A perfect storm of supply and demand is fueling the drug’s rapid rise in popularity.
January 27, 2015
Like most heroin users, Ory Joe Johnson’s addiction began with a
perfectly legal prescription. After a bad car accident in which he broke
his nose, jaw, collarbone and ankle, the Wyoming native was prescribed
Vicodin for the pain. The meds eventually ran out, but his dependence on
them remained. To fuel it, Johnson began dealing drugs, starting with
crank (a low-quality powdered form of meth), and as the years passed and
his addiction metastasized, eventually moving up to heroin. At the peak
of his dealing career, Johnson was funneling drugs to a network of
local college students and his reach extended to a constellation of
southern Wyoming towns.
The subject of a
recent GQ profile,
Johnson is now serving nine years in prison for possession and intent
to sell. Though he is just one dealer in just one corner of the country,
his story has much to say about how heroin is gripping its pale white
fingers around the throats of America’s small towns.
To make something clear right off the bat, we are not experiencing a heroin “
epidemic.” As the
GQ article points out, more Americans huff glue than use the drug, and the total number of users is a
tiny fraction
of the U.S. population. But for a number of reasons, including high
national rates of opiate addiction, rock-bottom prices, corrupt medical
professionals, and a surge in supply from Mexico, heroin usage is on the
rise. In 2012, some 669,000 Americans reported using heroin in the past
year,
according
to the National Survey on Drug Use and Health. That year alone, 156,000
people started using the drug—nearly double the number of people in
2006 (90,000). As the DEA’s regional head for the Midwest put it in an
interview with BBC, “Heroin addiction is probably at its all-time high.”
(Source GQ)
It’s
impossible to understand the drug’s recent resurgence without looking
at the rise of prescription opiates in the 1990s. In "
The New Heroin Epidemic,” a terrific investigative piece in the
Atlantic,
Olga Khazan traces the emergence of blockbuster pain medications like
Oxycontin and Percocet. Big Pharma executives waged an aggressive
marketing campaign to popularize the drugs, downplaying the risk of
addiction, sending thousands of doctors on junkets across the U.S. to
learn about the pills and offering sales reps millions in bonuses for
convincing doctors to prescribe them. Their efforts succeeded, but with
devastating consequences. As the drugs became more widely prescribed,
painkiller abuse
skyrocketed;
the number of deaths caused by prescription painkiller overdose
quadrupled between 1999 and 2011. In some states, prescription abuse was
facilitated by corrupt doctors who
overprescribed, sold prescriptions on the side, and even
exchanged the pills for sexual favors.
The
Atlantic
article uses the case study of West Virginia to explain how
prescription pill addiction heralded the current surge in heroin use. A
poor state with a high concentration of physically demanding
manufacturing and mining jobs and little else in the way of economic
opportunity, West Virginia was a ripe target for prescription drug
abuse. As Khazan writes, by 2009 residents were annually
filling
an astonishing average of 19 prescriptions per person. Around this
time, medical and state authorities started cracking down, jailing
corrupt physicians, establishing databases to prevent patients from
getting prescriptions from multiple clinics, and developing pills that
were less easy to crush into powder form. Prescription pill use fell.
But people were already addicted, and were going to find another outlet.
Three out of four new heroin users
say they abused prescription painkillers before turning to the drug.
This
spike in demand for heroin coincided with a surge in supply. Mexican
cartels, which are moving out of the marijuana market as legalization
gains a firmer hold in the U.S., are
sending cheap, high-quality heroin across the border. As the
Washington Post reported,
“The amount of cannabis seized by U.S. federal, state and local
officers along the boundary with Mexico has fallen 37 percent since
2011, a period during which American marijuana consumers have
increasingly turned to the more potent, higher-grade domestic varieties
cultivated under legal and quasi-legal protections in more than two
dozen U.S. states.” Heroin has advantages for both opiate addicts and
traffickers. It costs only $10 a pill, compared to $80 for oxycodone,
and is easier to transport and conceal than marijuana.
Of course, this isn’t the first time Americans have embraced heroin. But, as every article about the drug’s resurgence
points out,
the face of heroin use has changed. In the 1960s and '70s, heroin took
hold in urban centers. “Forty or fifty years ago heroin addicts were
overwhelmingly male, disproportionately black, and very young,"
according to the
Economist. "Most came from poor inner-city neighborhoods.” Today, many heroin users
live
in suburban and rural areas—places like southern Wyoming and the
foothills of West Virginia. Ninety percent of users are white, and more
than half are women. It doesn’t take too many logical leaps to
understand why the drug’s newfound popularity has been met with so much
attention, and why the media is so willing to label it an epidemic.
(Source: The Economist)
This
changing user demographic has been met with a shift in official
response. “Now that heroin addiction is no longer a disease only of the
urban poor, attitudes are changing. The Obama administration’s latest
national drug strategy, published in July, criticized ‘the misconception
that a substance use-disorder is a personal moral failing rather than a
brain disease,’”
according to the
Economist.
They have called for the expansion of needle-sharing services and
greater access to naloxone, a drug that can reverse the effects of
heroin overdose.
It’s critical that federal and state authorities
expand drug and psychological treatment services for heroin users.
Physicians interviewed in the
Atlantic article say that a
combination of drug treatment and talk therapy is the best way to wean
people off of its influence. But the areas that are particularly
blighted by the drug, like rural West Virginia, are often the least
equipped to handle it. They are economically depressed regions with
limited access to health services, few job opportunities and bare-bones
police departments. Only two-thirds of West Virginians
have
access to mental-health treatment, and the medical officer for the
Substance Abuse Mental Health Services Administration said that only a
handful of places in the country have enough providers able to offer
drug treatment alongside therapy. This is where we have to focus our
energies. Because in the kinds of towns where Ory Joe Johnson was
pushing heroin—dusty roadstops of 3,500—addiction
is an epidemic.
