The LIAAC Blog

News and thoughts from the Long Island Association for AIDS Care

Opioids, Heroin: The Crisis Hits Home

By Sara GuandoThe opioid epidemic has been declared a national emergency. In his remarks President Trump stated “Nobody is safe from this epidemic that threatens young and old, rich and poor, urban and rural communities.  Everybody is threatened.”[i] The statements have recognized a crisis that has been mounting over the years at a sweeping rate. Between 1999 and 2015, deaths from drug overdoses have quadrupled in the United States.

How did we get here?

In the mid-1990s, Oxycontin hit the market and the drug manufacturer, Purdue Pharma, began a large-scale marketing campaign for the drug. This seems typical for any new product but Purdue Pharma’s promotions were anything but typical. Knowing the apprehension of doctors to liberally prescribe opiates, Purdue Pharma marketing campaign included videos that positioned Oxycontin as a safe option for a variety of uses. They claimed that the risk of addiction was under one percent and encouraged both short and long term uses of the drug. As doctors accepted these claims to be true, prescriptions for Oxycontin grew rapidly in the late 1990s – early 2000s. The National Institute on Drug Abuse identified “drastic increases in the number of prescriptions written and dispensed, greater social acceptability for using medications for different purposes, and aggressive marketing by pharmaceutical companies” as key components of the onset of the nation’s ongoing opioid epidemic.[ii] In 2007, Purdue Pharma paid one of the largest pharmaceutical settlements in the amount of $634 million dollars, for its role in the opioid crisis. The company continues to face lawsuits around the country for misleading marketing.
How bad is it, really?

Fueled by a prescription drug addiction, users become more likely to try drugs intravenously and/or turn to heroin, both of which are cheaper options. According to a recent study, 75% of heroin users started by using prescription opioids.[iii]Additionally, because of the prescription opioid crisis, government agencies began cracking down on the prescription methods and practices. Databases were created as doctors and pharmacists suspected of not following guidelines were flagged and investigated. This led to prescription drugs being less available from reckless prescribing of opiates, and less capability for patients to “doctor jump,” meaning users were going to multiple doctors for similar problems and having multiple prescriptions written. However, whatever positive effect this may have had did not sustain, as these crackdowns are typically where the increase in heroin and injection drug use began. With prescription drugs less readily available, users attempted to obtain the drugs illegally, or turned to illicit drugs in their place. And so, America is now in the grips of a two-headed crisis, and this epidemic is not going down without a fight. The answers of how we move forward and combat this issue has proven controversial and time consuming as law makers and physicians seek the best response.

In the meantime…

  • 91 people die every day from opioid overdose.
  • 1 out of 10 new HIV diagnoses involve injection drug use.
  • If current rates continue, 1 in 23 women who inject drugs and 1 in 36 men who inject drugs will be diagnosed with HIV in their lifetime.
  • In the United States, injection drug use is the primary risk factor for transmitting Hepatitis C.

In short, this epidemic affects all areas of social, medical and mental health for users, families, and loved ones, and we need a solution.

I don’t use drugs. Why should I care?
I see it on the news. I hear about it. But, these drug addicts are making a choice. It’s their own fault.

 The issue is closer to home than you may realize. Heroin abuse has increased amongst most demographic groups: male, female, age categories, race/ethnicities, across incomes, and healthcare access. In fact, the highest increases of heroin abuse have been amongst demographics that were previously much less affected by the drug problem. Studies show “heroin use has changed from an inner-city, minority-centered problem to one that has a more widespread geographical distribution, involving primarily white men and women in their late 20s living outside of large urban areas.”[iv]And New York is no exception. From 2013 to 2014 overdose deaths caused by heroin increased over 24%, and have risen still since. Up to 500 people died on Long Island in 2016 from opioid overdoses, a new record high. And just this summer, in June 2017, over a two day period, nearly two dozen people overdosed on opioids.

