According to recent news reports from MSNBC [here] and Join Together [here], the crackdown on prescription opioid analgesics in the United States is fueling a resurgence of heroin abuse and addiction. And, experts note, heroin today is inexpensive, powerful, and more destructive to individuals and society than Rx-opioids.
Law enforcement officials report that there is a flood of cheap heroin coming from Mexico — now a leading source of the drug in the U.S. — and it is appearing in new areas than before, including upscale suburbs, where the drug was once hard to find. With an increased availability of heroin has come a spike in the number of visits to emergency departments for issues related to substance abuse, according to the national DrugAbuse Warning Network [here].
Until recently, heroin addiction was seen mostly in men living in urban areas, many of them minorities, the news reports observe. Today, in states like Ohio, most people entering treatment programs for heroin addiction are white, and many are young. They come from both poor areas and wealthy suburbs, and many are female.
While new regulations and law enforcement efforts have significantly reduced the illicit supply of Rx-opioids, those efforts have inadvertently driven many users to heroin. For example, the news reports note that, in Ohio, “doctor shopping” for opioid pain-relievers has become more difficult since the state’s database to track prescriptions went online. The state also passed a law last year to help fight “pill mills” that liberally dispense analgesics.
Similar steps to fight prescription drug abuse have been taken across the nation. Combined with new abuse-deterrent formulations that make certain Rx-opioids harder to crush for snorting or injection, the efforts have curbed the supply and the appeal of opioid analgesic abuse. However, this has had unexpected effects.
Rx-opioids have become expensive and often hard to obtain on the street. They now sell for anywhere from $30 to $80 dollars per pill; whereas, a more readily-available $10 bag of heroin offers a similar or better high. Therefore, unable to find pills, or to afford them, drug abusers go looking for something else to feed their craving — heroin is cheap, potent, and plentiful.
It is also deadly. In fact, the news reports indicate that Ohio saw a record number of heroin-related deaths in 2010, which now account for 1 in every 5 overdose deaths in the state. In early May 2012, one county in Ohio saw 5 fatal overdoses in 10 days due to a batch of overly potent, or badly cut, heroin. Experts worry other counties in Ohio may soon follow suit, and that those dying might be among the fastest growing demographic of heroin users — young people between 20 and 35 years of age. And, it may only be a matter of time before these trends sweep across the nation.
COMMENTARY: The Wrath of Unintended Consequences
As we have noted previously, it is clear that America has substance abuse problems of unprecedented proportions, as do most other countries worldwide. At the same time, well-meaning efforts to curtail the prescribing and distribution of opioid analgesics may be headed in the wrong direction by provoking several unintended consequences:
- As we cautioned more than a year ago [here], and the above news reports now confirm, there has been a renewed upsurge in heroin abuse and addiction, which is largely related to tightened controls on prescription opioids.
- Along with that, it probably will not be long before there are reports of increasing heroin-associated morbidity — eg, HIV/AIDS, hepatitis, tuberculosis, other infections — with attendant mortality. This not only has a devastating impact on individuals, but on families, communities, and society overall.
- New and restrictive rules governing pain management with opioid analgesics — such as those in Washington state — are limiting access to these essential medications for legitimate patients with chronic pain who benefit from strong-analgesic therapy.
- Left with few or no alternatives, some of those patients with undertreated or untreated chronic pain may be among a new generation of heroin abusers.
The most recently available government data are almost always several years old. So, federal reports of Rx-opioid abuse outdistancing illicit drug problems may not reflect current realities, and the news reports may be early warning signals of a tsunami of heroin-related morbidity and mortality to come.
Essentially, what we may have here is a “balloon effect”: squeeze a balloon in one place and it will expand somewhere else; curtail the availability of prescription opioids and heroin expands to fill the void — the illicit-drug cartels and dealers are happy to help this along. To be clear, however, this is not a justification for recklessly liberalizing Rx-opioid availability; rather, it is a reminder that societal problems of substance abuse and addiction are complex and multifaceted, and simplistic solutions that seek only to restrict drug supply have never succeeded in reducing demand.
And, in the case of prescription opioid restrictions, legitimate patients end up paying a terrible tariff in pain due to the misbehaviors of a small minority of the population and misguided or ineffective attempts at stemming the tide of drug abuse and addiction.
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11 comments:
And there you go..... Quick fixes reap catastrophic results. Targeting innocent populations is just WRONG! Now lets see what they come up with!!!
And we are surprised? I explained to a pyhsician years ago that it would be easier to manage my chrnic pain, less expensive to manage it on the streets. This was 25 yrs ago. To believe that people who honestly have a need for pain management are just now going to these other albeit extremely dangerous routes for pain control would be naive.
The fact that a patient may get pain control on the streets does not adress that they are in no way monitoried. This is scary.
Should we not try and focus the attention and monies on thise who abuse RX opiods rather than deny justified patients?
I am so sick of these so called "studies" on pain. I have been suffering for years after 2 spinal fusions. I have lost all respect for pain doctors. They have not shown me respect as a human being. As a result of my mistrust, I have not seen any type of doctor in over a year. After injections and RFA's my right leg is no longer functioning properly, can only walk maybe 2 blocks before my leg "goes out on me". I lose my balance etc. I am so happy for the pain docs that made so much $$$ from doing spinal fusions and injections etc. Shame Shame Shame on the medical community!!!!
