Tuesday, January 26, 2016

America’s Heroin Crisis: Pain Killers & Black-tar Heroin

Heroin is on a high right now. In Rutland, Vt., Albuquerque, N.M., and Charleston, W. Va. — where in 2010 the mayor’s own son was arrested for heroin possession — scoring heroin doesn’t require knowing “somebody.” More and more it requires just knowing anybody.

Between 2001 and 2014, heroin deaths nationwide increased 594 percent, according to the Centers for Disease Control. Of the 47,055 drug-overdose deaths in 2014 — an all-time high, and more people than died of liver disease or renal failure, of suicide, or in car accidents — heroin was responsible for over one-fifth.

(Blogger's Notes: America’s New Heroin Crisis Was Birthed by the Law of Unintended Consequences. The result of popular prescription pain killer pills such as OXYCONTIN, not that Double UO Globe brand pure heroin from the notorious Golden Triangle of Burma.)

Heroin used to be the go-to drug of Greenwich Village types. John Belushi, Janis Joplin, and Philip Seymour Hoffman all died with heroin in their systems. But it’s now often the drug of choice of coal miners, attorneys, dentists, and high-school students. Poor, young, white males are at especial risk. Nearly 90 percent of people who tried heroin for the first time in the last decade were white, according to a study in the journal JAMA Psychiatry, and the highest use rates are among persons making less than $20,000 a year.

The heroin spike, which began in earnest in 2011, is a deadly demonstration of the reality of the Law of Unintended Consequences. Opiates have a long and distinguished history, from ancient Egyptian religious rites to Victorian-era recreational use à la Sherlock Holmes, but were largely restricted to carefully regulated use in extreme medical cases shortly after the turn of the 20th century.

But in the 1980s, doctors began to prescribe opioids — a class of drugs encompassing natural opiates and semi-synthetic versions, such as hydrocodone and oxycodone — to patients experiencing lesser but chronic pain, as part of an industry-wide effort to more aggressively combat chronic suffering. That effort had a breakthrough in 1996, when Purdue Pharmaceuticals introduced OxyContin.

The pill, which was able to relieve severe pain for ten to twelve hours at a time, was hailed as a miracle, and prompted dozens of copycat versions. But by 2004, 2.4 million people twelve-years-old and older were using prescription painkillers for nonmedical reasons. The causes were several.

Pharmaceutical companies, which had vigorously marketed their miracle drugs, often had knowingly misrepresented their addictive properties (Purdue pleaded guilty to a felony charge of just this sort in 2007 and paid a $634.5 million fine); people were likely to underestimate the risk of drugs given them by a doctor; and many doctors got into a habit of overprescribing.

In the meantime, a small group of drug traffickers known as the “Xalisco Boys” — not a high-powered cartel, but small groups of poor Mexicans largely from the town of Xalisco — began to move black-tar heroin, the chemical structure of which is nearly identical to OxyContin, into the United States, setting up in midsized towns and selling mainly to whites.

In the late 2000s, federal and local authorities started looking for ways to cut down on rampant prescription-opioid abuse. Methadone clinics opened, and opiate-addiction programs began enrolling abusers. Naloxone, a drug that reverses the effects of an opioid overdose, was issued to first responders in certain jurisdictions. Prosecutors cracked down on doctors overprescribing opioids, and doctors administered them more judiciously.

In 2010, Purdue reconfigured OxyContin so that it could no longer be crushed and snorted, and in 2014 Vicodin and other hydrocodone-based drugs joined oxycodone on the Drug Enforcement Administration’s list of Schedule II drugs, one level below illegal substances such heroin, ecstasy, and bath salts.

But those much-needed reforms opened the door for operators more ambitious than the Xalisco Boys. Drug cartels, such as Joaquin “El Chapo” Guzman’s Sinaloa cartel, now move heroin into the United States in bulk. Border Patrol agents report that it’s not uncommon to find 50-, 60-, or even 100-pound bags concealed in vehicles passing through checkpoints along the southern border, and in a recent issue of The New Yorker, Ian Frazier noted: “Heroin confiscations at the border have increased from about five hundred and fifty-six kilos in 2008 to about twenty-one hundred kilos in 2012.

