Heroin-Related Deaths Rise As Heroin Use Falls

The divergence reinforces the case for harm reduction.


CDC numbers released last week indicate that the number of heroin-related deaths in the United States rose from 10,574 in 2014 to 12,990 in 2015. That 23 percent increase occurred even though heroin use, as measured by the National Survey on Drug Use and Health (NSDUH), declined last year. This development underlines a phenomenon I've noted before: Heroin use is more dangerous than it used to be. Since 2002, according to NSDUH, the number of heroin users has more than doubled, but the number of drug poisoning deaths involving heroin has more than sextupled. To put it another way, heroin users are about three times as likely to die from drug poisoning as they were in 2002.


Several factors may help explain this striking development. As the government cracked down on nonmedical use of prescription painkillers, a lot of opioid users switched to heroin, and these new heroin users were not accustomed to the black market's inconsistent potency. One reason heroin can be stronger than expected is the addition of the synthetic narcotic fentanyl, which has become more common in recent years. "Overdose deaths involving synthetic opioids other than methadone rose from 5,544 in 2014 to 9,580 in 2015, an increase of 73 percent," the CDC notes. "This category of opioids is dominated by fentanyl-related overdoses, and recent research indicates the fentanyl involved in these deaths is illicitly manufactured, not from medications containing fentanyl." Fentanyl aside, most heroin-related deaths involve drug mixtures, and it's possible the new heroin users are more inclined to combine it with other depressants.

The shift to the black market can't be the whole story, because there was a similar divergence between consumption of legal opioids and deaths involving them. Nonmedical use of these drugs fell slightly between 2002 and 2014, when the number of deaths involving them rose by 150 percent. It seems clear that fatalities are not a simple function of use rates, which means policies aimed at driving down consumption may not be the most effective way to reduce deaths. Such efforts may even have the opposite effect, as the crackdown on painkillers apparently did by driving opioid users to heroin.

Taking these points into account, a new set of recommendations from the Drug Policy Alliance (DPA) suggests several ways to make opioid use less dangerous, including wider distribution of the overdose-reversing opioid antagonist naloxone, legal reforms to protect bystanders who report overdoses, "drug checking services" that would alert users to the presence of adulterants such as fentanyl, and supervised injection facilities, where people can consume drugs in a safe and sanitary setting monitored by medical professionals. DPA says "SIFs have been rigorously studied and found to reduce the spread of infectious disease, overdose deaths, and improperly discarded injection equipment, and to increase public order, access to drug treatment and other services, and to save taxpayer money." DPA also suggests "heroin-assisted treatment," which gives addicts access to pharmaceutical-quality heroin. It says "research has shown that HAT can reduce drug use, overdose deaths, infectious disease, and crime, while saving money and promoting social integration."

These harm reduction measures go beyond "just say no" to grapple with the factors that make opioid use more dangerous than it has to be. It's doubtful that the Trump administration, which so far leans strongly toward old-fashioned prohibitionism, will be open to such ideas. But any response to the rise in opioid-related deaths that does not address the divergence between consumption and fatality trends will be missing an important part of the picture.

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  1. The number of users would have gone up more - but they kept dying on us.

    1. so this would lead to the conclusion that heroin users are too stupid to use heroin correctly.

  2. We ought to make heroin illegal. That would stop it.

    1. what we should o is mind or own business, absent a crime being committed to get money to get drugs, users are on their own...Darwinian behavior yield Darwinian results...Shakers anyone?

  3. A crackdown on non-medical use of painkillers? No, it was a crackdown on doctors who, on average, have much more property to seize via asset forfeiture than drug users.

    It's about the money. It is always about the money. People be damned.

    1. Don't forget power. It's always about power too. In which case, people be damned again.

      I'm not convinced this one is driven by asset forfeiture. Never underestimate the power of a good moral panic.

    2. And it also ended up being a crackdown on the medical use of painkillers. It's become more difficult for patients with pain to get appropriate medication.

    3. It's always about "doing the right thing".

    4. Well, control is still part of it. Drug users are denied certain government beenies like student loans and they attack the 2nd Amendment rights of drug users.

    5. Lost my comment! These doctors have forgotten that they are supposed to relieve suffering. The drug warriors are the reason I was forcibly retired, and, ironically, now suffer from inadequately treated neuropathic pain!

  4. There is wide consensus among experts that medical best practice requires that an individual struggling with opioid use disorder should have access to the full spectrum of behavioral, pharmacological, and psychosocial treatments. Effective treatment modalities also need to be available to people at all stages of the recovery spectrum. Barriers to effective treatment, gaps in provider education, and lack of standards of quality care, as well as the best methods and mechanisms to increase access to effective treatment and availability of different types of treatment, are best addressed on a state-by-state basis by experts representing the state's medical and healthcare community (physicians and nurses, medical universities and students, hospitals, etc.), insurance providers, treatment professionals, social workers, harm reduction providers, mental health professionals, and state and local government officials.

    "We're not spending enough on drug prohibition and the right people aren't getting paid"

    Fuck public health. Just legalize drugs. I bet John Q. Taxpayer would prefer that to taxpayer-funded heroin, subsidized junkies, and government shooting galleries "supervised injection facilities".

