On Opioids: America’s Drug Addictions and the Wacky Laws that Perpetuate Them

vintage heroinTwo years ago, a little silver car sat parked outside our home. As the sun was going down an ambulance, police cruiser, and firetruck suddenly arrived to pull an unconscious young woman with a bobbing ponytail out from the driver side of the car. A bottle of heroin had been found next to her. I never saw that young woman again, and the police came to impound her car a few days later.

Last July, I sat in the small chapel at a local funeral home staring at the body of my husband’s cousin. Only 29 years old, living less than a mile from our house, married and a daddy-to-be, and there he lay in an open coffin looking sound asleep. After months of staying clean he had found a dealer in the apartment complex he and his wife had just moved in to. That night he took heroin for the last time.


drug dog

McGruff the Crime Dog teaches kids to “Just Say No” to drugs. I remember this guy!

In 2013, Ohio Senator Mike DeWine decried heroin use as “a statewide epidemic.” (1) A rising tide of heroin-related deaths totaled over 900 for Ohio in 2013, a sharp increase from previous years that showed no signs of leveling off or decreasing (1). Heroin is cheap, easy to get, and often deadly (1). Heroin use is also directly linked to prescription narcotics, which studies (2) show has decreased in rates of abuse in my area, ostensibly due to tougher federal and state laws (3) implemented last year that limit their prescription by practitioners.

Many times a person will experience legitimate pain, be prescribed a narcotic, get hooked on the high, and then turn to heroin when their prescription is over and they can’t get a refill (2). Heroin is essentially morphine, a drug commonly used in emergency rooms for severe pain (5). It is one of the strongest opioids available (5) and it is a major problem that people are taking the leap from prescriptions like Vicodin and Percocet (hydrocodone and oxycodone) to street heroin. While lawmakers are right to be concerned about prescription opioid abuse, they are not focusing efforts on the much larger problem of heroin abuse, and the sad results are astounding.

Last May 2014, The National Institute on Drug Abuse, a component of The National Institutes of Health, presented the following information at the Senate Caucus on International Narcotics Control (4).

“To illustrate this point, the total number of opioid pain relievers prescribed in the United States has skyrocketed in the past 25 years  (Fig. 1).[4]  The number of prescriptions for opioids (like hydrocodone and oxycodone products) have escalated from around 76 million in 1991 to nearly 207 million in 2013, with the United States their biggest consumer globally, accounting for almost 100 percent of the world total for hydrocodone (e.g., Vicodin) and 81 percent for oxycodone (e.g., Percocet).[5]

This greater availability of opioid (and other) prescribed drugs has been accompanied by alarming increases in the negative consequences related to their abuse.[6] For example, the estimated number of emergency department visits involving nonmedical use of opioid analgesics increased from 144,600 in 2004 to 305,900 in 2008;[7] treatment admissions for primary abuse of opiates other than heroin increased from one percent of all admissions in 1997 to five percent in 2007[8]; and overdose deaths due to prescription opioid pain relievers have more than tripled in the past 20 years, escalating to 16,651 deaths in the United States in 2010.[9]

Pretty scary-sounding stuff, but notice in the argument above words like “opiates other than heroin” which may or may not include prescription narcotics, and may in fact include Suboxone (more on that in minute). Although the number of prescription opioids has increased over 10 years, the percentage of abuse represents only a fraction of the number of people taking these medicines, 305,900 to 207 million. Compare that to the numbers of heroin users which is double the amount of prescription narcotics abusers, “The number of past-year heroin users in the United States nearly doubled between 2005 and 2012, from 380,000 to 670,000” (4). Policymakers have put the emphasis on the wrong syllable and no one is being helped.

Indeed, the recent laws our country and states have implemented to purportedly alleviate the “problem” of prescription opioid abuse, has only exasperated the very real problem of heroin abuse, which is reaching epic proportions around the nation (4). I recently spoke with a local 25-year veteran chemical dependency counselor that I’ll call “Glinda” (not her real name). Poor Glinda was very frustrated with the current system of treatment for drug abusers, telling me quite frankly, “People are dying because of this new policy!” What policy was she referring to?

drug overdoes chart for Mont. Co

Glinda informed me that up until 5-6 years ago, the standard form of treatment for heroin users who wanted to be free was a very selective residential treatment program. After being selected for treatment, the heroin addict was admitted to a local hospital that partnered with the chemical dependency clinic. The patient stayed in the hospital for 3-4 days, being observed and weaned off all drugs. By the end of those 3-4 days, the patient was completely drug-free and then sent to a residential treatment facility for another 28 days, at least. Although it was not 100% fool-proof, Glinda admitted, “We had a pretty high success rate.” This program had been in place since 1960 in Dayton, Ohio, until about 5 years ago when drug companies came out with Suboxone (also known as buprenorphine), a drug created to help users stop their opiate addictions. A slightly less intense form of synthesized heroin, Suboxone is still a powerful narcotic with the same potential for addiction.

