Heroin

Alarm About a 'Heroin Epidemic' Skyrockets As Heroin Use Falls

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Yesterday the Substance Abuse and Mental Health Services Administration (SAMHSA) released the results of the 2013 National Survey on Drug Use and Health (NSDUH). As I noted a couple of weeks ago, when SAMHSA gave us a preview of those data, the number of respondents who reported using heroin in the previous month fell by 14 percent last year, despite ever-rising concern about a new "heroin epidemic." While NSDUH probably misses a substantial number of heavy users (exactly how many is unclear), the trends identified by the survey still should indicate whether heroin consumption is on the rise or on the wane (as both government officials and journalists tend to assume). Hence it is instructive to compare past-month heroin use measured by NSDUH (in thousands of users) with mentions of a "heroin epidemic" in the newspaper and wire service articles collected by Nexis:

NSDUH & Nexis

On the face of it, there is no obvious relationship between the level of heroin use and the level of press attention to it. Notice that the spike in 2006, when the number of past-month users was higher than it has been in any year since then, seems to have prompted no journalistic response whatsoever. The more gradual increase seen after 2009, by comparison, coincided with an initial drop in "heroin epidemic" mentions, followed by a slight increase. Then the number of mentions skyrocketed, rising from 82 in 2011 to 273 in 2012 and 633 in 2013. So far this year there have been nearly 2,300 references to a "heroin epidemic" in these news sources, reflecting the tremendous attention attracted by the actor Philip Seymour Hoffman's death on February 2 (which was caused by "mixed drug intoxication" but generally attributed to heroin alone). That single incident seems to have generated more talk of a "heroin epidemic" than everything else that happened in the previous 12 years. In any case, coverage of the putative epidemic really took off around the time when heroin use started to fall.

This disconnect between drug use and public alarm about it is a pretty familiar phenomenon by now. Ronald Reagan ramped up the war on drugs at a time when drug use was already declining. His successor, George H.W. Bush, gave his "bag of crack" speech years after cocaine consumption peaked (as measured by NSDUH's predecessor, the National Household Survey on Drug Abuse). Just as Hoffman's death seems to be the single most important factor driving the recent explosion in press coverage of heroin, the 1986 death of basketball player Len Bias, at a time when cocaine use was falling, drove the political panic that gave us insanely disproportionate federal crack sentences (even though Bias snorted cocaine rather than smoking it).

As the sociologist Nicholas Parsons points out in his recent book Meth Mania, press panics about speed likewise have been only tenuously related to the number of people consuming it. Parsons found that coverage of methamphetamine in Time and The New York Times shot up in 1967, driven largely by a single incident: the rape and murder of Linda Fitzpatrick, the 18-year-old daughter of a wealthy Greenwich, Connecticut, couple who dropped out of an exclusive private school and reportedly got hooked on Mephedrine. In that respect, Linda Fitzpatrick was the Philip Seymour Hoffman (or Len Bias) of her day.

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  1. But I repeast myself, facts and results mean nothing, only the agenda. See global warming and the war on drugs.

  2. On the face of it, there is no obvious relationship between the level of heroin use and the level of press attention to it.

    It takes a while for heroin addicts and soccer moms to process information. That’s the lag.

  3. Facts, who needs facts and fancy graphs I know in my heart heroin is on the rise because I bought some for the first time in like 10 years last night and I know people who died, duh.

  4. I’d be interested to see numbers by state or region. A lot of the “heroin epidemic” sorts of stories I hear are about how use appears to increase in certain regions. Those stories may well not be terribly grounded in fact either, but it could also be becoming more of a problem in some places while still declining nationally.

    Not that anything like that would change my views on what drug policies are appropriate.

    1. I reckon some places keep more accurate stats than others. Though, how one could compile accurate statistics on a behavior that those engaging in try to keep hidden, I don’t know.