 There is more danger to drug use than an overdose. The spread of disease, including HIV and Hepatitis is a huge concern. Mental illness, loss of work, and destruction of families are common as addiction takes hold of a person’s life. Treatment options are not as clear, nor as available, as other medical conditions. The societal stigma and criminal nature of illicit drug use can be incredibly damaging to people seeking help. Moreover, the fact that this crisis was created by the companies that we trust our lives and our quality of life with often goes unseen. Because of stigma, isolation, and the threat of having to stop using a drug they have become dependent on, users tend to live in the dark. Maybe not in dark, deserted alleys that TV suggests, but in the shadows of everyday life. They are our neighbors, friends, family members, who keep part of themselves as hidden as they can. So, we should all care. No one is a good, law-abiding person one day and then wakes up the next and decide to inject themselves with heroin.  It’s easy to blame a drug addict for “getting themselves addicted” but in reality; it’s more complicated than that.

How many degrees of separation are you from this crisis? Chances are, on Long Island, you aren’t far from it.

Next time, we will dive into the options. What can we do? How do we combat this epidemic and protect our loved ones? How do we get people the help they need, and stop the spread of HIV and Hepatitis? Join LIAAC for Part 3 of our blog series on the Opioid Crisis.

 

References

i. The White House. Remarks by President Trump Before a Briefing on the Opioid Crisis. (8 August 2017) https://www.whitehouse.gov/the-press-office/2017/08/08/remarks-president-trump-briefing-opioid-crisis

ii.  Office of the New York State Comptroller, Thomas P DiNapoli. Prescription Opioid Abuse and Heroin Addiction in New York State. 2016 June. Retrieved from http://www.osc.state.ny.us/press/releases/June16/heroin_and_opioids.pdf

iii. Seelye, Katharine Q. The Numbers Behind America’s Heroin Epidemic. (30 Oct 2015) Retrieved from https://www.nytimes.com/interactive/2015/10/30/us/31heroin-deaths.html

iv. Cicero, Thomas, Ellis, Matthew, & Surratt, Hilary. The Changing Face of Heroin Use in the United States: A Retrospective Analysis of the Past 50 Years. 2014 July. Retrieved from JAMA Psychiatry. http://jamanetwork.com/journals/jamapsychiatry/fullarticle/1874575

More References

Center for Disease Control. Drug Overdose Death Data.(December 2016) https://www.cdc.gov/drugoverdose/data/statedeaths.html

“Purdue Pharma OxyContin Commercial” (22 Sep 2016) https://www.youtube.com/watch?v=Er78Dj5hyeI

“Purdue in $634 million settlement over Oxycontin” (20 July 2007) http://money.cnn.com/2007/07/20/news/companies/purdue/index.htm

Center for Disease Control. Understanding the Epidemic. (December 2016) https://www.cdc.gov/drugoverdose/epidemic/index.html

Center for Disease Control. HIV and Injection Drug Use. (March 2017) https://www.cdc.gov/hiv/risk/idu.html

Campbell, Cecily, Canary, Lauren, Smith, Nicole, Teshale, Eyasu, Ryerson, Blythe, & Ward, John. State HCV Incidence and Policies Related to HCV Preventive and Treatment Services for Persons Who Inject Drugs — United States, 2015–2016. (12 May 2017) https://www.cdc.gov/mmwr/volumes/66/wr/mm6618a2.htm

Morales, Mark. “Nearly 500 People Died on LI from Opioid Overdoses in 2016” Mark Morales (9 April 9 2017) http://www.newsday.com/long-island/nearly-500-people-died-on-li-from-opioid-overdoses-in-2016-1.13387679

Brooks, Khristopher. “Police: 22 opioid ODs, 1 fatality in 48 hours cause for concern” (30 June 2017) http://www.newsday.com/long-island/suffolk/police-22-opioid-overdoses-1-fatality-in-48-hours-a-cause-for-concern-1.13705833

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