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
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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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