      Here in VT there is particular attention paid to heroin. It’s difficult to believe that the problem is as bad as it’s made out to be. Having lived in other places, it seem that the term “epidemic” is hardly appropriate when applied to VT. It’s just that when dope is found in a place noted for it’s idyllic scenery and maple syrup, the villagers get concerned.

      It’s ironic, though, not surprising that the only reason that there is as much heroin as we have now, is this “crackdown of prescription diversion” that was all the rage a couple years ago. Right after physicians jumped eagerly on that bandwagon, the market predictably shifted. Junkies now get more H instead of pills. People in pain get more ibuprofen instead of percocet. No one wins, except the those that get an indulgent kick out of taking away drugs away from people.

      So, compared to the ideal, it’s an epidemic. But compared to everywhere else. it’s pretty low, while the rates of overall opiate use here is pretty steady.

      1. *”on” not “of”

  5. Linda Fitzpatrick, the 18-year-old daughter of a wealthy Greenwich, Connecticut, couple who dropped out of an exclusive private school and reportedly got hooked on Mephedrine.

    Copy editor needed.

  6. Jacob – while the Past Month Heroin number is down from last year, the Past Month for OxyContin is up. If you factor both opiates in the analysis, the number of users are rising (693K – 2013, 781K – 2014). This is still a significant problem and needs attention from government and health care providers.

    I had this disease effect my family, and while there’s no clear path to recovery, there are many avenues. If you want a personal perspective, please feel free to contact me.

    1. I think it does make sense to look at all opioids and not just heroin as they can be substituted for one another pretty readily.

      But also remember that you are addressing mostly a bunch of libertarians and anarchists here who will question the notion that it needs attention from government.

      1. Zeb – it depends on what you want government to do. For example: decriminalize possession of opiates so people aren’t thrown into the court system and instead shown ways they can get help.

        1. Again, as Zeb noted as libertarians we take issue that you need government to show people ways they can get help. Just because it’s a good thing doesn’t mean government is the correct moving agent to do something. Just the opposite in most cases.

          1. What government can do is get people information, and maybe ride to help if needed. There are lots of resources but little coordination.

            Some private groups are taking up the challenge. Example: http://www.learn2cope.org/

            1. Most heroin addicts posses far more accurate information than the government does. Also, they can hustle a ride better than just about anyone else.

              1. Agreed.

        2. Sure, harm reduction stuff is a lot better than simple criminal prohibition, and probably the best we can hope for with hard drugs any time soon.

          I have some personal experience with people who have had opioid addictions as well and one big thing that I noticed is how fucked up the rehab industry is, largely because of how many people are forced into the programs by the courts. Too many people are there because they have too and too many rehab facilities just exist to meet the demand created by court mandated treatment. I think more diversion into such programs as an alternative to criminal punishment will just make that worse. Most people will seek help on their own when they are ready to make a change.

        3. I have experience with heroin addicts. Anyone who wants help, can get it. The only thing the gov’t can (should) do is legalize it. Legalizing it would allow for decent people to be involved in supplying it, which would allow a means of reliable grading and ensure no harmful additives are used. Also, it would enable users to easily acquire clean needles and narcan, to protect from overdoses.

          If by help, you mean using force and intimidation to coerce them to stop, we’ve tried that. Substituting institutions won’t change the results. Nothing about addiction should be addressed with violence and coercion.

          1. Getting help for addiction is NOT as easy as you seem to be suggesting. Unless you have “lived” it, be mindful of judging.

            “Methadone clinics”, which are now able to prescribe Suboxone in many cases, are scattered throughout the states, predominantly in large metropolitan areas. In my state, there are 12 methadone clinics, some of which are not clinics, per se, but rather individual physicians, many of whom are not certified to treat addiction. Of those 12 “clinics”, four are in one large city while the rest are scattered across the state. Several of the clinics in my state have not been accepting new patients for more than 6 months. Instead, they are referring addicts to clinics that are literally hours away…..one of the closest in my area is in another state, which often eliminates the option of using one’s health insurance to cover costs. These facilities often require a daily pilgrimage to the clinic to receive each day’s dose. This is highly inefficient, emotionally stressful, time consuming, and adds increased financial burden (gas for the drive, time away from work, etc.) for the suffering addict who is trying to overcome a tremendous obstacle. Add to that a general lack of or poor quality “support” (in terms of counseling) for the recovering addict.

