How Is Your Medicine Cabinet Fueling a Heroin Boom?

The nation is in the middle of an epidemic of prescription-drug abuse, and the government’s trying to turn things around.

Picture taken on January 15, 2012 in Lille, northern France, of drug capsules.
National Journal
Clara Ritger
May 13, 2014, 12:57 p.m.

Law­makers and fed­er­al health of­fi­cials are gath­er­ing Wed­nes­day on Cap­it­ol Hill to talk about how to stop the na­tion’s swell­ing opi­ate ad­dic­tion.

The gov­ern­ment is already work­ing to com­bat high rates of pre­scrip­tion-drug and heroin ab­use, but Wed­nes­day’s hear­ing at the Sen­ate Caucus on In­ter­na­tion­al Nar­cot­ics Con­trol is an op­por­tun­ity for sen­at­ors — led by Demo­crat Di­anne Fein­stein of Cali­for­nia and Re­pub­lic­an Chuck Grass­ley of Iowa — to check in on wheth­er ex­ist­ing policies are work­ing.

“Policies have to bal­ance the needs of chron­ic­ally ill pa­tients to get ne­ces­sary medi­cine with the real­it­ies that opioid ad­dic­tion is a ser­i­ous, dan­ger­ous epi­dem­ic,” Grass­ley said in an email state­ment. “The hear­ing is im­port­ant to in­form Con­gress of the com­plex­it­ies of the chal­lenges be­fore us and the tools avail­able to help treat and pre­vent opioid ab­use and over­dose.”

Wed­nes­day’s dis­cus­sion is one in a series of re­cent hear­ings on Cap­it­ol Hill about opi­ate ad­dic­tion, fol­low­ing re­ports earli­er this year that ef­forts to stop pre­scrip­tion-drug ab­use have res­ul­ted in a heroin boom.

Fol­low­ing the Cen­ters for Dis­ease Con­trol and Pre­ven­tion’s move clas­si­fy­ing pre­scrip­tion-drug ab­use as an epi­dem­ic — a term used to de­scribe a sig­ni­fic­ant num­ber of cases of a dis­ease bey­ond what should be ex­pec­ted — the Obama ad­min­is­tra­tion de­signed the 2011 Pre­scrip­tion Drug Ab­use Pre­ven­tion Plan. Re­cent ef­forts have fo­cused on edu­ca­tion for pa­tients and pro­viders, mon­it­or­ing to keep pa­tients from doc­tor shop­ping to get mul­tiple pre­scrip­tions for pills, prop­er med­ic­a­tion dis­pos­al to lim­it the sup­ply of un­used drugs in homes, and en­hanced law en­force­ment to stop il­leg­al pill mills.

“We’re work­ing to change the avail­ab­il­ity of the pills and the no­tion that be­cause these pills are used to treat pain that there’s low risk,” said Ra­fael Lemaitre, com­mu­nic­a­tions dir­ect­or of the Of­fice of Na­tion­al Drug Con­trol Policy.

Health of­fi­cials from OND­CP, the Sub­stance Ab­use and Men­tal Health Ser­vices Ad­min­is­tra­tion, the Na­tion­al In­sti­tute on Drug Ab­use, and the Drug En­force­ment Ad­min­is­tra­tion are sched­uled to be in at­tend­ance Wed­nes­day.

The is­sue stems from the fact that pre­scrip­tion paink­illers — like heroin — are opioids that can lead to ad­dic­tion. When doc­tors over­prescribe Vicod­in or Oxy­Con­tin, two com­mer­cial drugs con­tain­ing the opi­ate act­ive in­gredi­ents hy­dro­codone and oxy­codone, pa­tients are at risk of de­vel­op­ing a deadly habit.

Some four out of five heroin users star­ted ab­us­ing pre­scrip­tion drugs first, ac­cord­ing to a re­port re­leased last year by SAM­HSA, and 68 per­cent of new pre­scrip­tion-drug ab­users say they get their pills from a friend or fam­ily mem­ber. As people be­come chron­ic users, that num­ber drops to 41 per­cent — shift­ing in large part to buy­ing pills from friends, deal­ers, or the In­ter­net.

But just be­cause someone is ab­us­ing paink­illers doesn’t mean they’re on the road to heroin ad­dic­tion: Only 3.6 per­cent of people ab­us­ing pre­scrip­tion drugs moved onto heroin with­in five years, the SAM­HSA re­port found.

In all, heroin use climbed to 620,000 people in 2011 from 373,000 people in 2007, ac­cord­ing to the re­port, com­pared with the roughly 12 mil­lion people who re­port us­ing paink­illers non­med­ic­ally each year.

Opioid pain re­liev­ers alone res­ul­ted in 16,651 deaths in 2010, up 21 per­cent from 2006. More people are dy­ing now from drug over­doses than they are from car ac­ci­dents or sui­cides.  An­drew Ko­lodny, a doc­tor and the chief med­ic­al of­ficer of Phoenix House, a na­tion­al non­profit ad­dic­tion-treat­ment and pre­ven­tion or­gan­iz­a­tion, is sched­uled to testi­fy at Wed­nes­day’s Sen­ate hear­ing.

“People think this must be safe to ex­per­i­ment with be­cause it came from mom’s medi­cine chest and a doc­tor pre­scribed it,” Ko­lodny said. “They don’t un­der­stand that these are es­sen­tially heroin pills. The act­ive in­gredi­ent in Vicod­in is nearly identic­al to heroin. The ef­fect that heroin pro­duces in the brain is in­dis­tin­guish­able from hy­dro­codone and oxy­codone.”

The reas­on why some people move onto heroin, Ko­lodny said, is be­cause they run in­to trouble get­ting doc­tors to pre­scribe the pills or find that in their area, heroin is a cheap­er al­tern­at­ive.

A spokes­per­son for Grass­ley said that prob­lem — the cost and ease of ac­cess of heroin — would be part of the fo­cus of Wed­nes­day’s hear­ing.

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