Entering A World of Pain(Killers)vvv

In 1986, the drug in the news was cocaine. It was portrayed as the drug of choice for the wealthy, jet-setting, indulgent, yuppie demographic in powder form, and of those in run-down urban areas in the form of crack. Its use was rampant and cited as a major factor in the need for increased law enforcement and seizures. Yet rarely were the dangers of the drug, and its impact on human lives, discussed. On June 19, 1986, that changed.

Len Bias was dead.

The University of Maryland basketball star – the ACC player of the year and an All-American – had been drafted by the NBA defending champion Boston Celtics just two days earlier. He was drafted second overall and seemed destined for stardom. His autopsy revealed a cardiac arrhythmia brought on by a cocaine overdose. The conversation about cocaine, once entirely focused on trafficking and law enforcement, changed forever. Cocaine was a killer. It could reach anybody, and we as a nation started to focus on its dangers, which were significant.

On February 2, 2014, a new generation – and a very different society – was again jolted into facing a brutally harsh reality. This time the drug was heroin, and the casualty was the Academy Award-winning actor Phillip Seymour Hoffman. The dangers of a heroin overdose leapt to the front page. It was on Twitter. Facebook. CNN. Fox News. MSNBC. The rest of America was catching up to what many of us already knew: Heroin was not a drug limited to urban areas. It is in our suburbs. It is used and abused by movie stars. It is killing people.

As more high-powered painkillers are prescribed, more become available on the black market. According to the National Center for Injury Prevention and Control (NCIPC), nationally sales of prescription painkillers per capita have quadrupled since 1999 and the number of fatal poisonings due to prescription painkillers has also quadrupled. Enough prescription painkillers were prescribed in 2010 to medicate every American adult continually for a month. Yet those who have become addicted to these painkillers – for whatever reason – have found that it is cheaper to buy heroin on the street than Oxycontin, so it is not just prescription pain pills sending people to emergency rooms.

According to SAMSHA, in 2012 the number of people aged 12 and older who used heroin in the past year more than doubled, bringing the total to 669,000. From 2007 to 2012, the use of heroin in the United States increased 79 percent. Today, experts estimate that at least a half-million people in the country are addicted to heroin.

Taking suburban Chicago as just one example, heroin-related deaths in DuPage County increased 55 percent in 2012. In Will County, such deaths increased 80 percent. McHenry County reported a 77-percent increase. Finally, in Kane County, heroin deaths increased 200 percent in just one year.

Of course, all of the discussion and media exposure in the world will not make a difference unless there are tangible, effective changes in policy that will allow us to reduce the number of heroin overdoses that are currently skyrocketing. Policymakers have finally taken heed and are now working to implement change. In addition to the already-existing House caucuses – the Addiction, Treatment, and Recovery (ATR) caucus and the Prescription Drug Abuse caucuses – in April the senate Health, Education, Labor, and Pensions (HELP) Committee Chairman Tom Harkin (D-IA) and Ranking Member Lamar Alexander (R-TN) announced the establishment of the HELP Committee Prescription Drug Abuse Working Group. A press release issued by the committee states that the bipartisan staff Working Group will examine the characteristics and challenges of prescription drug abuse; what the federal government, state governments, public health groups, health care providers, law enforcement, and others are doing to address it; and consider ways to further address the issue. Senators Harkin and Alexander have invited all members of the HELP Committee to join and contribute to the Working Group.

From March to May, there were at least five hearings or briefings on Capitol Hill concerned with the abuse of an addiction to opioids. Treatment Communities of America sponsored one of the first briefings on the subject in 2014, featuring policymakers such as ONDCP acting director Michael Botticelli and Representatives Clay (D-Missouri), Rep. Barbara Lee (D-CA), and Rep. Karen Bass. “TCA was honored to work with our friends at both the Addiction, Treatment, and Recovery Caucus and the Congressional Caucus on Prescription Drug Abuse to shed more light on the urgency of dealing with the epidemic of prescription drug misuse and expanding access to treatment,” said Dr. Sushma Taylor of the TCA. “Working with the leadership of ONDCP, Acting Director Botticelli and leaders on Capitol Hill who joined us at the briefing, we look forward to working with Congress this year on solutions that ensure treatment for those in need and tearing down barriers to treatment that exist in current law.”

