It’s nearly a year since I warned about bumper heroin crops in Afghanistan, and months since raising the issue of soaring opiate painkiller abuse in the US. Yet the debate is still fresh, it seems, after reporting this week about the speed with which heroin use continues to increase in America.
Using stats from the substance misuse treatment centres in a sample district, heroin use increased 425% between 1996 and 2011. Four out of every five people presenting for treatment for their heroin use reported first becoming addicted to opiate painkillers. Use of these painkillers, in the same sample, had increased 1,136%.
But the really interesting part is how and why this happened.
On one side, there is the argument that this epidemic rise in opiate use is due to the drug companies. Marketing techniques for OxyContin, for example, were apparently so aggressive that doctors were ‘convinced’ (by what means, I am unsure, but we can imagine) that the tablets were completely safe to prescribe long-term. (Now I haven’t got a degree in medicine, but it would take more than a marketing campaign to persuade me that making an opiate slow-release stopped it from being addictive..)
Whatever methods the drug company used, they worked, and as sales soared, so did the deaths. In 2009, more than fifteen and a half thousand people died of opiate painkiller overdoses in the US – more than double the numbers in 2002.
The manufacturers were later fined over six hundred millions dollars for misleading doctors and patients about the addictive nature of the pills.
But there is another perspective – that the War On Drugs is to blame for the over-prescribing and addiction problems. The DEA, according to some, have turned decisions that should remain in the medical domain into legal issues – by scapegoating legitimate prescribers.
The case of pain specialist William Hurwitz is a poignant one. Of the hundreds of patients under his care, fifteen were found to be selling their medication. This was without Hurwitz’s knowledge. However, he received a custodial sentence of fifty-seven months for distributing narcotics.
As someone who has worked in drug treatment for many years, this is a chilling tale. There is no way of ensuring that meds are not diverted – even on daily supervised consumption, where pharmacists are paid to watch people take their medication every day, people will hide meds in their cheeks, sneak them out and sell them on in the spat-out form. And people will buy them. Such is the desperate nature of opiate addiction. But if I were held responsible for my patients making these choices, would I continue to provide prescriptions? Unlikely. And then, for the majority taking their meds as prescribed, where would they turn when the script stopped and the withdrawal symptoms and agonising pain set in?
Unsurprisingly, this type of prosecution discouraged doctors from signing legitimate prescriptions for people with genuine chronic pain, raising human rights issues for sufferers. In response, unscrupulous, or humane (depending which stance you take), doctors set up ‘pill mills’ – centres where prescriptions for opiate painkillers were provided more freely than was medically advised, both to pain sufferers and to addicts. The black market became flooded and, conversely to DEA intentions, that meant that the tighter legislation in fact enabled the boom in opiate dependence.
Whatever your beliefs about opiate prescribing, there is no doubt that America is facing a top-down public health crisis. And now, here we are – 2014. Poverty, depression and opiate addiction. Just in time for the heroin mega-crop. Yeehaa, as the they say in the States.
Ooo, doesn’t it make you nostalgic…