Opioids

How Many More People Have to Die From Heroin and Fentanyl Before We Try Something Different?

U.S. policymakers continue to pursue programs that punish at the expense of ones that save lives.

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A popular site for heroin users in the Kensington neighborhood of Philadelphia. PHOTO CREDIT: Bastiaan Slabbers/NurPhoto/Sipa/Newscom

A panel of experts recently projected that 500,000 Americans could die of opioid-related overdoses between now and 2027, surpassing the annual death toll from AIDS during the worst years of that epidemic. Some of the experts polled put the potential opioid-related death toll at 650,000 over the next 10 years.

We can reach that grizzly milestone with our eyes closed if we just keeping doing what we've done for the last decade. But a future in which opioid and opiate-related overdoses claim more lives than a deadly communicable disease is no more inevitable than our present moment was a decade ago.

We got here by reacting poorly to the increase in prescription opioid abuse and associated deaths. There may be no point in asking how many more people would be alive today if we had made different choices when we first recognized this problem, but it's instructive to revisit the early days of this crisis anyway.

According to data from the Centers for Disease Control, just over 2,000 people died from heroin-related overdoses in 2005. In 2015, heroin killed 12,989 people. The total number of drug overdose deaths in 2005 was 29,813. In 2015, 52,404.

We have a pretty good idea of what happened between 2005 and 2015. Law enforcement cracked down on pill mills, the Food and Drug Administration admonished pharmaceutical companies to make their drugs harder to snort and inject, and the CDC and Health and Human Services discouraged doctors from prescribing pain medication.

In addition to being public health policies, these were also price signals. The black market responded accordingly with cheap heroin and then cheap illicit fentanyl. As Vox recently reported, there are many places throughout the U.S. where black market heroin and fentanyl now kill far more people than prescription pills.

With each new death record—and we are setting them every year now—the overdose problem moves further out of a realm regulators can control into one they can't and never will. Oddly enough, they don't seem to realize it.

Earlier this summer, Kentucky's legislature passed a law creating a three-day limit on opioid prescriptions for acute pain, meaning that no prescription can be for more than three days worth of pain relievers. In Massachusetts, Gov. Charlie Baker wants a five-year mandatory minimum for any person who provided the illicit drugs that led to an overdose death.

The Justice Department recently asked the U.S. Sentencing Commission to require every person convicted of distributing fentanyl to serve prison time, regardless of how little fentanyl is involved, whether they knew they were distributing fentanyl at all, and whether anyone died as a result. As Dr. Jeffrey A. Singer writes at Townhall, there's also a push to conduct more surveillance of doctors and their patients.

These are the same strategies that got us here.

The list of things we refuse to try, meanwhile, is depressingly long. Heroin maintenance programs—of which there is not a single one in the U.S.—would provide fentanyl-free gear to people who can't or don't want to enter medication-assisted therapy; and safe injection sites—which we also don't have, despite their success in our neighbor to the north (and, uh, Iran)—would provide a place for those people to use under medical supervision.

We should be removing barriers to offering medication-assisted therapy; there should be no limit on how many patients a doctor can help at one time and HHS shouldn't require days' worth of training in order to administer the associated medicines.

Anybody should be able to buy naloxone wherever they can buy Tylenol. No one should face incarceration or arrest for reporting a drug overdose.

There are more libertarian policies, of course, but the ones I've just listed wouldn't require the U.S. to do something novel or break any international agreements. They would require us to accept that our problems with drugs, like most problems that universally afflict our species, cannot be eradicated at the population level.

If we don't try these things now, we shouldn't expect a future that's better than our present.

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  1. A panel of experts recently projected that 500,000 Americans could die of opioid-related overdoses between now and 2027, surpassing the annual death toll from AIDS during the worst years of that epidemic.

    How long before Stormfront shows up in the thread and says that as long as it’s white people in flyover country, they don’t give a shit?

    1. 500,000 less Trump voters, yeah! GayJay/McMuffin 2020 !

    2. I’m not “Stormfront” and I don’t care about the politics.

      This is people dying from a purely self-inflicted choice. I am no more concerned about them than I am people who eat too much, don’t exercise and either stroke out or have heart attacks. More to the point: Make the drugs legal. If someone wants to kill themselves, that’s their business and should not be a reason to spend tax dollars.

  2. In 2015, heroin killed 12,989 people. The total number of drug overdose deaths in 2005 was 29,813. In 2015, 52,404.

    *gulp*

    Wow, that went from about where gun homicides are to where national traffic deaths are in ten years.

    1. I wonder if reporting has increased or the parameters have changed in that decade of time, but eh. Start with the small fry generally popular illegal drugs and disparate impact drugs, and work your way up to heroin. If you start talking about heroin, people are going to look at you like you’re nuts.

      Why is possession of crack worse than possession of cocaine? Same drug, different user.