Chemical dependency counselors hate it.”

Poppies

Dorothy Gale sleeps among the poppies in “The Wizard of Oz”.

What went on behind the scenes one can only guess at, but, Glinda told me, lawyers, policymakers, lobbyists, and state and city medical boards all  jumped on the Suboxone bandwagon (6) as a cheaper alternative to hospital detox programs. Laws were passed to ensure medicaid would pay for new Suboxone and methadone clinics, which popped up over the city of Dayton and state of Ohio like daffodils in spring. According to Glinda, these clinics simply hand out free Suboxone or methadone (an opiate drug even stronger than heroin) to any user who comes in asking. They are limited to one round a day or week depending on the clinic. Users are supposed to go through counseling before they can have the drugs, but Glinda said, “Many times this ‘counseling’ is nothing more than an hour-long video.”

Glinda told me that Suboxone users sometimes take an additional anti-anxiety medicine with benzodiazepines like Xanax, Valium, or Ativan, to get back the extra high suboxone purposely leaves out, often resulting in the user’s death. However, many other times users will take their free drugs and just sell them on the street for heroin. “It may be a cheaper ‘solution'”, Glinda said, “but no one is getting clean. Chemical dependency councilors hate it.” The article, The Misguided Obsession with Heroin / Opiate Maintenance Drugs (Suboxone, Subutex, Buprenorphine, Methadone) (7), from The Clean Slate Addiction Site, echoes Glinda’s concerns,

“Most of the research on drugs like Suboxone (a popular formulation of Buprenorphine and Naloxone) checks the effectiveness of the drug over a 12 week period. That’s it. And as stated above, long term results are essentially unknown. Also, most of the “success” that’s found with drugs like Bupe and Methadone is that people who take it stay engaged in treatment programs longer than those who just receive counseling (without drugs).  

If the NESARC results from heroin and prescription opiate users are to be factored into the equation, we might decide less treatment is better. After all, those opiate and heroin addicts who received treatment had MUCH longer periods of abuse and dependence before actually remitting. Which in itself means more occasions of use, which means more opportunity to overdose.”

At the same time safer (compared with street heroin) and documented prescription narcotics are being locked down, marijuana (8) is becoming legalized in various forms around the nation and addicts get their stronger-than-prescription-narcotics Suboxone or methadone free, allegedly to help them get off of narcotics. By severely limiting the prescription of legitimate narcotics, not only have policymakers been contradictory, they have effectively tied the hands of America’s doctors and punished law-abiding citizens in real pain, in order to prevent them from potentially becoming law-breakers. But we also have laws in place that essentially reward law-breakers by giving them free drugs, as a way of trying to make them law-abiding citizens. We are making more heroin addicts with these policies, not fewer, and the numbers sadly corroborate.

After speaking with Glinda for over an hour, my final question was simply, “What can we do to change this?” Her response, “Activism is the key. Contacting policymakers including county commissioners and boards of health (these links are for Montgomery County and Ohio), and pointing out the facts that these [Suboxone and methadone] clinics just are not working. Then maybe we can help save some lives.” Or, in the words of one of my favorite films…


Sources (in order of appearance)

https://www.mikedewine.com/dewine-heroin-epidemic/

http://mha.ohio.gov/Portals/0/assets/Research/OSAM-TRI/Dayton.pdf  (Pages 114-118)

http://www.usatoday.com/story/news/nation/2014/08/21/us-restricts-hydrocodone-painkillers/14387867/

http://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2014/americas-addiction-to-opioids-heroin-prescription-drug-abuse

http://mcintranet.musc.edu/agingq3/calculationswesbite/convchart.pdf (Pages 2-3)

http://www.thefix.com/content/best-kept-secret-addiction-treatment?

