The Opioid Epidemic: How We Got Here

By Dan Kersten

 

The United States is in the midst of an epidemic. I am not talking about the Zika Virus or some other medical condition. The nation is gripped by a plague of heroin and opioid addiction. According to the U.S. Centers for Disease Control and Prevention (C.D.C.), overdoses involving the use of opioids have quadrupled since 2000. In 2014 alone, nearly 30,000 deaths across the nation were caused by opioids. Heroin-related deaths increased 26% from 2013 to 2014, again this data is from the C.D.C. Opioid- and heroin-related injuries have increased in essentially every single demographic: no one sex, age, or economic group has been spared the devastation.

Broome County, like most counties across the nation, has not been spared. Of the 53 drug overdoses recorded in the County to date, 48 (about 91%) were related to heroin or opioids. That may seem insignificant, but compared to 2014 when there were only 39 overdose deaths or 2011 when there were only 13 overdose deaths, that is shocking. The future seems bleak as well. Broome County is projected to have an overdose mortality rate of 40.8 per 100,000 in 2016. The current rates in New York State and the rest of the United States are 9.1 and 9.3, respectively.  

As chef, author, television personality, and former heroin addict Anthony Bourdain asks in his CNN show Parts Unknown, “What happened? How did the kid next door, along with mom, pop, and grandma too, become users of hard-core illegal narcotic drugs, the worst drug, with the worst reputation?” This did not just happen overnight; this was decades in the making. In fact, I could discuss the history from the 1930s onwards. However, I will not have the space to do that and I imagine that many of you may get bored, stop reading the article, and return to playing Pokémon Go. I will focus most of the conservation in the 1960s and 1970s and beyond.

Heroin has been claiming lives for decades now: singers Billie Holiday and Janis Joplin in 1959 and 1970, respectively, and comedian John Belushi in 1982 (actually died from speed, a combination of heroin and cocaine). Heroin was a drug for performers to use and abuse. It was also a drug of the inner cities. From the Fifties and through the Seventies, America’s cities were a hot spot for heroin abuse. Bourdain rather poignantly yet accurately assesses the situation, “Heroin was mostly seen as a poor people problem, somebody else’s problem. The sort of thing that musicians and criminals got into, marginal people, far from the white Main Streets of Mayberry, USA. What those people did to themselves, well, it was unfortunate, but not our problem. Until somebody broke into your house.”

In the 1970s, the Nixon Administration stepped into the picture. Nixon, in the summer of 1972, started our nation’s War on Drugs. Among those drugs considered most dangerous was heroin, placed on the Schedule One list of drugs. Thus we began an era of criminalizing addiction—a mental disorder. For suburbia, little changed. Heroin was not a drug that “Mayberry, USA” used. It was the drug of poor people, of the wacky artists, of the urban crawlers.

The crisis began to move in the 1990s, moving into suburbia. Not in the form of heroin, in the form of a pill: opioid pain medications, that is. Opioids were not a few item; they have been around for quite some time prior to the Nineties. However, their use grew rampantly in this decade. From 1999 to 2014, the sales of prescription opioid painkillers quadrupled according to the C.D.C. But who grew it, and why?

The answer is multifaceted. It involves pharmaceutical companies, government regulators, and physicians. Drug companies did not properly research these drugs, releasing them with incomplete data and misleading advertising. Government regulators simply accepted the available science, approving the drugs on this incomplete data. Physicians, too, accepted and fed into the inappropriate data. The two latter groups could, and should, have looked further into the data and asked questions. They did not. Patients demanded pain killers and the doctors, many pressured to keep pain scores down to prevent poor hospital pain scores and risk payment delays or governmental sanction, gave it to them. The epidemic began.

So how did this issue go from opioid medications to heroin or, as Bourdain called it, “the worst drug, with the worst reputation?” Federal and state governments saw the explosion of pain-killer prescriptions and decided to act. They made it harder for pain medications to be prescribed, not a bad start. However, they did not remember that opioid medication and heroin work in a similar fashion—they both affect the opioid receptors in the brain.

In essence, the government allowed the progression from pain-killers to heroin by simply reducing the supply of opioid medications and little else. As Dr. Ruth Potee, a family physician in Western Massachusetts who was interviewed in Bourdain’s Parts Unknown, explained, “Everybody starts with pills. There’s nobody who goes from marijuana to heroin. There’s an in-between step. Always pills, it’s pills that people get from their doctor.” It should not come as a shock that soon after the increasing regulations on pills, heroin-related overdoses began to skyrocket.  

And like that, the suburbia’s pain medication epidemic grew and turned into suburbia’s heroin epidemic. That is where we are today. Opioid overdoses are rising: whether it be heroin or opioid or synthetic opioid medications, like fentanyl which took the life of Prince just a few months ago.

I wish that I could say that the crisis was plateauing. Sadly, the overdose rates continue to rise each year and, more than likely, will be higher this year than compared to last. The trend will continue.

The epidemic grows stronger.

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