The Heroin Epidemic: How Did We Get

The Heroin Epidemic: How Did We Get

Substance abuse is a very slippery slope. Nobody ever intends to become addicted, but the recreational abuse of alcohol or use of drugs becomes an increasingly central part of one’s daily life. The past several years have seen the emergence of what experts refer to as a heroin epidemic ¹ due to rates of heroin use and addiction having quadrupled over the course of just the past decade. Although heroin use is a major concern today, numerous other substances have made their destructive mark in years past. These chemical threats wax and wane much like trends in fashion, but there are usually specific factors that precipitate these periodic epidemics. They prompt the following question: What confluence of events resulted in us being in the middle of a major heroin epidemic?

Overcome by Opiates

Conceptualizing the genesis of the heroin epidemic actually begins with what’s almost universally believed to have been the direct precursor, which is the prescription drug epidemic. Although the addictive properties of opiates such as oxycodone have been known and acknowledged since the 1960s ², OxyContin — the trade name of a powerful opiate painkiller containing oxycodone — was released in 1995 and quickly became the preferred medication for the treatment of moderate to severe pain. Part of this preference was due to incentives offered by Purdue Pharma ³, the makers of OxyContin, who encouraged healthcare providers to prescribe OxyContin in lieu of alternatives, eventually resulting in a high-profile lawsuit ⁴. However, other pharmaceutical companies were developing and releasing their own opiate painkillers in order to be competitive with Purdue, making the saturating the market with highly addictive drugs.

After just a few years, the high volume of painkillers that were recklessly dispensed⁵ was beginning to cause substance abuse problems among patients as well as people who were buying these drugs on the street. Although it makes up less than five percent of the global population, the United States has been estimated to account for at least 80 percent ⁶ of the world’s opioid supply and 99 percent of the world’s hydrocodone.

Annual painkiller overdose deaths climbed every year from 1999 to 2010, when it was determined that approximately 60 percent of all drug overdoses involved pharmaceutical substances. In order to curb the exceedingly high rates of prescription drug abuse, there were policy changes instituted that made getting opiate prescriptions more difficult. State-level prescription monitoring databases began tracking the dispensing of opiates to ensure that patients weren’t receiving duplicate prescriptions by seeing different doctors. Meanwhile, most pharmaceutical companies began making their products resistant to tampering and abuse.

Heroin: The New Menace

By 2010, there were a number of measures in place and pending that limited the amount of prescription opiates that were being abused. In fact, within two years, the number of addicts for who primarily chose to use opiate painkillers dropped from 35.6 percent to 12.8 percent ⁷. However, this meant that there were many people addicted to painkillers who could no longer obtain their drug of choice. As a result, many of them to turned to heroin as a replacement. Since heroin and prescription opiates are both derived from opium, they offer very similar effects. A major difference between heroin and painkillers is that the former is cheaper, more accessible and available, and it is significantly stronger in most cases.

Whereas heroin users in the 1960s were mostly a small number of young men from poor neighborhoods, contemporary heroin users are often middle-class individuals in their twenties who are using heroin as a rebound ⁸ for a prior prescription drug addiction. In fact, a rehabilitation facility in North Carolina found that the majority of incoming patients were lawyers, nurses, cops, and even ministers, many of whom even lived in very affluent neighborhoods. This challenges perceptions ⁹ of the stereotypical heroin junkie due to the epidemic reaching even the top rungs of society. In many cases, people addicted to heroin had started out using opiate painkillers for legitimate purposes, eventually becoming physically and physiologically dependent. When painkillers started being harder to find and much more expensive, these people felt like they had no choice but to substitute opiate painkillers with heroin.

Unfortunately, this is a shift that could have been predicted. Substance abuse is a human behavior and should be treated as such. But many of the intervention initiatives addressed only the substances and the doctors who provided them, leaving users to switch to the next best thing. Like a child who can’t reach a toy once it’s been moved to the highest shelf, many who had become addicted to opiate painkillers simply replaced them with something comparable that was within reach.

Where to Go from Here?

It’s difficult to determine the number of Americans currently addicted to heroin with a high degree of accuracy since there are many who don’t want to admit their dependencies. This accounts for the discrepancy ¹⁰ between conservative estimates of 600,000 and generous estimates of 1.5 million. However, after taking various factors into account, the actual number of Americans who are addicted to heroin at this very moment is likely about one million ¹¹. As a result, officials have been trying to develop more and better strategies for alleviating the nation’s heroin problem.

Unlike a number of European countries, there’s been an aversion among U.S. officials with regard to harm reduction initiatives, such as providing heroin addicts with clean syringes, assisting them with administration, or even providing them with actual heroin in a similar manner as methadone maintenance programs in the US. Despite evidence ¹² that harm reduction strategies can result in a marked improvement in addicts’ overall health, initial efforts to curb rates of addiction targeted the sources of addictive substances. However, more recent proposals show a shift in focus from the addictive substances to the individuals that are addicted to them.

The Comprehensive Addiction and Recovery Act ¹³, or CARA, is an expansive plan that addresses the problem in many different ways. Specifically, the act’s plan includes expanding addiction education efforts for people at all age levels ¹⁴, making naloxone available to law enforcement and emergency first-responders to reduce opioid overdose deaths, providing addiction treatment and recovery services in prisons, improving the availability of drug disposal programs, launching evidence-based heroin and opiate treatment and intervention programs at the national level, strengthening prescription monitoring programs to track drug diversion and abuse, and providing more funding in the form of government grants to improve the availability of addiction treatment. Additionally, the Patient Protection and Affordable Care Act — known colloquially as “Obamacare” — has made substance abuse treatment an essential benefit ¹⁵ covered by most health insurance plans, including government health plans like Medicaid.

While the fight against heroin addiction is still underway, a menace that has reached epidemic-level proportions will invariably take time to resolve. In the meantime, there are numerous resources available for those who need them. Whether you or a loved one is suffering from addiction, Rehab International is here to help. Our goal is to fight back against the addiction epidemic by providing every addict with the treatment and programming that best addresses his or her needs. For a free consultation with an admissions coordinator, call Rehab International, and let us help you return to a healthy, happy life.

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