 10.2 deaths by heroin overdose per 100,000 has nearly doubled since 2000 (5.3 percent), meaning that the OD deaths have increased by over 90 percent in the past dozen years.

“The opioid crisis we raised an alarm on two years ago has continued to hit the state hard,” said Susan Servais, executive director of the Massachusetts Health Council, in a release. “If we hope to turn the tide on substance abuse and address persistent health disparities, we need to recommit ourselves to community-based prevention policies.” That report came on the heels of another report released last spring that unofficially recorded 185 deaths by heroin overdose in a four month span between last November and February of 2014, which prompted Gov. Deval Patrick to declare a public health emergency in Massachusetts in March.

Widespread Problem

But it’s not just Massachusetts. With a little digging (okay, a Google search), I found out that it’s pretty much the story everywhere—at least in the states where they track such things. In 2013, the Maryland Department of Health and Mental Hygiene reported a 54 percent rise in heroin-related overdose deaths between 2011 and 2012. And according to the Center for Disease Control, which issued a detailed report on opiate related deaths, heroin overdoses doubled nationwide from 2010 to 2012, based on a sampling of 28 states encompassing 56% of the U.S. population. Of the 18 states with reliable reporting on heroin overdose death rates in this study, 15 had statistically significant increases in heroin death rates. And not one state had a decrease.

What’s Behind It?

In a sampling of studies conducted in the last couple of years, two primary reasons were cited for the increase. First, there is an increase of the amount of pure heroin entering the US (the CDC report stated that it has doubled). But the second (and more significant) factor appears to be the one that people in addiction recovery have known for years: prescription opiate addicts turn to heroin because it is cheaper and easier to get a hold of than illegally sold prescription drugs. You get a lot more bang for your buck when prescription opiates like Oxycontin and Perc 30’s sell for $1 per milligram, and heroin sells for about one-tenth of that price for an equivalent effect.

But I’d Never Stick a Needle in My Arm…

Those who say they’d never do heroin due to the stigma or because they’re afraid of needles just don’t understand the power of addiction. According to the National Institute on Drug Abuse, one in 15 people who take non-medical prescription pain relievers (or, as I used to call it, people who party) will end up trying heroin within 10 years. And the percentage of people who abuse prescription pain medications who ended up on heroin rose from five percent in 2004 to 14 percent by 2010.

If you want anecdotal evidence of just how that happens, just go to an NA or AA meeting and listen to the shares. We’ve all heard the ones that begin, “I said I’d never stick a needle in my arm, but then one day when I was dope sick and I couldn’t get any OC’s or Percs.” And so it begins.

Is the Solution Worse than the Problem?

One of the driving forces behind addicts graduating from prescription painkillers to heroin came ironically enough as a result of the Oxycontin manufacturers making the pills harder to abuse. In 2010, a new formulation of Oxycontin was introduced, which made the pills harder to crush (to snort) or dissolve (to inject). Which probably sounded like a great idea at the time to anyone who doesn’t understand how adaptable addicts are, because the result was kind of a whack-a-mole carnival game solution: You knock out one problem and another pops right up.

“The most unexpected, and probably detrimental, effect of the abuse-deterrent formulation was that it contributed to a huge surge in the use of heroin, which is like Oxycontin in that it also is inhaled or injected,” said Theodore J. Cicero, PhD, principal investigator for a study published in the New England of Medicine.

The government has actually been cracking down on the over prescribing of prescription medication for about a decade, and while critics say it is fueling the increase in the number of heroin overdoses, it’s also reducing the amount of fatal prescription drug overdoses, which number about 16,000 per year compared to 3,000 for heroin. Although it sounds like a Catch-22 situation, it’s probably a necessary step in order to reduce overall opiate dependence.

“Reducing inappropriate opioid prescribing remains a crucial public health strategy to address both prescription opioid and heroin overdoses,” CDC Director Tom Frieden said in a statement. “Addressing prescription opioid abuse by changing prescribing is likely to prevent heroin use in the long term.”

So How Do We Prevent Heroin Overdoses Now?

The smart-ass response of course is “Don’t shoot dope.” But there are things that you can do to prevent death if you or your friends choose to keep doing heroin. To stop an immediate overdose, start carrying naloxone (Narcan®), which reverses the effects of an overdose. I’m not a recovering heroin addict, but a lot of my recovery circle is, so I keep a kit in my glove compartment. To find out where you can get one, click here. I think of carrying Narcan the same way I do a CPR: I may not ever use have to use it, but if it comes down to life or death, it’s good to have the tools handy.

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About Author

Johnny Plankton is the pseudonym for a freelance business and comedy writer/editor (and recovering alcoholic) who lives in Boston. He is also a grateful member of America’s largest alcohol recovery “cult” as well as Al-Anon.