http://www.thecleanslate.org/the-misguided-obsession-with-heroin-opiate-maintenance-drugs-suboxone-subutex-buprenorphine-methadone/

http://www.governing.com/gov-data/state-marijuana-laws-map-medical-recreational.html

http://www.mcohio.org/government/bcc/index.html

https://odhgateway.odh.ohio.gov/lhdinformationsystem/Directory/GetMyLHD


Read More:

http://www.daytoncitypaper.com/a-light-at-the-end-of-the-tunnel/

http://novusdetox.com/heroin-effects-history.php

http://www.historytoday.com/ian-scott/heroin-hundred-year-habit

http://www.drugabuse.gov/publications/drugfacts/heroin

http://www.drugpolicy.org/new-solutions-drug-policy/brief-history-drug-war

9 comments

  1. Pingback: A Rock and a Hard Place: Pain Patients Suffer from Heroin Laws Fallout | The Rambling Soapbox: Writings and Thoughts of Loura Lawrence
  2. Pingback: Strangulation on Medicine: My Life as a Pain Patient | The Rambling Soapbox: Writings and Thoughts of Loura Lawrence
  3. Pingback: On Opioids, One Year After DEA Reforms: Part 1 of 2 | The Rambling Soapbox: Writings and Thoughts of Loura Lawrence
  4. JanL

    informative article. I would disagree with ‘Glinda’ that the Suboxone or Methadone clinics “simply hand out free …to any user who comes in asking”. I went multiple places with a family member trying to seek help; there was no ‘free for the asking” dispensing of any alternate drug. Unfortunately, I have the experience learned from a family member and another very special young lady with drug usage. I have seen the ravages of heroin and other drug abuses. That family member is 2 1/2 years clean, but as shown by your husband’s cousin, that can be destroyed in an instant. I witnessed my family member fall from a gainfully employed person with a home and a child to a homeless, living-on-the-street & in abandoned houses person, living from fix to fix. Lying, stealing, whatever it took. One person got clean; the other is slowly killing herself. At age 33, she looks much older. Although I’m a nurse, I had no knowledge of how addictive these drugs are and of the power they have to enslave usually rational people. Mainly, those addictions break the hearts of the people that love them, and especially their children who are innocent victims!

    Like

    • L. Lawrence

      I am so sorry, Jan. “The ravages of drug abuse” indeed. It breaks my heart too, especially when children are involved. We have another family (who helped inspire this post) who has a young child and has been in and out of rehab centers, on and off heroin, Suboxone, and who knows what else. She has had plenty of chances. Her child is in temporary custody with other family, and now we wait to see what she will do.

      One thing the counselor stressed to me was that there are no good programs anymore for those trying to get off drugs. Chemical dependency counselors are extremely frustrated. What had been working for years, policymakers cut funding to for Suboxone clinics. She told me one coworker who works at a different clinic from her, lost 3 clients in one week! Serious, sad, and maddening that lawmakers are focusing on a molehill (prescription narcotics abuse) when there is a mountain called heroin right in front of them.

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      • JanL

        and in my journey with my family member, found out each county has a different guideline. Greene County’s clinic (at least in 2012) was a Suboxone clinic; Montgomery County’s clinic was a Methadone clinic. but of course, if you are homeless, where do you live? My family member was so, so, so fortunate to go through the Montgomery county clinic, and wean himself from the methadone too. After his inpatient rehab, taking him there daily to get a methadone dosage was shocking and enlightening. Hundreds of people went in and out that place while I waited outside; from the most professionally dressed people to the shabbily dressed; young, old, walkers, bus-riders, bicyclists, car-riders, car-drivers, taxi occupants… little children tagging along. and I know, this is only the portion that I witnessed. then later, accompanying to Narcotics Anonymous meetings and such… truly, OMG!! Ok… I better stop, but trust me, we truly learned more than I ever want to know about the rapid descent into hell that can occur, and family cannot do one thing to stop it! Love, hate, support, denial, isolation, tears, begging, help or refusal to help… nothing was effective. Until he finally asked for help… and then another journey of seeking help began. Professionals know it is a rare thing that an addict will actually follow through with their program, and be able to remain clean.

        Liked by 1 person

        • L. Lawrence

          It is awful to watch a loved one spiral out of control, but I am so glad that one of yours finally did ask for help and meant it. Thank you for letting me and readers know that drug addicts come in all shapes and sizes and backgrounds. It is easy to forget this sad fact.

          Like

  5. Frank Abernathy

    Excellent blog, Loura! Very informative, comprehensive, and well referenced! I like it! Would you like to hear about a radical alternative that might stem the tide of heroin addiction?

    Like

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