      1. I find it hard to imagine that the parameters or reporting changed dramatically enough to essentially render a two-fold* increase. And tracking heroin/fentanyl overdoses should be pretty elementary stuff. ‘Cause of death: _________’

        It’s not like date rape or something where educating the public and/or social stigmas change. I mean, even where stigma does exist in drug use– when they find a body or you end up comatose in the hospital, the toxicology results don’t change.

        I mean– I don’t know the history of fentanyl etc, but maybe people were showing up and fentanyl didn’t show up in a toxicology test.

        What we do have is talk of ‘opioid’ overdoses which include over-the-counter painkillers– the use of which has pretty much exploded, so we’re not just talking about injecting heroin cooked in a spoon in a back alley.

        *I originally typed a four-fold increase, but if you read the quoted sentence carefully, it separates heroin from ‘drug overdoses’ but is written in a way that makes it easy to miss. Drug overdoses overall went from 29k to 54k in 10 years, heroin was ~13k of that 54k in 2015.

    2. Try to mitigate the pain of existence like a thug, die with your veins burned out like a thug.

      1. Hrm…

        Actually, if you look at the age demographics of opiod overdoses, the 45-54 cohort took the lead in deaths back in the early/mid 2000s and hasn’t lost the lead since. The cohort that’s seen the biggest increase, however, is the 55-64 cohort, which now has as many deaths as the 45-54 cohort did back in 2005 or so (when it was the leader).

        And while my 30-second google search didn’t turn up more specific demographic data, everything I’ve read indicates that many of these new deaths are from users who were not your stereotypical users. They were middle-class, educated, and so-on. Got started on prescription pain pills and swapped over.

        So unless “thug” now means “middle manager”, your characterization seems a bit off.

        1. Someone was sick during sarcasm day.

          1. Miss sarcasm day like a thug, look like a chump like a thug.

            1. Escher missed sarcasm day like a Baaaawwwsss!

          2. Sure, why not.

        2. The people in the 45-54 cohort in early/mid 2000s–who didn’t die in the meantime–are now by and large in the 55-64 cohort today, right?

          So is this at all surprising?

          1. That’s kind of how I read it. America’s addicts are aging.

  3. Of all the overdose deaths you seem so concerned about, how many were accidental overdoses?

    1. I am inclined to think that most are accidental. It would be strange if that much of an uptick was due to a big jump in suicides that just happened to coincide with a significant increase in adulterated heroin and a decrease in the availability of prescription pills.

      1. I’m not really thinking about suicides as much as people who just jam in everything they can to see how high they can get. Like alcoholics who drink themselves to death because they don’t know where their limit is anymore.

        1. … you just defined “accidental overdose” in such a way as to exclude folks that didn’t intend to overdose but accidentally did.

          1. To be fair, there is a difference between someone who thought they were taking, say, 10mg of oxy but were instead taking a 100mg black-market tablet and someone who took the 100mg because the 75mg didn;t do anything for them anymore.

            In both cases the person ODs, and it was certainly accidental. But there’s a difference, isn’t there?

            1. ^This.

  4. As Vox recently reported

    Among “news outlets”,Vox is the most rabid cheerleader for the WoDs these days

  5. A panel of experts recently projected that 500,000 Americans could die of opioid-related overdoses between now and 2027, surpassing the annual death toll from AIDS during the worst years of that epidemic.

    Two totally unrelated numbers; two personal choices that can lead to death.
    The only thing we know for sure is that there would be fewer deaths if the federal government would stop trying to help.

  6. It’s a self correcting problem if left alone.

    1. Much like land mines.

  7. Grisly, methinks.

  8. I find it hard to get my head around this crisis. If I were to need painkillers for some period of time, and found I became addicted, I would seek medical treatment, not head out to buy risky street heroin. Is there a stigma to having become addicted via a doctor’s prescription that precludes seeking treatment??

    1. It may be that the prescription runs out, or becomes difficult to obtain because your previous doctor who played it fast and loose with the Prescription pad got busted, lost his license, or simply got cautious because xe was under scrutiny.

      So yeah, I can definitely see cases where someone who previously had access to prescription painkillers switched to something off the street. And when we say ‘street’, since this epidemic is happening in flyover country as much as it is normally attributed to a purely ‘urban’ problem, that could just be Scooter who lives in the farmhouse down the way.

      1. They don’t call it “hillbilly heroin” for nothing.

      2. There should be no requirement to get a government permission slip to buy drugs. I don’t buy the “drug addict as victim” canard – except in cases where the content of a drug is misrepresented. (“I thought I was shooting heroin, but I was sold fake junk and was actually mainlining cyanide!”)

      3. Creech/Diane:
        What is happening now is that doctors are pulling back from giving opiates to their regular patients, for fear of being charged by FDA or DEA as pill pushers, and they are not helping the patients to withdraw in a reasonable manner, so the patient suffering from withdrawal has no choice but to look to the streets for opiates. . They discover that heroin is far cheaper and available than any other opiate, and now they get hooked on heroin. Now the heroin is being cut with fentanyl and people are overdosing.
        There is a pain management specialist in Texas who has suddenly just stopped writing any more opiate prescriptions and he’s giving his patients one month to withdraw. In some cases that is not long enough .
        Furthermore, the patients still have intractable pain, with NO reasonable options given to them, so what are they supposed to do? Suffer for the rest of their lives? What would you do?

