The real reason that so many more Americans are using heroin
President Obama has committed to sign the Comprehensive Addiction and Recovery Act, which includes among its provisions new policies to reduce inappropriate prescribing of prescription opioids such as Oxycontin and Vicodin. Given the ongoing epidemic of addiction and death caused by opioid painkillers, this seems like sensible public-health policy, but some critics charge that tighter prescribing rules simply cause prescription opioid users to switch to heroin, thereby feeding a second opioid epidemic. The prestigious New England Journal of Medicine recently published the first systematic analysis of this terrifying possibility.
Wilson Compton of the National Institute on Drug Abuse, who led the analysis, discovered that the timing of the prescription opioid and heroin epidemics is not consistent with the simple narrative that increased controls on the former instigated use of the latter. Heroin use and heroin-related emergency-room visits and hospitalizations were rising for years before the 2009-2011 period in which controls of prescription opioids expanded — for example, by strengthening of state prescription-monitoring programs, crackdowns on pill mills and the introduction of an abuse-deterrent formulation of Oxycontin.
Compton and colleagues also noted that fatal heroin overdoses began rising in 2007 — prior to the initiation of tighter opioid prescribing practices — and have not showed any consistent relationship with prescription opioid overdoses since. Heroin deaths rose from 2011 to 2012, when prescription opioid deaths had their only year-on-year drop, but they kept rising the next year, when prescription deaths were flat and have kept increasing since the time that prescription opioid deaths began rising again.
If controls on prescription opioids are not driving the heroin epidemic, what caused this drug to reemerge? Compton and colleagues point to the establishment of heroin markets that expanded access to a cheaper, more potent opioid that appealed to people addicted to prescription painkillers. This is highly plausible, given evidence that Mexican heroin traffickers made special efforts to expand into communities with established prescription opioid problems.
Compton also points out that “addiction to pharmaceutical opioids drives many people to seek new sources whether there are any controls in place or not.” As users become tolerant to the effects of opioids, they often consume an increasing amount of the drug until they simply cannot afford to purchase the dozens of pills they want each day from legal or illegal sources. Heroin, which once may have seemed unthinkable, thus becomes attractive because of its affordability.
Compton does not deny that some people, particularly those who are already using some heroin in addition to pharmaceutical opioids, might increase their heroin use if their doctors cut them off their prescription, and indeed studies of people being treated for heroin addiction document that such patients exist. But consider this analogy: If you live in Hawaii, most of the tourists you meet will have arrived by airplane, but it does not follow that most of the world’s tourists who board airplanes are going to Hawaii.
By the same token, studies of the select sample of people being treated for established heroin addiction by definition will never capture data on the far larger number of people who responded to reduced access to pharmaceutical opioids by ceasing use of those drugs. Nor will such studies make apparent an even more important group of beneficiaries of more careful opioid prescribing rules: the individuals in the future who will not be inappropriately prescribed opioids in the first place.
Keith Humphreys is a professor of psychiatry and mental-health-policy director at Stanford University.
Filed under: General Problems
IMO the DEA is getting paid off by the Cartels who smuggle heroin and counterfeit opiates into the country. It wasn’t until the American people started to question the DEA’S usefulness and even existence that the DEA started focusing on legally prescribed opiates and the doctors who prescribe them. We rarely ever hear about huge shipments of illegal drugs being seized by the authorities anymore, but almost every week we read about another doctor or clinic being raided and investigated. So ask your self this.
Since the beginning of the War against the legally prescribed opiate medications began, have any of you heard about the DEA’S usefulness coming into question by anyone else but the chronic pain community?
That’s right, it’s a huge NO! The average American is going to believe what ever BULLSHIT the government feeds them. The government has the national media in their pockets so reporters like Anderson Cooper regurgitate what ever they are told to. The American public sits and watches CNN and says to themselves that if Anderson is saying it, it has to be true. Now ask yourselves this.
Why hasn’t CNN, FOX NEWS or MSNBC done a report on the epidemic of chronic pain? So many of us have written letters and emails to the producers of all their prime time shows asking for them to report. Thousands upon thousands of us wrote letters to the producers of AC 360 after that one sided report was done and all we got was negitive articles in news papers like the Boston Globe. The government has stifled our voices and the only concussion I can come up with is because they actually want to increase illegal drug use. Look at all the ways money can be made by driving honest pain patients to the streets for illegal drugs.
First, it lowers Medicare and Medicaid prices because they are no longer paying for expensive medications.
Next, it fills the prisons with nonviolent people who simply wanted pain relief and reallocation of funding is a good way to hide Blackbox funding.
Then, the addiction treatment industry which is a huge contributer to supper pacts for campaign funds is in the money too along with big pharma who produces overdose treatment drugs.
