Giving Drug Users a Shot in the Arm

Every July I have the good fortune of spending a week at Fordham University in New York City, where I teach ethics and mentor fellows enrolled in a training program supported by the US National Institute on Drug Abuse (NIDA).

Even though I am a senior faculty member in that program, I suspect that I learn more from my students — researchers who work with drug users, commercial sex workers and other marginalized populations — than they probably learn from me. One of the things that I learned about this week was the resurgence of heroin use that has followed in the wake of the prescription drug epidemic.

I’ve written many times about America’s addition to prescription painkillers like OxyContin. First approved by the US Food and Drug Administration in 1995, that drug was a godsend to patients with severe and unremitting pain, such as those with late-stage cancer.

Unlike most short-lived analgesics that were available in US pharmacies at that time, OxyContin provided a potent dose of a painkilling opiate that was released over a long period of time. Instead of taking pills or taking shots every hour or so, patients prescribed OxyContin only needed one or two pills a day to get relief. Heavily promoted by pharmaceutical reps, within a few years OxyContin became one of the most overprescribed (and most abused) of the prescription drugs.

This is because what made OxyContin so useful for cancer patients — the large opiate dose — also made it attractive to drug users. By grinding up and inhaling or injecting the pills, they could get a very intense and very quick high. Just a few short years after the drug was first approved for use, prescription drug overdose death rates in the US more than tripled.

In response, state and federal drug enforcement agencies have cracked down on the use of these pain medications. In 2012, for example, the New York State legislature passed a law called the Internet System for Tracking Over-Prescribing/Prescription Monitoring Program (ISTOP/PMP).

That program requires physicians to check the State-run Prescription Monitoring Program to look for evidence of opiate abuse before prescribing a drug like OxyContin to a patient. Similarly, drug companies have begun manufacturing formulations of the drug that are harder to abuse, such as a gel or paste.

These efforts to stem the tide of prescription opiate abuse have been fairly successful, with the number of prescription-drug overdoses declining in the past couple of years. But the crackdown has driven addicts to seek other ways of getting high, fueling a new epidemic of heroin abuse across the country. Three-fourths of heroin users switched to the drug after first becoming addicted to prescription painkillers.

Deaths from an overdose of heroin, largely non-existent in recent years, have started to surpass other drug-related fatalities in many regions of New York and the rest of the US. Nationwide, deaths from prescription abuse have dropped an average of 5 percent annually but heroin overdose deaths have surged by 35 percent.

Outside of salacious news reports or commentaries like this, however, the new heroin epidemic (like the preceding painkiller epidemic) is largely hidden but surprisingly pervasive. Most of us probably assume that it’s the commercial sex workers in the Bronx, the homeless sleeping in Central Park, or the unemployed twenty-something living in a remote trailer in the Catskills that are addicts. But that’s not the case.

In fact, heroin addiction seems to cut across all social, racial and economic groups. Addicts are no longer the stereotypical “junkies” portrayed in the movies. Heroin and painkiller abuse affects all New Yorkers, regardless of wealth, education, or ethnicity. The financial analyst who lives next door to you might have become addicted to the painkillers given to him for his bad back. When he could no longer convince his physician to renew his OxyContin prescription, he started using heroin to stave off the symptoms of withdrawal. He’s just as likely to be an addict as the unemployed veteran who lives in a downtown homeless shelter, but more able to hide his addiction from prying eyes.

So how can we address this hidden epidemic, particularly given the fact that heroin is one of the most addictive and habit-forming drugs? It’s time to end the so-called “War of Drugs.” That war’s one success has been the crackdown on the use of prescription painkillers, and has itself driven the surge in heroin use.

We can start by reducing mandatory state and federal sentencing minimums for minor drug charges like possession of heroin for personal use. This is not to say that we shouldn’t arrest and imprison the dealers, but law enforcement should go after those who sell and distribute large quantities of drugs. The addicts should instead be referred to drug treatment center.

Moreover, we can bolster current drug treatment programs, by making drugs like methadone, buprenorphine, and naltrexone widely available, by destigmatizing their use and by providing psychological support and recovery services at little to no cost. Even in urban communities like New York City, let alone bucolic rural communities in upstate, there are few doctors and few clinical that can provide comprehensive drug treatment services.

The new heroin epidemic isn’t a criminal issue. Rather, it’s a public health problem. We need to stop treating addiction as a crime and start treating it as an illness. Drug users are victims not criminals, and they are deserving of our compassion and our help.

[This blog entry was originally presented as an oral commentary on Northeast Public Radio on July 16, 2015, and is available on the WAMC website.]

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About Sean Philpott-Jones

A public health researcher and ethicist by training, Sean holds advanced degrees in microbiology, medical anthropology, and bioethics. He is currently Chair of the Bioethics Department at Clarkson University's Capital Region Campus and Director of the Bioethics Program of Clarkson University-Icahn School of Medicine at Mount Sinai, and Director of two Fogarty-funded programs to provide research ethics education in Eastern Europe and in the Caribbean Basin. Until his term expired in August 2012, he served as Chair of the US Environmental Protection Agency’s Human Studies Review Board, an advisory panel that reviews the scientific and ethical aspects of research involving human participants submitted to the EPA for regulatory purposes.
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