Opiate abuse rising across America

With the recent death of famed actor Phillip Seymour Hoffman, due to what appears to be a heroin overdose, we are given pause to reflect on that drug’s place in our culture. Heroin and other opiates constitute a significant threat on many frontiers. It’s time that law enforcement, the medical community and public policymakers find a more effective strategy to curb this rising tide.

According to the Foundation for a Drug Free World (www.drugfreeworld.org) heroin (like opium and morphine) is made from the resin of poppy plants. Milky, sap-like opium is first removed from the pod of the poppy flower. This opium is refined to make morphine, then further refined into different forms of heroin.

Multiple sources confirm that over 90 percent of the world’s opium supply comes from Afghanistan. Its total export value was about $4 billion, of which almost three-quarters went to traffickers. About a quarter went to Afghan opium farmers.

Estimates vary widely as to the extent of U.S. heroin abuse. The National Survey on Drug Use and Health reported 153,000 current heroin users in this country in 2007. Other sources estimate that the figure could be as high as 900,000.

What is more certain is the fact that opiate abuse accounts for almost 18 percent of all hospital admissions for drug and alcohol treatment. Apart from the immediate risks of overdose, heroin users contract diseases like AIDS and hepatitis at rates far outpacing the average person. As Drug Free World observes: “By the late 1990s, the mortality rate of heroin addicts was estimated to be as high as 20 times greater than the rest of the population.”

The American solution to opiate abuse has a long and baffling history. The first wave of opiate abuse in the U.S. came in the form of an 1850s-era spike in opium use. The “solution” to this problem was to provide addicts with a less-potent substitute. That substitute was morphine. Morphine addiction soon became a much greater problem than opium ever was. The “solution” for the morphine epidemic was another “non-addictive” drug, heroin. Again a substitute was devised: methadone. Methadone proved to be more addictive than heroin.

All this suggests that the strategy of offering substitutes is likely a lost cause. In order to assail this health crisis, one should consider the so-called “gateway” to heroin use. It’s not marijuana, nor alcohol or even nicotine — although all three are often comorbid with heroin. Rather it is the growing abuse of prescription painkillers.

Most authoritative studies of opiate addiction observe that a majority of intravenous heroine users began their pathway to addiction through the abuse of opioid painkillers like oxycodone, hydrocodone, meperidine, hydromorphone and propoxyphene. These are better known by their brand names: Demerol, Dilaudid, Darvon, Percodan, Roxiprin, Percocet, Endocet, OxyContin, Dicodid, Hycodan, Hycomine, Lorcet, Lortab, Tussionex and Vicodin. As this partial list suggests, there are many different brands and types of prescription opioids available in the U.S.

Most of the illegal trade in these drugs begins with a legal prescription. Pills are either stolen or purchased from the prescription holder and transferred into the underground economy of illicit drugs.

Once criminals figured out how to monetize addiction, a process was begun in the U.S. that led nowhere good. While the number of opiate abusers is small compared to tobacco, alcohol and other drug addicts, it still presents a major public health crisis. Until such time as we develop more effective, comprehensive and lasting public policy, we can expect the countless, largely anonymous versions of Phillip Seymour Hoffman to fill our nation’s morgues.