How many jobs will be created by driving pain sufferers to the streets? The answer to that is tens of thousands in the federal prison system alone.
So why should the DEA, ATF and other alphabet soup law enforcement agencies take out the hundreds of cartel members when they can use the tens of millions of chronic pain sufferers to demand more tax dollars and drive funding for a stupid war on drugs that will cause more death then the 3 wars we are currently in?
I agree w/everything u write,,,and I would add a couple of things,,Between 2002 and 2009 the dea got thrown out of Bolivia,Peru,Chile and other South American Countries,,,for HUMAN RIGHTS ABUSES,,,so where are those dea agents employed now???I will bet my farm,,,they are the ones going after our innocent doctors,,,and us..They use the internet ILLEGALLY,,so get into our private emails,what we buy on line,,etc,,they can see who has medicines,,,What doctors are talking up,,etc,,,,It easier to frame our doctors,,,,,but the bottom line is,,those agents who got thrown out of South America,,,,needed a job,,,,,plan a simple,,,soo they went after us,,,SICKO’S,, taking medicines away from the medically ill,,,and ruining innocent doctors lives,,,so they can have their assets,,,I think every agent,klondyne and those who agreed to sign these death guidelines into place should be put in jail,,for murder,,torture,genocide and crimes against humanity,,,mary
The laws being decided on and how they will negatively impact the pain management world is available to see on my website, http://www.doctorsofcourage.org. Several are discussed on posts, and most are listed on the pages on laws. These laws are not in anyone’s best interest. They are simply a means to attack more physicians to confiscate more assets. I think the government plans on taking care of the deficit with physicians’ incomes.
The answer is to fire all the present legislators by voting them out of office. Then impress upon the new ones that they need to make doctors exempt of criminal charges as was originally intended by the CSA in 1970.
I love your website, and thank you for documenting how the DEA has gone rouge and is attacking our nation’s doctors. My jaw hit the floor while reading your website. I had no clue our government was behaving in such tyranny. I think the civil assets forfeiture should be done away with, outlawed, banned! It’s absolute hogwash how the DEA is getting away with taking out good doctors, for no good reason.
I cannot for the life of me understand how a doctor can be prosecuted because some patient didn’t follow the directions on the damnn bottle, and the patient is the one that took more than prescribed and ends up overdosing themselves. What has happened to personal responsibility? How can the doctor be held at fault? Because the government has gone insane!
I’m figuring that any “pill mills” were shut down years ago. These doctors they’re going after now are truly legitimate doctors! In some places, there are no more pain management doctors. There is no care left for legitimate patients in some areas of our country! The pendulum has swung way too far, and actual legitimate patients are being tortured because they have no access to pain medication.
Not to mention, those of us still receiving care are having our meds tapered, even though we were stable for years because of the CDC guidelines. The guidelines were for primary care doctors, I thought. But here we are! Those of us that followed the rules and jumped through the hoops, month after month, year after year, are silently, or not so silent, suffering more because of the actions of a few. Bless you Mrs. Cheek.
And for some reason I’m unable to comment on your website, and I have Java script and cookies enabled. If you happen to read this, would you please reply and tell me what else I could try so I can participate on your website. Thank you.
Exactlly ,”boilerrph,” there is not an addiction crisis at all,,it is what Klondyne wants ,”labelled,” as an addiction crisis,,for his filler up Pennhurst facilities,,what it really is,,is medocally ill humanbeings w/painful medical condition being forced to endure that physical pain from medical illness,,by forcing them into rehabs because they have no other option but death to stop their physical pain from medical illness,,,,its ALLLL 1 big lie,,,,,which the government is very good at doing,,,cause they have doing doing it for 50 years,,,lieing to the public!!!,,,but this lie is willfully torturing and causeing genocide onto the medically ill,w/painful medical conditions!!!!,,,mary
I can give them a study…my friends rehab group of 30 people. 28 of whom were being treated for chonic pain with opiates legitimately and had no.problems until their pain doctors.for one reason or another cut them off cold turkey. Their choices: Black market pill buying or Heroin. When they could no longer afford the pills on the street, they took their chances with heroin. Every. Doctor they tried to establish with denied them. Not sure what was in their files, they all jumped thru the hoops as required and are now left hanging and seen as addicts since they went to rehab. They will never get pain management ever as they are labled an addict. The other 2 patients were alcoholics. My friend has to wean off the Suboxone because her professional impairment contract demands total abstinence. She still has pain. She was forces on disability, while she would rather work in her field bit cant without pain relief. 2 buldging discs, stenosis and cysts on her spinal cord…and they expect her to be on zero pain meds during her contract.