Incredible as it may seem, one of the most notoriously addictive drugs to ever appear on the black market has been making a comeback. Over the past decade or so, heroin use in the U.S. has been skyrocketing. Between the years 2007 and 2012, the number of Americans using this powerful opioid doubled to nearly 700,000. In 2010, death by heroin overdose took the lives of more than 3,000 people, which represents a 55 percent increase in the death rate since the year 2000.
Heroin has a killer reputation, and in this case that phrase is meant literally and is well earned. A UCLA study in the National Institute on Drug Abuse, tracking the life histories of nearly 600 heroin-using men for a period of 33 years, found that more than 50 percent of them had died by the end of the survey, a rate that was approximately 75 times higher than for non-heroin users in the same age range. About one-fifth of these men died directly from overdose, another fifth from accident, homicide or suicide, and the remainder from serious health conditions quite possibly related to prolonged substance abuse (liver disease, cancer and heart disease).
Prescription Painkillers Leading to Heroin
Out of the 38,000 deaths from drug overdose this country experiences each year, about 75 percent are caused by the misuse of opioids. In addition to heroin the opioid class of drugs includes prescription painkillers such as OxyContin and Vicodin, and addiction experts believe the rise in prescription drug abuse has actually helped to fuel an increase in heroin consumption.
Narcotic painkillers are highly addictive, but the supply is at least partially controlled, making them expensive and difficult to find. But with the world’s illegal heroin trade thriving, the black market has been flooded with plentiful supplies, driving down prices and making heroin a cheap and easy alternative for opioid addicts desperate to feed runaway habits.
In recent years, heroin addicts and victims of heroin intoxication have been filling up drug treatment facilities and emergency rooms all across the U.S. This epidemic of illness and injury represents an emerging public health crisis, and things are expected to get much worse before they get better. Attempts to control the widespread availability of painkilling prescription medications have been undertaken, but in the case of heroin it appears the horse is now out of the barn and running completely out of control—and no one is quite sure how to lure him back inside again.
Heroin Addiction and U.S. Health Care
Treatment and rehabilitation do provide the best sources of hope for heroin addicts and their families. But there are a number of obstacles preventing substance abusers from getting the type of intensive and medically appropriate help they so desperately need. Some of the most significant factors include:
- The continuing stigma associated with heroin use: Illegal drug use has always been considered unsavory and disreputable, a sign of immaturity and questionable character. Historically, no drug has carried a bigger stigma than heroin, and that may be preventing people with heroin addiction from coming forward to ask for help. While rehab facilities have seen a big jump in the number of patients seeking treatment for heroin abuse, experts estimate that up to 90 percent of all heroin addicts will never seek professional help for their drug dependency.
- The high cost of treatment and the lack of insurance: The U.S. health care system is the world’s most expensive, and that is a significant barrier for most people suffering from drug addiction. Insurance coverage for addiction treatment has always been spotty at best, and that goes double for heroin addiction. Because the symptoms of heroin withdrawal are not directly life threatening, insurance companies will normally refuse to pay for in-patient heroin detox and rehabilitation. This ugly reality undoubtedly stops many heroin addicts from asking for help, or makes it impossible for many who do enter treatment get the long-term, comprehensive care they require. Even in those uncommon instances when coverage is available, insurance companies will only pay for 30 days of inpatient treatment, and addiction experts agree that this is not nearly enough time to help a person overcome an opioid dependency. Under the new Affordable Care Act, coverage for treatment services has been expanded somewhat, but at least for now that will only help a small percentage of those who are in need of addiction rehabilitation services.
- Stagnant research budgets and a lack of innovation in the treatment industry: Federal government investment in substance abuse treatment research has been kept at a minimal level for years. The $320 million spent in 2013 represents a drop in the bucket against a problem that costs the U.S. economy billions of dollars in lost productivity annually. State and local budgets are even more constrained, and the result of so little funding is a lack of innovation and a shortage of good data about what works and what doesn’t. Based on their first-hand experiences, rehabilitation specialists aren’t exactly flying blind here, but the quality and effectiveness of the services they provide could be improved dramatically with expanded research budgets.
- An overloaded, overcrowded system: The number of beds available for those in need of inpatient treatment services is just a fraction of what is required. Two-thirds of all residential treatment facilities and outpatient treatment programs rely on scarce public monies to fund their services, so once again the system is at the mercy of short-term political considerations. It is absurd to have waiting lists of several months for those seeking treatment from life-threatening addictions, but that is exactly the current situation. Obviously governments do face real budgetary constraints, which can make it extremely difficult to tackle massive social and public health problems of all types. But the stigma of weakness and moral failure drug addiction carries has certainly made it easier for politicians and bureaucrats to look the other way.
Heroin and Our Harrowing Future
The substance abuse treatment system clearly needs a significant infusion of funds to handle the emerging crisis of heroin addiction, in addition to combating drug and alcohol dependency in general. Health insurance reform and cost containment in health care could help the situation as well, by providing greater access to the system to those who are kept away by financial considerations.
But throwing endless amounts of money at the problem, or focusing entirely on after-the-fact intervention, will not be enough to head off America’s growing heroin problem. Preventive medicine is always the best course of action against any dangerous activity that involves an element of (foolish) choice, and smartly conceived public relations campaigns that set the record straight about heroin and its potentially deadly effects are badly needed.
Heroin’s shocking return may have caught addiction experts and public health advocates off-guard for a while but there is no excuse for complacency or ignorance. Heroin is back and as bad as ever, and the American people are at grave risk as a result.