          2. Methadone clinics are also notorious for short-term treatment and leave an addict facing the “methadone cliff”….a few day’s supply of methadone ending with a 2mg dose (a.k.a. 2mg cliff) which, more often than not, leaves an addict, particularly a “hard-core” or long-term addict, to withdraw from the methadone rather than continuing to “taper down” and wean off the drug. Many addicts have reported similar and severe withdrawal symptoms as they had experienced coming off of heroin or other opiates/opioids.

            1. There is a slowly growing number of “addictionologists”, medical doctors certified to chemically treat substance abuse. However, a single visit to one of these specialists can cost $200 or more per visit out of pocket…..prescriptions extra, to the tune of several hundred dollars per ‘scrip. Suboxone strips are about $7.00 per 8mg strip, retail. Higher doses cost more. If one is lucky, he/she may have medical insurance that will cover such expenses, thus, reducing the out-of-pocket costs. Many insurance prescribers will not cover such expenses. However, this leads to an issue of medical privacy. Once an individual goes to a private physician and, particularly if they pay with medical insurance, their history of drug use becomes a part of their permanent medical record that any “authority” can easily access. This can lead to the loss or denial of future healthcare coverage or specific medical treatment…..God help the addict who then becomes legitimately ill or injured and requires narcotic pain medications to alleviate pain. Most physicians are extremely reluctant to prescribe narcotics to an addict as doing so, particularly outside of a hospital stay, can cost that physician his/her license to practice medicine. (Thank you federal government and your misinformed drug propaganda and the “War on Drugs”.)

              1. This issue also adversely affects many legitimate chronic pain patients who become “chemically dependent” upon prescription narcotics. Over time, a pt develops a tolerance to a drug, which means that pt will then require an increasing dosage to maintain an “acceptable” level of pain mgmt. These folks aren’t “addicts” in the strictest sense of the term but, their withdrawal experience is no less miserable as one withdrawing from heroin. Many pain mgmt. practices have adopted “zero tolerance” policies for those who test positive for any other drug or even who test (+) for quantitatively higher or lower levels of a drug than the therapeutic range. These people may not be using illegal drugs or even illegally purchasing more of their specific drug but never-the-less are “fired” from their pain mgmt. program simply because they took a few extra pills, and, the physician will not/cannot prescribe an increase in medication to properly treat pain. Once “fired” from a pain mgmt. program, a pt may find it difficult, if not impossible, to find another practice that will accept them as a pt.

                1. There is an informal “three strikes” rule that effectively renders a pt ineligible for further pain mgmt. programs. Most pts enrolled in pain mgmt. use health insurance to help cover expenses and, therefore, there is that permanent medical history that comes into play. These same folks are then left with no “step down” process for weaning off of the narcotic by their doctor or they must seek help from a methadone clinic (which may refuse to accept these people into their program) or they must seek help from an addictionologist…..again, with the same problems mentioned above.

                  1. Also, many detox/treatment facilities require that a pt be medically cleared by an ER physician prior to being accepted into their program. In many states, emergency rooms are permitted to administer a one-time, single dose of a narcotic to alleviate withdrawal symptoms. However, most physicians are extremely reluctant to do so. Some even adopt the “let ’em suffer” mentality. I’ve personally witnessed this while working trauma. Once admitted to an ER for treatment, assuming treatment is rendered, this becomes part of a pts permanent medical record. Many detox/treatment facilities often have delays in admitting pts into their programs. Some addicts must wait days or even weeks to get into a program. Naturally, an addict will seek “alternative” methods to manage withdrawal symptoms in the absence of medical intervention. So again, with all due respect, getting help detoxing from and weaning off of drugs is not as easy and readily available as you seem to be suggesting.

