Every year in the United States, doctors prescribe enough opioid painkillers to give one bottle to every adult in the country. This over-prescription of painkillers, officials believe, has contributed to the heroin epidemic that now grips many American cities.
The epidemic has touched the lives of student athletes, mothers, fathers and beloved celebrities, with more than 28,000 opioid- and heroin-related overdose deaths reported in 2014, according to the CDC. In response, the Obama administration is treating it as a public health crisis, calling for an allocation of $1.1 billion in new funding to help those seeking treatment.
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Instead of trying to prosecute the problem away, the administration is seeking to view the crisis through a public health lens. This approach includes educating doctors on the possible effects of prescribing powerful opioids like oxycodone, hydrocodone, codeine, morphine and fentanyl. Such prescription medications are the gateway drugs for 80 percent of heroin users, according to Baltimore City Health Commissioner Leana Wen.
“We’re beginning to develop this culture of a pill for every pain,” Wen said. “There is a culture of access that we have to change.”
America’s appetite for heroin has grown stronger, with more than 28,000 overdose deaths in 2014, according to the CDC, with numbers only increasing year by year.
The CDC links the spike in overdoses to fentanyl, a drug thought to be 50 to 100 times more potent than heroin. Fentanyl became a household word after the April 2016 death of megastar Prince, who apparently took an accidental overdose of prescription fentanyl. What many Americans may not know, though, is that fentanyl is often used to “cut” heroin sold on the streets.
“In the ER, I would prescribe [fentanyl] to someone who has just been in a terrible car accident and their hip is out of joint and they’re screaming in pain,” Wen told Rare. “If somebody is using heroin and they don’t know that fentanyl is now mixed in it, they’re going to overdose and die, which we’re seeing nationwide.”
The drug was first introduced under the name Sublimaze in the 1960s and was initially only administered through a needle, but is now available through pill form, patches, injections and even in lozenge form. Despite the drug’s now-ready availability, many users don’t know they’re buying heroin laced with fentanyl.
If somebody is using heroin and they don't know that fentanyl is now mixed in it, they're going to overdose and die.
In Baltimore, where more than 20,000 people are known to be using heroin, the health department has issued a “Don’t Die” campaign, posting and disseminating fliers that instruct users on how to avoid an overdose while using heroin. One of the directives is to pay attention to any changes in color and texture of the drug, and to inject slowly if a change is noticed.
[graphiq id=”dY5K14dSeN” title=”Drug Poisoning Deaths per 100,000 People by County” width=”600″ height=”539″ url=”https://w.graphiq.com/w/dY5K14dSeN” link=”https://www.graphiq.com/wlp/dY5K14dSeN” link_text=”Drug Poisoning Deaths per 100,000 People by County | HealthGrove” align=”left”]
The skyrocketing rate of heroin-related overdose deaths has also increased the usage of Naloxone, also called Narcan. If administered within 3-5 minutes of an overdose, this prescription drug can prevent death.
The use of Narcan/Naloxone is not new; the World Health Organization placed the drug on its list of essential medications in 1983. But some high schools are now stocking Narcan so that staff can respond to an overdose if necessary. And U.S. public health officials are pushing to make Narcan widely available. In Baltimore, for instance, Wen has issued a blanket prescription for Narcan so every resident of the city can access it.
The White House in March announced that the Substance Abuse and Mental Health Services Administration (SAMHSA) is offering a new $11 million funding initiative for up to 11 states to purchase and distribute Naloxone and train first responders and others on its use.
In Baltimore, heroin addiction has gotten so bad that the health department issued a “Don’t Die” campaign to instruct users how to avoid an overdose.
The face of addiction has changed dramatically in the past decade. The number of non-Hispanic white Americans using heroin has increased by 114 percent in the past ten years. So has the number of middle-class Americans using the drug — up by 77 percent, according to the CDC. From 2002 to 2013, the number of women using heroin has increased by 100 percent, while the number of 18- to 25-year-olds using the drug has increased by 109 percent.
These changes have led to nationwide calls for “compassionate” care in confronting the crisis. This marks a drastic change in tone from the government’s long-running “War on Drugs,” which disproportionately affected minorities—specifically Black men — and emphasized zero-tolerance rules and stiff prison sentences.
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Now that the conversation has become less about “junkies” making a criminal choice and more about everyday Americans getting hooked on heroin through prescription gateway drugs, the focus has shifted away from blaming the users and more on interrogating the system that has led to the current crisis.
This system has been decades in the making. Between 1991 and 2013, prescriptions for opioid painkillers increased from 76 million to 207 million per year in response to patients’ pain concerns.
Once addicted to painkillers, the transition from abusing opioids to heroin can be linked to money: one 30mg tablet of oxycodone can cost around $50, while a bag of heroin can be purchased in some places for $5.
Rare politics reporter Yasmeen Alamiri and videographers Tolleah Price and Dan Yar spent months researching and reporting this series — traveling to Maryland, New Hampshire and other heroin-torn places while talking and listening to users, police officers, public figures and devastated families all affected by the epidemic. See the full series at on.rare.us/HeroinInAmerica.