U.S. Heroin Overdoses Tripled in Three Years

While U.S. law enforcement cracks down on prescription opioid use, heroin use—and overdose—is skyrocketing.

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A government study confirms what local police departments and anguished families have known for several years: Overdose deaths from heroin are exploding.

The study, by a division of the Centers for Disease Control and Prevention, found that heroin-related deaths tripled from 3,036 in 2010 to 8,257 in 2013.

The stark rise in heroin deaths appears to be a consequence of a government crackdown intended to address a separate, equally troubling addiction issue. Beginning about a decade ago, state law enforcement officials cracked down on the availability of oxycodone and other opioids. In response, heroin manufacturers in Mexico and Colombia boosted production, increasing the supply and making their illicit product cheaper than pills.

The result: Deaths from prescription opioids remain high, but have leveled off, with 16,235 dying in 2013. That’s just a 1 percent increase over the previous year.

While the number of overall deaths from heroin has been rising since 2000—the report says that it has nearly quadrupled since then—the 2014 death of actor Philip Seymour Hoffman from a combination of heroin, cocaine, and other drugs drew national attention to the problem. (Fatal heroin overdoses often involve other drugs.)

According to the report, 6,525 men died from heroin overdoses in 2013, compared to 1,732 women.

The report noted a shift in the racial composition of the deaths. In 2000, non-Hispanic black people between 45 and 64 had the highest rate of heroin deaths, 2 per 100,000. By 2013, non-Hispanic white people between 18 and 44 had the highest death rate, 7 per 100,000. The age-adjusted rate for heroin deaths increased in all regions of the country, but the rate was highest in the Midwest.

In a statement, White House drug czar Michael Botticelli said the rising overdose deaths underscored the need for a “’whole of government’ approach to combatting the opioid epidemic.” He noted that the Obama administration’s 2016 budget proposed $133 million in new funding for these efforts.

“The Administration’s strategy invests significant resources in overdose prevention—including identifying those at risk of overdose and the signs of overdose, and expanding the use of naloxone—as well as in increasing access to Medication-Assisted Treatment to help more individuals sustain their recovery from opioid use disorders,” Botticelli said.

The recent rise in deaths has resulted in a greater push to get emergency medical technicians, police, and fire departments to carry naloxone, a drug that can reverse heroin and prescription opioid overdoses. Many states—including California, Massachusetts, and Michigan—and cities—New York, Baltimore, and Chicago—make the drug available to first responders, the CDC says.

Dr. Andrew Tatarsky, the founder and director of the Center for Optimal Living in New York, an outpatient treatment facility in New York, commended the government support of naloxone and the FDA’s 2002 approval of buprenorphine, an alternative to methadone that people may take at home.

But he said the grim statistics emphasize how misguided federal drug policy is. “The war on drugs focuses on the availability of drugs rather than on effective prevention and treatment,” Tatarsky said. He is a proponent of harm reduction therapy, which seeks to reduce the harmful consequences of drug and alcohol use.

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Traditionally, treatment providers in the U.S. have embraced the faith-and-abstinence-based approach of Alcoholics Anonymous and its offshoot, Narcotics Anonymous. While methadone and buprenorphine, or opioid replacement therapy, can be helpful, they are available to fewer than a quarter of those in treatment. And many people, Tatarsky said, are deterred by the notion of abstinence.

According to government statistics, Americans with substance use disorders related to opioid painkillers is 2.1 million, with another 467,00 dependent on heroin. (Language involving substance and alcohol use has shifted in recent years. The DSM-5, the psychiatric bible, has replaced “addiction” and “abuse” with the terms “substance use disorder” and “alcohol use disorder.” They connote a spectrum of severity.) According to a 2011 study, about 80 percent of those who try heroin for the first time first used prescription drugs. Typically, new heroin users begin by snorting or smoking the powder and move on to injecting it. Injecting heroin delivers the fastest, most intense high.

Dr. Adi Jaffe, a psychologist and co-founder Alternatives Behavioral Health, an outpatient treatment center in Los Angeles, said that the deaths revealed a larger truth about America’s bizarre history with prohibiting drugs. “We assume that by banning substance after substance, we’ll get the results we want. But what we did was increase the use of other drugs, and drive crime up.”

Jaffe, who also lectures in the psychology department at UCLA, said the U.S. needs to look at drug use from a more realistic standpoint. “Look, it’s why you give condoms to adolescents. It’s understanding that sex will happen, so you’d rather it happen safely. Are kids going to experiment? Every indication says yes. So why focus on abolishing instead of more education?”