The Allure of Opioids: A Look at the Painkiller and Heroin Epidemic
Philip Seymour Hoffman’s overdose has vaulted the conversation about heroin, prescription painkillers, and addiction into the mainstream media. The statistics are demoralizing, their implications even more staggering.
As always, there’s no better place to start with than the facts. As the Financial Times recently reported, the amount of people using heroin in the United States has skyrocketed:
“The number of people in the US who said they had used heroin in the past year climbed to 669,000 in 2012 from 373,000 in 2007, according to the annual survey conducted by the federal Substance Abuse and Mental Health Services Administration. It estimated that the number of people addicted to or abusing heroin had reached 467,000 by 2012 – or more than twice as many as the 214,000 in 2002.”
Many news outlets have focused on the cause of the explosion, settling on prescription painkillers as the root of the epidemic. In short, the ballooning of heroin users can be attributed to two stages in the world of prescription pills.
First, the proliferation of painkillers, made possible by the pills’ incredible addictiveness and doctors’ predilection to over prescription, created a massive number of opioid addicts. The even scarier side of this: the over prescription to adults results in easy access for children, some studies showing as many as 1 in 5 US teenagers have abused prescription medications. Second, the danger posed by these pills initiated a wave of responses: law enforcement cracked down on illicit opioid trade and illegal prescriptions, the price of pills rose in response to increased demand, and companies changed the consistency of the pills, which made them more difficult to crush and, thus, more difficult to snort.
All in all, feeding one’s addiction through pharmaceutical drugs became more difficult and more costly. Addicts responded by purchasing heroin on the street, a place where they can find a bag for as cheap as $10, a price markedly cheaper than that of an opioid pill.
The problem, though, is two-fold. First is the issue of consistency. Prescription pills are created in labs by massive companies and then approved by the FDA. They are made pursuant to very strict chemical formulas, which means, for lack of a better term, you know what you’re going to get when you pop a Vicodin or an OxyContin.
Street heroin is a whole different story. Take the heroin that killed Philip Seymour Hoffman. It was laced with fentanyl, a painkiller present in drugs used to treat cancer patients. It’s not surprising that people who pop pills end up dying in droves when they inject heroin, a drug with which they have no experience that also contains potent and unknown chemicals.
Second is the issue of geography. Our country’s relationship with heroin has developed within the confines of cities. Heroin first took root in urban locations with an urban clientele, and until now, that was where it remained. But, unlike heroin dealers, doctor’s offices and prescription pads can be found all over the United States. Pharmaceutical pills are found in the medicine cabinets of suburban and rural houses not just city apartments. The result is that heroin, the most realistic alternative, also has migrated to those areas in force.
As someone who views the war on drugs as an inexcusable failure, news of this epidemic poses more questions than it possibly can ever answer. So, where do we go from here? In one way, Hoffman’s death seems to have triggered an unavoidable explosion of reporting on the painkiller (and now heroin) epidemic. To be fair, people have been talking about prescription painkillers for a while. But, even though we all knew they were there, knew they were a serious problem, they still appeared as part of a dark underbelly, a trend on which our media and our society haven’t shined the brightest of investigatory lights.
Maybe it’ll be different now. In the days after Hoffman’s death, Aaron Sorkin wrote a piece in Time Magazine in which he wrote of his and Hoffman’s conversations about drug addiction. He revealed that Hoffman had once spoken about dying of an overdose, saying that such a death, through its news coverage, may end up saving ten people from falling to the same fate. Maybe Hoffman was right. But, maybe instead of saving ten people, his death can do more. Maybe it can change the country’s relationship with opioids and heroin. Maybe it can initiate honest and productive dialogue that results in treating this epidemic for what it is: a disease that should be treated and handled within the realm of public health. The New York Times already has run an opinion piece by a New York City emergency room doctor that focuses on the importance of Naloxone, an opioid antidote that has been in clinical use for more than thirty years. Here’s to hoping that such dialogue continues.