Chronic patients that are suffering will resort to using this method to control their pain or committ suicide. Which is the choice the US government is going to take? The economy is horrible so I'm sure many people want OUT of this hell. The Congress hasn't done one thing in the past 4 yrs to help this country. People are fed up, pain patients are stress to the point they don't care if they live or die. The stress of trying to get legal prescriptions filled has worn down pain patients. They just can't handle it anymore. At least with prescription drugs, they are regulated and the doseages remain stable.
I honestly don't think that the DEA did any thinking before acting in decronic way of what they would be creating. Did they honestly think that pain patients would just suffer? Did they think that addicts would just stop using because they took away the drugs?
Do they know what it's really feels like to wirhdraw?? I'm sorry it's not just a mild flu. That BS. It can cause death no matter what a doctor or scientist say.
The DEA and the Government is causing all of this. because the they have college degrees doesn't mean they have common sense. They are going to see now what they have done.
I am not surprised that this happening.
Human beings are tired. Enough is enough.
They better come up with a better way and start backing off doctors, pharmacies, Pharmacuetical distributors because this going to get worse than it already is.
God Bless us all!
Get rid of the DEA, the war on drugs needs to stop, at the healthcare level.
Not surprised at all,Im a legitmate pain patient,that has a hard time getting my legal scripts everymonth and now have to take something for anxiety,a week before my appointent,the dea has screwed all pain patients from thier meds and myself may have to go to the streets to get meds thanks alot dea!!! for such a wonder planned out enforcement of pain meds,its ironic the streets are the only place to get meds now that the dea dont allow enough in the state of florida,and has scared every pharmacy into losing thier licence to fill sch2 narcotics,how pathetic,and you the goverment started it to begin with for allowing pill mills to operate,every gov official in office needs to go,obama,bondi,scott,narco all of them!!!!
This is no surprise. By forcing the CPP to jump through a hundred different hoops (BAD enough when one can barely walk, much less jump) the pharmacies are STILL denying many, MANY people access to their legitimately acquired medicines. Spend a few days in constant, unrelenting pain and of course, people will try to find something to ease their suffering. NOW- with the DEA's heavy handed tactics, I have zero doubt that once these people get busted for heroin, no doctor will allow them back. THIS is the way the DEA is under-handedly playing a game where they change the rules midway through. The DEA is EVIL and NASTY, their efforts have PUNISHED the masses, in an effort to stop a few. Since when is that sort of treatment acceptable in the USA? It isn't. But, the ALL POWERFUL DEA is out and looking to throw the "baby out with the bathwater".
SHAME, SHAME, SHAME on you, DEA!!!!
Maybe we will be the first Generation who gets to tell their great great grandkids that they remember when pain medication was paid for in alleys with amateur Pharmacists in "dime bags",because they government legislated Opiods out of America.
No more Pain Control No more Anesthesia it is all illegal for import or consumption a New period of "Prohibition" which will work as well as the first one!!
especially with Mexico more than happy to give Americans anything and everything but the kitchen sink.
The NBC Nightly News report interviewed the father of a young man who died of a heroin overdose. The teenager who died had said he could just make a phone call and get the heroin delivered to his mailbox in 15 minutes. They lived in an upper class suburb.
This story is incredibly sad, and speaks to the level of desperation that can develop from untreated (and under treated) chronic pain. What is even more amazing to me, is that BOTH chronic pain and addiction, are MEDICAL conditions that require medical treatment....Instead, we punish, arrest, and criminalize BOTH, which only makes them worse. (a discussion for another day). As noted in the commentary, these are complex issues....ones that can't be fixed with simplistic ideas like decreasing the supply of opioids. Do they think (untreated) addicts will simply "change their minds", and stop abusing drugs? Do they think that (untreated) patients in severe pain will curl up in a ball and die, without first trying to find some relief? If any of these law makers spent a HOUR, never mind a day, in the body of a patient with severe, untreated, chronic pain, this discussion would never need to happen. They would instantly understand the torture of being a chronic pain patient with no relief. Then again, they wouldn't be able to concentrate enough to understand.....they would just lay there listening to the SCREAMING pain, and wonder how any human being could EVER let someone suffer this way. Good question.
The only hope Ive had for relief, here in America, is suicide. Im going to use inert gas. I met a guy at my work, and I know he knows where to get heroin, otherwise I have nothing to do with the black market or the people in it. Im going to try the heroin, maybe Ill finally get some relief. I really dont want to die, its a rational decision rather than purely emotioal. Maybe with pain relief from the heroin I will stave off suicide.
Today my pain management clinic said the DEA has determined that people on long term narcotic pain medication are prone to suicide. To fix it, the DEA is demanding that providers decrease patients medication to "acceptable "levels. It took YEARS to come up with the right combination and dosage of medications to allow me to function. Not a full normal life, but pain I can tolerate. Now the DEA is forcing my doctor to lower my dose which will make me once again bedridden because the pain will be too much to bear if I try to move.
Please write to your Senators and Representatives about this blatant abuse of power. The DEA's suicide count will most likely go up significantly when so many patients have their medication reduced to a level that does not control their pain!
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