      2. I don’t know that I’d support wholesale legalization of most currently illegal drugs. I do, however, think that the laws in the United States are bass ackwards in terms of their application to many small-time users. Our criminal justice system is FULL of small-time users, many of whom are sentenced for a minimum of 3-5 years…..sometimes more. There are criminals who have been convicted of far more serious and violent crimes that actually do less time in the system. On average, murderers, rapists, child molesters and the like only serve approximately 30% of their sentences while many drug offenders are handed down mandatory minimums such as 9 years at 85%. States with the “three strikes” laws, such as MO, CA, MA, etc., subject some of these non-violent offenders to life in prison, many of them without the possibility of parole. Again, many murderers get off with far lighter sentences.

        The main role for government, in my opinion, is first to correct such lopsided legislation and allow court discretion to allow the punishment to fit the crime. We then can proceed from there.

    2. When exactly did the abuse of opiates become a “disease”?

      1. Mr. Mouse: admittedly, the SAMHSA numbers don’t show the number of people addicted to opiates, only the number that used in the current year AND month. It is however the only reliable statistics that show trends if you make the inference that if you used in the current year AND the current month you might have developed a physical (in the case of opiates) dependency.

        In other words, abuse becomes a disease when you wake up one morning with every muscle in your body in pain, you’re shaking uncontrollably, you can’t control your bowels, and the only way to stop it is to take more opiates.

        1. As I say below, I’m not wild about using the word “disease” in this context, but that is neither here nor there.
          But the physical withdrawals are really not the serious part. Yeah, it sucks, but it passes in a few days. But serious addicts are still addicts after going through the withdrawals. The disease (if you want to call it that) is psychological.

          1. Withdrawal from opiates, although generally not as serious as that from alcohol, can indeed be prolonged and quite miserable. The misery can lead an addict to suicide, cause serious gastrointestinal bleeding and severe dehydration. The belief that opiate withdrawal only lasts for a few days and is no more uncomfortable than a mild case of the flu is simply not true in many cases. I’ve known patients who experienced the worst of withdrawal symptoms for 10-20 days, and, it often takes months or even years for the body to “reset” biological rhythms, endocrine function, and brain chemistry. The hypothalamic thermostat may take as much as two years or longer…if ever…to be fully reset in some patients. The longer an addict uses, the quantity used per “fix”, the quality/purity of the drug used, combined with psychological factors, all factor in to how long recovery will take for a given individual. A “recovering” addict who has been “clean” for a decade or more may still experience very strong, very real “cravings” that can facilitate changes in brain chemistry and a withdrawal reaction.

            See my other post regarding the classification of addiction as a “disease” below.

        2. This specific article was about a report that singled out heroin use. The article in reference did not include the use/abuse of other opiates/opioids.

      2. It’s a 12 step program thing to call addiction “your disease”. I’m not wild about the word choice, but a lot of people use it.

      3. Numerous primary research studies by both psychiatric and neurobiological researchers have conclusively reported physiological genetic predisposition to addiction. Do a Google or Nexis search for “genetic predisposition drug abuse” and you’ll be directed to many links to primary research articles. While I will concede that a person first chooses to “experiment” with, or try, a given drug, addiction is NOT merely a psychological “choice”. Arguably, it could very well be cited as a legitimate genetic disorder…..and may be someday as more research directs medical science…..especially as science gains knowledge into the link between clinical depression and other mental disorders and addiction.

        1. BTW…..on a related note (in a round-a-bout sort of way)…..in the mid-90s, Dan Rather of CBS News proudly reported on the “discovery” that linked homosexuality with specific genes, i.e. of the homosexuals in the study, most had genetic similarities…..they had a genetic predisposition for homosexuality. Thus, by the same reasoning, homosexuality could then be classified as a genetic disorder, which could then, in theory, be viewed as a “pre-existing condition” by health insurance providers and coverage to those individuals denied. I’ve never seen a story, so proudly promoted on prime-time news, die a quicker death.

  7. The “Mis-Information” War on Drugs continues…..

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