WAR ON OPIOIDS

05.15.14

America’s Oxy-Express Route to Heroin Addiction

Shocked senators were told yesterday that the over-prescription of opioid painkillers was creating an epidemic of American drug addicts

“Wow,” uttered Senator Dianne Feinstein during the second Senate hearing on America’s opioid epidemic Wednesday. Given the upsetting statistics that five of the U.S.’s leading drug policy experts were revealing on the Senate floor, her shock was understandable.

While only accounting for about 5 percent of the population, the U.S. now consumes 99 percent of the world’s Vicodin and 84 percent of its Oxycontin.

According to the Centers for Disease Control, 12 million people reported using prescription painkillers non-medically in 2010 (meaning without a prescription or only for the feeling), the most recent year for which there is data. Since 1999, the number has led to an over 400 percent increase in female deaths and 265 percent increase in male deaths involving opiates. In 2008, the CDC reported 14,800 deaths from prescription painkillers. Two years later that number had increased to 16,651. Opioid overdose deaths in America are now greater than heroin and cocaine combined.

But prescription opioids are only the beginning of the problem. While the high is similar to that of heroin, pain pills are roughly six times the price. But with opioids status as the second-most addictive substance to tobacco, those who get hooked on prescriptions are likely to search for another way to get high. Which may explain why the number of heroin users nearly doubled from 373,000 people in 2007 to 620,000 in 2011.

After the dirty work of explaining to Sen. Feinstein and cohorts what the drug landscape in America is, Dr. Andrew Kolodny, chief medical officer of nonprofit drug rehabilitation organization Phoenix House, was the first to take the reins. “This epidemic was caused by the medical community,” he said, looking at Feinstein. “We [doctors] were responding to a campaign that encouraged long-term use. Minimized risk and maximized comfort,” he said. Instead of lessons about the dangerous, addictive, and deadly qualities of prescription opioids, he got lessons on relieving pain. The result was the over-prescription and over-consumption of prescription opioids that still exists today—or at least that’s how he sees it. “Most patients with chronic pain on long-term opioids… we’re probably harming them,” he says.

But doctors aren’t the only ones at fault, Kolodny says, even if they are the original purveyors of the drugs. “The CDC is calling for reduced prescribing, especially for chronic pain. But the FDA continues to approve dangerous opioids and continues to allow marketing of opioids for chronic problems like low back pain.” It’s a move that he says turned medicine cabinets into death traps. Without a complete overhaul of the opiate world, he worries it will continue. “Overdose deaths will remain at historically high levels, heroin will continue flooding into our neighborhoods, our families will continue to suffer.”

It’s “rogue pain clinics” that Joseph Rannazzisi and others in law enforcement view as the enemy.

“Thank you very much. Candidly, I am really struck,” a visibly stirred Feinstein told Kolodny. “This testimony is amazing. That heroin statistic; enormous abuse of painkillers. Thirty years ago, I was mayor of a big city, and we had our share. But nothing like today. Nothing like today,” the senator said. Feinstein said she plans to “look into” the FDA’s role immediately, adding: “But now we have the problem of doctors overprescribing.”

Acting Director of the Office of National Drug Control Policy Michael Botticelli jumped in to explain what efforts the federal government is taking to amend this issue—in particular, an online mandatory prescriber education. “It’s very, very clear this is driven by well-meaning physicians who are not trained in looking at alternatives,” Botticelli said.

But it was Joseph Rannazzisi, deputy assistant administrator of the Drug Enforcement Administration, whose testimony was the most impassioned. It’s “rogue pain clinics” that Rannazzisi and others in law enforcement view as the enemy. “These things are essentially just prescription pain mills,” he says. After successfully busting America’s biggest pain clinic in Florida in 2010, the DEA has watched the operations spread nationwide. “We decreased the number in Florida…now they’re in Tennessee,” Rannazzisi tells Feinstein. And while quashing the Gator State’s reputation as the “Oxy-Express” may have saved many lives, it’s left others who depended on these drugs for real treatment in pain.

It’s the double-sided nature of prescription painkillers—both life-saving and deadly—that Dr. Nora Volkow, director of the National Institute on Drug Abuse, is trying to untangle. “We have a serious problem with the number of people with severe pain,” she said. “We do not have adequate treatments.” A formidable presence whom The New York Times dubbed “A General in the Drug War,” Volkow is fighting for something soon forgotten in the quest to save America from prescription painkillers: We still need them.