In late April, Senators Whitehouse (D-RI) and Portman (R-OH) held a bi-partisan roundtable on opiate abuse in the criminal justice system. Also participating were Senator Ayotte (R-NH), Rep. Bobby Scott (D-VA), and Senator Markey (D-MA). The Corrections industry, the pharmaceutical industry, and the states all weighed in. Also present was Governor Shumwin of Vermont, who earlier this year devoted his entire State of the State address to the issue of heroin abuse in his state. The National Institute on Drug Abuse (NIDA), the government’s scientific authority on the subject, represented by Dr. Redonna Chandler also attended. She discussed NIDA-funded research on the correlation between high-risk behavior and addiction, as well as the need to address the root cause of the disease of addiction, regardless of the drug abused. She highlighted integrated services for addiction treatment that could conceivably take place at every step of the criminal justice process: pretrial, prosecution, sentencing, incarceration, and release.

One form of treatment that is receiving large support at the federal level is Naloxone, which is an opioid antagonist that reverses the effects of an opioid overdose. In March, Senator Ed Markey (D-MA) introduced the Opioid Overdose Reduction Act to protect individuals who administer lifesaving opioid overdose prevention drugs. According to the Senator’s press release, death from heroin and other opioid overdoses may be prevented if a victim is administered an opioid overdose prevention drug, such as naloxone, in a timely manner. However, the willingness of medical and non-medical personnel to provide and administer overdose-reversal drugs may be deterred by potential civil liability. Senator Markey’s legislation will ensure that individuals who have been properly trained and who administer an opioid prevention drug are protected from civil liability. The bill also ensures that health care professionals who prescribe an opioid overdose drug to a person at risk of overdose or a third party, such as a family member of an abuser, are not liable for civil suits. It is co-sponsored by Senator Kelly Ayotte (R-NH)

Whitney Englander of the Harm Reduction Coalition praised the legislation: “The Opioid Overdose Reduction Act is an important step forward in protecting our communities and families from the tragic effects of the opioid epidemic,” she said. “This bi-partisan legislation creates a national floor of protections for health professionals, first responders, and bystanders who administer lifesaving opioid overdose reversal medications. As we lose 40 Americans every day to opioid overdose, we request Congress to pass this vital legislation swiftly.”

Vice President Biden recently said in a speech about the budget, “Show me your budget, and I’ll tell you what you value.” For years, the Center for Disease Control (CDC) has done tangential work on alcoholism and prescription drug abuse, but in this year’s proposed budget, they seek to take a giant leap forward. The FY 2015 budget request for CDC includes an increase of $15.6 million to expand the existing Core Violence and Injury Prevention Program (Core VIPP) to additional states with the highest burden of prescription drug abuse. The CDC has put on the record what most of us have known for years: prescription drug overdoses represents a growing public health concern, as evidenced by the more than 60 people who die every day in the United States from these overdoses, most of which involve prescription opioid pain relievers. These deaths have increased four-fold between 1999 and 2010 and now outnumber deaths from all illicit drugs – including cocaine and heroin – combined. Abuse of opioid pain relievers claimed more than 16,600 lives in 2010, resulted in more than 400,000 emergency department visits in 2011, and cost health insurers an estimated $72 billion annually in medical costs.

Not to be ignored is how the attitudes toward opioid abuse in larger policy circles are finally shifting from a focus on criminal justice to a focus on public health. The involvement of the CDC speaks to this, as does the commitment of organizations traditionally concerned with public health to the cause. Groups such as Trust for America’s Health (TFAH), and the Association of State and Territorial Health Officials (ASTHO), which advocate for general public health, are putting resources into awareness of the opioid abuse and overdose issue. As a result, the number of policy makers on Capitol Hill concerned with the issue, once a very small group, is beginning to grow steadily.

A new report issued by TFAH last November, entitled Prescription Drug Abuse: Strategies to Stop the Epidemic, found that prescription drug abuse has quickly become a top public health concern, as the number of drug overdose deaths – a majority of which are from prescription drugs – doubled in 29 states since 1999. The rates quadrupled in four of these states and tripled in 10 more of these states. Misuse and abuse of prescription painkillers alone costs the country an estimated $53.4 billion each year in lost productivity, medical costs, and criminal justice costs.

Vice President Biden’s point about values cannot be understated. Maybe, just maybe, policy makers are finally showing us that a healthier population with minimal opioid abuse is something they value.


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