The heroin “epidemic” is the new bête noire of local news organizations and to a lesser extent government legislators. It was mentioned on the Democratic debate last night, so I have a couple tabs on it open that I want to clear out. “Between 2002 and 2013, the rate of heroin-related overdose deaths nearly quadrupled,” is the media/politician take-away. High rate of change is always an attention grabber, even if in terms of gross numbers it’s not that high. “…and more than 8,200 people died in 2013”. That is a good chunk of people, and like with anything, you want that number to be zero. A comparably lethal cause of death is that from the viral hepatites. Around 4 times as many people die from falls (think the elderly) and car accidents, for some perspective.
My annoyance is that like most things, a cost/benefit determination does not factor into the conversation. Is it going to be worth billions of dollars and abrogations of civil liberties to save at most a couple thousand people a year from an ultimately self-inflicted injury? I’m not saying you have to answer that “no”, but I want that question entertained.
So who’s using more heroin? Well, it’s probably easier to say who isn’t. Fromm 2002-2013, kids age 12-17, non-whites (when counted as a single group), and people on Medicaid all did not undergo significant changes in heroin overdoses. So it is growing pretty well across the board. Although, again, not with children, so the whole we-need-to-do-something-now-because-dying-kids argument doesn’t hold a lot of water in this case.
Not today, Helen.
If you look at the CDC’s graphic, the “quadrupling” of deaths would have been closer to doubling if we had stopped looking in 2011. Fatality rates have basically been matching addiction rates until 2012. Around 2011, the death rate went parabolic and got away from the addiction rate the next year. What gives? My speculation, although I don’t have have much in the way of hard evidence pointing to causality, is the crack-downs on prescription opiates that started being implemented by state governments around the same time.
Scroll down to the bottom of that same graphic and you’ll see that people addicted to prescription opioids are 40x more likely to be addicted to heroin. Scientists are loathe to call that causative, but considering that the drugs are extremely similar from a pharmacological standpoint, it makes sense that you can essentially swap out one for the other. Corroborating evidence is the concurrent growth trends in prescription opioid overdose deaths. Fatalities as a result of those, too, have been increasing rapidly in the past decade or so (see page 2).
So what’s up with that? Well, that’s hard to say. At least some portion of that is likely a consequence of OxyContin (generic: oxycodone) becoming available as a brand of opioid pills in 1996, and the marketing that came with it. That’s not to lay the blame at the feet at marketing. It’s more of availability and convenience thing. In 1996, someone could say, “hey, we have a pill for that”. It’s less about Big Pharma duping the gullible masses into taking dangerous drugs than people want a pill to cure what ails them, and if you’re selling, they’re buying.
So why did people start getting into opioid pills in the 90’s? As a Millennial, I am obligated to inform you that I Grew Up In The 90’s TM, so my rose colored glasses may be tinting my perspective, but I don’t think the 90’s were that bad. I know the Simpsons started going downhill in the late-90’s, but is that a big enough reason for the surge? I wondered if we just switched out one depressant for another, so I Googled alcohol consumption, and that seemed pretty level. Frankly, I don’t have a good answer for the why, other than sheer availability.
But to get back to my speculation about heroin, it seems reasonable to conclude that the rise in prescription opioid addiction fueled the recent heroin addictions, and the surge from 2012 is due to the government catching up to the trend and trying to Do Something About It TM. The regulations implemented made it harder to access opioid pain medications. Plug that into Econ 101 and you get the analysis that a decrease in supply (caused by the regulations) with even a constant demand increased the price of prescription opioids. Even if the literal sales prices of the meds stayed the same, the figurative prices of getting your hands on it went way up. Meanwhile, the price of heroin has been dropping significantly since the 90’s. It seems that somewhere around 2011-2012, people decided heroin was the easier option than prescription pills.
We can ban or restrict either of these substances, but if there’s a will, there’s a way, and people who are addicted are going to figure out some way to get their hands on something that works on opioid receptors. Politicians will no doubt double-down on prohibition, despite it’s terrible track record of efficacy, because the government knows how to do that. Being in charge of making laws telling people what they can and can’t do is what the government does. And if we’re asking the government for a solution, we shouldn’t be surprised when that’s exactly what they decide to do. The root of the issue is that people are becoming addicted to opioids. Part of this is prescribing habits themselves. The drugs have substantial addictive properties, and just handing them out willy-nilly is going to cause issues. But that’s more a side-note than the real issue: addiction. Addiction is certainly a complicated issue. Some chemicals are more addictive than others. But at some point, people (or at least a substantial number) are deciding to take these addictive chemicals in an addictive manner. And that’s a hell of a problem to deal with. Why would a man take so much Oxy that he would think not only switching to heroin was an okay idea, but then inject heroin habitually? Is there a good answer for that? A simple answer? Is there an easy fix to that?
Asking why someone is killing themselves with drugs, and why don’t they stop, is not any easy thing to do. What pain are people dealing with that is so substantial? What can we do about it? These are uncomfortable questions that lack a quick and easy fix. But they are, at the heart of it, the questions we have to deal with. But that would be hard. So we ask are politicians what they are going to do to “stop it” instead. So we will not get a solution to our real problem. When the politicians inevitably do not solve the problem either, we can pick our political sides and lay the blame accordingly, because blaming other people is easier than confronting the real issue. As long as our frustrations and anger is dissipated somewhere, though, we will be satisfied. Anything is better than admitting we don’t know what to do.