Julie Dostal '19
In the 1980s into the early 1990s, the crack-cocaine epidemic and the crime arising from drug use and drug-related violence became the cornerstone of a political era’s national dialogue. The War on Drugs – the title. Tough on crime – the agenda. In his book, Cocaine Blue, Cocaine True, Eugene Richards followed the lives of Americans living within communities permeated, if not controlled entirely, by drug use, abuse, and the economy arising out of a demand for illicit drugs. In response to his experiences in cities such as Detroit, New York, and Philadelphia, Richard referred to drugs as the issue of our time. Yet, during his visits to the Midwest, the author brushed aside the danger of prescription drug use. He wrote, “when I go out to photograph in the Midwest, lots of people are addicted to pills — serious amounts of painkillers, Klonopin and drugs for all kinds of psychological conditions. They don’t have to rob anyone. They just go to their doctor, then get stoned to the f---ing bone on prescription drugs. You can carry on your life as a middle class addict.” Perhaps Richards did not believe prescription painkillers could produce the type of horrific dependency that seemingly inevitably leads to crime, violence, or overdose. Moreover, perhaps Richards and others crafting the rhetoric on drug use in America failed to consider that the dangers of addiction do not dissipate in more affluent areas where drugs are prescribed by doctors, not dealers.
The modern drug epidemic ravaging the United States often begins on a prescription pad and ends in a lethal overdose from an inexpensive and readily available baggy of heroin. Today, ninety-one people will die as the result of an opioid overdose. Last year alone, 33,000 Americans died due to opioid use and abuse. The majority of drug overdose deaths now involve opioid use (more than six out of ten). This staggering loss of human life does not include fatalities arising from opioid related deaths, such as those stemming from opioid-related crimes. The mass loss of life occurring as a result of the opioid epidemic of course invites the question of how to mitigate the crisis. This question is made all the more difficult when one considers that the opioid crisis has defied many of the modern assumptions surrounding a drug epidemic.
The market and marketing of prescription opioids has helped create the broad environmental availability of such medications. Since 1999, the number of prescription opioids prescribed and sold in the United States has quadrupled, yet there has not been an overall change in the amount of pain that Americans report to their attending health-care providers. Last year alone, over 237 million prescriptions for opioids were written and filled in the United States. 650,000 opioid prescriptions are dispensed a day. The health-care providers in the highest prescribing state, Alabama, wrote three times as many opioid prescriptions as doctors in the lowest prescribing state, Hawaii. The climate surrounding prescription opioids is different and difficult. Health-care providers are not viewed as drug dealers or enablers, nor am I arguing they should be viewed in this way. However, the implicit trust and reliance on a medical professional drastically decreases the stigma surrounding the use of prescription opioids. The method of procurement through the legitimate healthcare market also adds to the greater social acceptability for using the medications for different purposes. This social acceptability leads to another harsh reality of the opioid epidemic.
Whereas the drastic increase in filled opioid prescriptions points to the need for reform in prescribing practices, social acceptance of opioid medications leads to the free or charged for exchange of pills between friends and family members. Twenty-seven percent of opioid users fill their own prescriptions. Twenty-six percent receive the medication free of charge from relatives or friends with a prescription. Another twenty-three percent purchase them from friends or family members. The use of drug dealers within the illegal trade of opioids is smaller than in any other illicit drug market in the United States, composing only thirteen percent of the trade. Due to the nature of the prescription opioid market, the Center for Disease Control (CDC) and the U.S. Department of Health and Human Services (HHS) were forced to develop a new approach to combatting the opioid epidemic that begins in doctors’ offices. The CDC set new guidelines for prescribing practices and awarded 30 million dollars to twenty-nine states in order to improve safe prescribing methods. HHS now emphasizes the importance of Medication-Assisted Treatment (MAT) with an emphasis on the life-saving reversal drug, Naloxone. The attempted reforms to prescription practices and rehabilitative measures are relatively new, so the success of the reforms is not yet quantifiable.
While the CDC and HHS attempt to combat the opioid epidemic by altering distribution and response mechanisms to prescription pill abuse, the explosion of heroin use in the United States adds another layer of complexity to the crisis, as the use of prescription pills and trying heroin are intimately linked. Today, 580 Americans will initiate heroin use. Among new heroin users, approximately three out of four report abusing prescription opioids prior to using heroin. The increased availability, lower price, and increased purity of heroin in the United States also likely contributes to the rising rates of heroin use. According to data from the DEA, the amount of heroin seized each year at the southwest border of the United States was approximately 500 kg during 2000–2008. This amount quadrupled to 2,196 kg in 2013.
After it crosses the southwest border, heroin disperses all across the country. However, opioid, and especially heroin, distribution largely defies traditional drug trafficking patterns. One may find heroin as readily available at a high school party in suburban New Hampshire as a family home in West Virginia. When taking into account disparities in population size, opioid overdoses occur no more frequently in urban areas than rural areas. The states reporting the highest number of opioid overdoses are located in Appalachia, the Midwest, and New England. Opioid overdoses occur most frequently involve individuals over forty. According to the CDC, the rate of heroin use among white adults increased by 114% between 2004 and 2013. The rate among non-white adults remained relatively unchanged during the same period. A new type of drug market and a new type of drug user fuel the opioid epidemic. As Eugene Richards contended in 1988, drugs may be the issue of our time; however, the difficulties of combatting the opioid crisis may challenge pre-existing conceptions regarding drug users and force Americans to consider that drug use and abuse are not symptoms of a region, demographic, or class.