  5. Just a personal story. When I was a teenager and young adult, I liked drugs. I liked them alot. I tried all kinds and flirted with a serious problem for awhile. I also have hard working parents who expected the same out of me. When I was eighteen, I had to stay clean long enough to pass drug tests to get a decent job. Once I started the job, I had to stay clean most of the time because I worked 50 to 60 hours a week. A couple of years after that, I had the opportunity to go to trade school. I had to almost entirely quit drugs after that point because I was working the same hours and going to school for an additional 30 hours a week. This lasted two years. Not long after that I married and started a family and completely quit any drugs.

    I guess my point is, *The solution is to go to work, better yourself and grow up.

    *This approach can be used on most problems facing society today.

    1. *** meekly raises hand ***

      So, you're advocating for drug-testing of congresscreatures?

      1. IQ tests...score below a preset number, off to the glue factory...

  6. "SIFs have been rigorously studied and found to reduce the spread of infectious disease, overdose deaths, and improperly discarded injection equipment, and to increase public order, access to drug treatment and other services, and to save taxpayer money."

    "Plus, think of the JOBS!"

    As SIV just noted, there's another approach that just might save taxpayer money.

  7. Just legalize it already. If you want to prevent deaths from OD, just have Bayer sell heroin OTC at the local CVS. If heroin addicts can go from NY to LA and know that they're going to get the same cut wherever they go, that would dramatically cut down on the OD deaths caused by heroin.

    1. All OD's would then be "user error" or intentional.

  8. Meh, who cares about dead junkies?

    1. People mandating Naloxone availability?

    2. any stats on recidivism of narcan recipients and eventual OD?

    3. The live ones do a lot of property damage, so there is some public interest involved prior to their deaths.

    4. Their family members?

      I had a family member OD on heroin, and it kind of messed up everybody tangentially related to dealing with it.

      1. So it's about selfishness. Got it.

        1. Selfishness? You mean rational self intetest right? What the hell kind of libertarian are you?

    5. People who know them.

    6. Drug warriors, hence the drug war.

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  10. Most of the people who died from heroin overdose were people who started drug use recreationally - often by stealing prescriptions from others. In other words, they had a compulsion to steal drugs which created a 'disorder' that lead to a compulsion to steal drugs.

    Usually they died by combining heroin with other drugs and alcohol - often every bottle in the house. In other words, it's usually suicide. Treating it as a disease (like the Surgeon General says) will only make the problem worse. Legalization and harm reduction is the solution here.

    Also many people overdosed after getting cut off from their life-saving medication by their doctors. This is a big cause of suicides among veterans.

    So the basic problem is hopelessness, which by the way is why Trump won - instead of thinking up ways to kill yourself, you can fantasize about ways of killing others.

  11. Heroin-Related Deaths Rise As Heroin Use Falls

    Well, since drug overdoses and accidental falls are two leading causes of death, that make perfect sense.

  12. Maybe the answer is that as heroin and opiod use becomes more pervasive it's consumed by a wider array of people who are more susceptible to its effects, such as much younger or older people, people with more more other chronic health issues or those who are more frail otherwise.

  13. The Data in the White House press release does not add up in any useful way, for either 2014 or 2015, and their link is non-useful as it just takes you to the CDC's 'Wonder' database, which is non-useful if you don't want to spend all day guessing how to use it, then trying to replicate how the White House used it. When subtotals in a press release don't add up to totals, however, one is reluctant to grant credence to any numerical observations.

    One suspects the only intention here was to get Congress to pass a $1 billion non-solution - oh look! that happened!

    Uncharacteristically Reason does not provide links to its own data sources, specifically 'Nonmedical use of these drugs fell slightly between 2002 and 2014", but if they are using Table 7.3C from the '2014 National Survey on Drug Use and Health: Detailed Tables' I suspect the line for 'Pain relievers' is simply not worth using for that purpose, due to 8 trend reversals in 12 time periods as well as a couple of high P values from Tests of Differences of Percentages (however, I am no statistician, perhaps I'm being too sceptical).

    1. As for 'heroin' deaths skyrocketing while heroin use is only rising gradually, the fentanyl explanation needs to be knocked off its perch before it's worth spending much time looking for a better one. Both heroin and fentanyl are powders, with fentanyl 50 to 100 times as potent by weight, i.e., adding a grain of fentanyl to 100 grains of heroin can double its potency.

      Presumably the manufacturer does not want to kill her customers (caveat - she might want to take them right to the edge of death ... ), but blending two powders together to achieve a uniform distribution of two ingredients present in a 100 or even 50 to 1 ratio is not, shall we say, for the faint of heart. Legal pharmaceutical companies know how to do this (carefully, very very carefully), but it is a mechanical problem, not a chemical problem (I chuckle thinking of the Afghan heroin manufacturers working on this problem, although it seems not to be their problem to solve), and it seems clear the current manufacturers have not invested enough in men and machines and expertise.

      When they do, I predict the 'heroin' deaths will fall back to their previous levels, and the White House and its media friends will have to find a brand new drug scare to keep us all paying into the coffers of Washington's Drug Warriors.

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