Is Heroin the New Opana?

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From CDC data released 3/15

From CDC data released 3/15

The Center for Disease Control and Prevention (CDC) released new data last month showing a rapid rise in heroin overdose deaths. While total overdose deaths from opioids remained level for the past few years, deaths involving heroin escalated sharply.

The rate has tripled since 2010, and nearly quadrupled since 2000. Males have a four times higher rate than females with the highest rate seen in white males aged 18 to 44. All areas of the country had increased heroin overdose death rates, but the highest were seen in the Midwest, with the Northeast right behind them. The South, for a change, had the lowest rate of heroin deaths, after the West.

Those of us treating patients at OTPs knew heroin was moving into areas where pain pills once dominated, but I had no idea deaths had tripled in three years. That is appalling even to me, and I see appalling things all of the time. I can’t stress enough how bad this is.

Why is this happening? I’ve read and heard various opinions:

 Some people speculate that since marijuana became legal, that crop is less profitable to Mexican farmers, who switched to growing opium poppies. This is just a theory, though the timing supports the premise. I don’t know how it can be proved, short of taking surveys of Mexican farmers, which seems problematic and unlikely to happen.

 As we implemented measures to reduce the availability of prescription opioids, the price increased. Heroin is now cheaper than pain pills in many areas, and heroin’s purity has increased. Many addicts who can’t afford pain pills switch to heroin to prevent withdrawal. NIDA (National Institute for Drug Addiction) estimates one in fifteen people who use prescription opioids for non-medical reasons will try heroin at some point in their addiction.

Maybe that’s why the South still has the lowest heroin overdose death rates: we still have plenty of prescription opioid pain pills on the black market.

 With the increased purity, heroin can be snorted instead of injected. Many people start using heroin by snorting, feeling that’s safer than injection. It probably is safer, but addiction being what it is, many of these people end up injecting heroin at some point.

 Heroin has become more socially acceptable. In the past, heroin was considered a hard-core drug that was used by inner city minorities. Now that rural and suburban young adults are using heroin, it may have lost some of its reputation as a hazardous drug.

Most experts in the field agree that much of the increase in heroin use is an unintended consequence of decreasing the amount of illicit prescription opioids on the street. But we are doing the right thing by making prescription opioids less available. Physicians are less likely to overprescribe and that’s essential to the health of our nation.

Now it’s critical that we provide all opioid addicts with quick access to effective treatment, no matter where they live.

The face of heroin addiction has changed. It is no longer only inner-city minorities who are using and dying from heroin; now Midwestern young men from the suburbs and rural areas are the most likely to be using and dying from heroin.

In the past, when drug addiction was seen as a problem of the poor and down-trodden (in other words, inner-city minorities), the general public didn’t get too excited. But when addiction affected people in the middle classes, there was a public outcry. The Harrison Act of 1914 was passed due to public demand for stronger drug laws.

I think the same thing will happen now. Suburban parents will organize and demand solutions from elected officials for this wave of heroin addiction. Indeed, I think that’s already started to happen.

Let’s make sure a big part of the solution is effective treatment.

Let’s make treatment as easy to get as heroin.

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11 responses to this post.

  1. Posted by Catie on May 3, 2015 at 2:35 am

    Good to see these points in one location. Saw this recently and was dumbfounded: http://m.whio.com/news/news/crime-law/percocet-was-really-heroin-in-disguise/nk4ZW/
    I suspect this has or will lead to the increase in heroin use/o.d. as well.

    Reply

  2. agree – let’s solve this problem.

    Reply

  3. This is a very scary trend to see rise. We were just discussing this at training and the few clients I’ve met with since I’ve returned have all reported that the reasoning for coming to treatment or returning to treatment is because of heroin addiction with one or two reporting a close friend dying from overdose. I would have to agree that the reason for the rise in heroin use is due to the stricter laws on the access to prescription opioids. This will be something for me to focus more on than I did in the past for sure.

    Reply

  4. Posted by Chris on May 3, 2015 at 12:32 pm

    Yeah, we need to fix this problem, but how? My son passed from a heroin overdose 3 years ago. Now they administer narcan. That’s great but what about making them go into treatment after? You know these kids are using again after being saved. It’s not preventing them from using again.

    Reply

    • My heart goes out to you.
      If an addict refuses treatment, you can’t usually force them to go.
      Have you considered going to Alanon or naranon – for friends and family affected by addiction – to talk to other parents who’ve faced similar?

      Reply

      • Posted by Chris on May 4, 2015 at 12:37 am

        Y son was in treatment. He was released the day he passed. His insurance ran out. I have gone to meetings. The naranon meetings are for families of an addict. My addict is gone. The grief groups are parents like myself who are so devastated and it’s hard for me to sit among them. It’s truly a sad meeting…

  5. Posted by jada walker on May 3, 2015 at 2:09 pm

    My state Kentucky pretended they did a lot to help fight the heroin epidemic. Here’s what they did,
    passed a law to allow needle exchange. However each countu gets to decide wether they r willing to do it. Most aren’t mainly big city’s. I live n a small town where people buy used needles from each other because they r desperate to gst one. Then use the same one over and over again. Next
    putting 24 million n to treatment abd having Medicaid pay for more treatment. Except for methadon. Treatment!?!? The most successful treatment for this disease, the Gold standard n care but no let’s not use that! Kentucky is jumping in the vivitrol bandwagon. Thing is that’s not going to help the majority of active drug addicts. When I started methadone maintenance I didn’t know I wanted recovery. It wasn’t until I got on the medicine and wasnt sick and chasing drugs I realized recovery read possible. I was 7months pregnant had used all thru my pregnancy. When I got on MMT I was sent to a 10 day detox. Started on methadone detoxed from the rest of the illicit drugs. From There sent to30 day inpatient rehab. I don’t like the whole rehab set up but I will say I got more out of it from being on MMT while there then if I was sick the whole time.
    Vivitrol is more for someone who went thru rehab and wants to do our that way. Not a person n active addiction. Plus it’s dangerous once that stuff runs outv a lot of addicts will use except now the tolernce is Gone!!That’s a dangerous recipe

    Reply

    • I think one thing we’ve seen is that there’s not one way for everyone to recover. It’s nice to have options, and Vivitrol is only one option.

      Reply

  6. Thank you so much for writing this. I have been working with a patient with a significant other (also a patient) that has a medical condition and has been in jail for some time. The jail has denied my patient’s significant other needed medication since being admitted and knowing of the diagnosis. I have tried to provide her with as much information as possible but tells me that she has tried to tell them and they do not care.

    It’s a shame that no one seems to care until a tragic event like what happened in Michigan takes place and even then, they don’t accept any responsibility for that person’s death. I hope more measures are taken to change how people are treated in jail, especially those in treatment and with medical needs.

    Reply

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