    2. I think that is an area where medical establishment has dropped the ball. You have to anticipate that some people who are prescribed heavy-duty pain killers are going to be prone to addiction and won’t just be able to deal with feeling crappy for a while and then get over it. And given all the pressure doctors have been under to prescribe less opioids, I’m sure that a lot of people like that just had their prescriptions cut off and weren’t given any help getting off of the stuff.

      A more realistic approach to all of this, both from doctors and government would help. Deal with the fact that some people will both have legitimate need for pain killers, and also might enjoy them and develop an addiction that is more than just withdrawal symptoms when they stop.

    3. oh you have never been hooked on opiates I see or known anyone that has. Gotta have it! Seeing medical treatment seems like a waste of time when you could be seeking the next fix!

    4. What is happening now is that doctors are pulling back from giving opiates to their regular patients, for fear of being charged by FDA or DEA as pill pushers, and they are not helping the patients to withdraw in a reasonable manner, so the patient suffering from withdrawal has no choice but to look to the streets for opiates. . They discover that heroin is far cheaper and available than any other opiate, and now they get hooked on heroin. Now the heroin is being cut with fentanyl and people are overdosing.
      There is a pain management specialist in Texas who has suddenly just stopped writing any more opiate prescriptions and he’s giving his patients one month to withdraw. In some cases that is not long enough .
      Furthermore, the patients still have intractable pain, with NO reasonable options given to them, so what are they supposed to do? Suffer for the rest of their lives? What would you do?

  9. The answer to the title question is obviously ‘all of them’.

  10. Also, and everyone seems to forget this, there is a huge psychological component to addiction, it’s not just a physical problem. With opiates, the mind-body distinction of the addict is not differentiated and they might have problems with various social powers, past history of mental and/or physical abuse and so on that essentially led them to self-medicate. Same can be said of addiction to any drug, but the predisposition to addiction to a particular drug is largely mental and dependent on the specific mental effects of that drug.

  11. Wow, that War on Drugs thingy is really racking up the body count these days.

    Somewhere, Nixon is smiling.

    1. Nixon didn’t outlaw narcotic analgesics. You’re thinking of Woodrow Wilson

  12. Safe injection sites are not necessarily a good idea. The experience in Canada has been mixed, at best, with many up there saying that it’s been a failure.

    I could be interested in safe injection sites and heroin maintenance, IF they were coupled with mandatory treatment to get people off the drugs, and benign confinement for those who refuse or are incapable of accepting and responding to treatment. Just helping them shoot up and walk around like zombies is not a winning idea.

    1. “Benign confinement.”

      As a band name: meh
      As a public policy: {releases bolt on LE6920)

  13. Good question. Let us ask AG Sessions.

    AG Sessions: “All of them! And a mandatory life sentence for anyone convicted of dealing any amount of fentanyl!”

    American Public: “Yeah! For the children!”

    Republicrats: The Parties of Fuck You, That’s Why.

  14. Fentanyl is only technically a drug of abuse. It is much too powerful; its therapeutic dosage is measured in micrograms. It is not even a first line narcotic for pain control, because it is too strong and short acting.

    It’s given transdermally for long-term chronic pain, and IV as an adjunct to anesthesia. There are safer drugs to use for breakthrough pain.

    I say all that because it is worth educating people about how dangerous that shit is in a non-clinical environment. The potential for adulteration is an excellent reason to abstain from using street dope until libertarians win the WOD.

    Actually, shooting dope to get high is a bad idea all around. I know people are gonna do it and that it is futile to try to eliminate it completely, but I really, really wish it wasn’t a thing.

  15. Do the stats on this: fifty thousand deaths in one year is about 0.07 percent of the population. Yes every death is a preventable tragedy, but this is not an epidemic. The number of people being properly treated with opiates, who will suffer every day for the rest of their lives without them, is a far far greater number. These are the real victims of the drug policy they are contemplating now, and they will be ignored while the DEA pats itself on the back for reducing opiate prescription numbers by forcing doctors to abandon hundreds of thousands of pain patients. Way to go.

  16. What I don’t get…I thought the Libertarian argument against drug control was that people were adults who should be able to make mistakes in that regard.

    But if WE have to financially support their idiotic decisions, I don’t think legalization makes a ton of sense.

    If you’re going to make me pay for it, then I should have some say here. If you want to do drugs and not rely on others to pay for your treatments, etc — fine. But if I have to ALSO pay for rehab treatments, then fuck your “freedoms”. Your freedom to take drugs shouldn’t override my freedom to not have to bail you out of your poor decisions.

    I don’t like smoking and don’t wish to ban it because of freedom. But I do not want to pay to help YOU kick the habit, either.

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