In New York in 2014, more than two hundred kilos had been seized by July, more than twice as much as during all of 2013.” A decade ago, heroin in those quantities was unthinkable.   But markets abhor a vacuum, and as access to prescription opioids is more diligently controlled, heroin is an easy-to-find alternative, and a cheap one. Prices vary by location, but a single “bag” (usually 100mg) of heroin is typically comparable to a pack of cigarettes.

By comparison, an illicit 30-milligram OxyContin tablet can run upward of $90. “Hillbilly Heroin” — street slang for the prescription painkiller — is in open competition with the real thing. And it’s earning the attention of the presidential candidates.

New Hampshire, site of both major parties’ first primary contest in just two short weeks, suffered about 400 drug-overdose deaths for 2015 (toxicology reports for several cases are still pending), an approximately 17 percent increase in drug-overdose deaths from 2014 to 2015, on top of an astonishing 73.5 percent increase from 2013 to 2014.

Oxycontin-addicted baby.
According to the state’s Chief Medical Examiner’s Office, the rapid rise in overdose deaths in recent years is largely attributable to the emergence of fentanyl, a synthetic opioid that is often added to heroin or to other drugs. The CDC reports that fentanyl “is estimated to be 80 times as potent as morphine and hundreds of times more potent than heroin.” It’s little mystery — chemically speaking — why the Granite State has among the highest per-capita rates of addiction in the country.

A WMUR poll in October poll showed that drug abuse was New Hampshire voters’ foremost concern. New Hampshire officials are having trouble getting hold of the problem. Last fall, Governor Maggie Hassan (D.) called the drug epidemic an “all-hands-on-deck moment for New Hampshire,” but she has often appeared at sea.

In mid January, after just one year in the position, Jack Wozmak resigned as Hassan’s handpicked “drug czar,” a job at which he “failed spectacularly,” wrote the Manchester Union Leader’s editorial board. The paper also criticized Hassan’s acting Department of Health and Human Services commissioner, Jeffrey Myers, for prioritizing Medicaid expansion over substance abuse — a decision her opponents say was motivated by Hassan’s decision to challenge incumbent Kelly Ayotte (R.) in this year’s Senate race.

Last week, Hassan signed two bills penned by the state’s legislative task force, set up during a special session last year — but the bills are modest, at best. Meanwhile, residents are concerned. A WMUR poll in October poll showed that drug abuse was New Hampshire voters’ foremost concern; 25 percent cited the drug epidemic, up from just 3 percent one year before.

Talking with National Review, Joe Harding, director of the state’s Bureau of Drug and Alcohol Services attributes the increase to efforts by government and nonprofit organizations to spread awareness of the danger of misusing prescription drugs, to prescription-monitoring, and to efforts to target at-risk populations. But it is also an inevitable side-effect of more widespread usage.

As Manchester mayor Ted Gatsas told the Los Angeles Times last month, “If this has not touched you yet, it will very soon.” Manchester, the state’s largest city, saw 75 overdose deaths last year. For presidential candidates, the crisis has meant getting specific — and, often, personal.

Earlier this month, at a forum on heroin addiction at Southern New Hampshire University, Jeb Bush told the story of his daughter, Noelle, who was jailed for prescription-drug abuse and crack-cocaine possession in her twenties. “What I learned was that the pain that you feel when you have a loved one who has addiction challenges and kind of spirals out of control is something that is shared with a whole lot of people,” Bush told the audience.

It was the first time he had discussed his daughter, now 38 and in recovery, on the campaign trail. Carly Fiorina has also related the story of her step-daughter, who died prematurely from an alcohol and prescription-drug addiction. But it’s Chris Christie who has seized on the drug crisis.

In October, at an event in the town of Belmont, Christie related the story of a law-school friend who became addicted to prescription painkillers. Video of the anecdote, which the Huffington Post published on Facebook, has been viewed more than 8 million times. Christie has emphasized thinking of drug addiction in terms of rehabilitation, not retribution. “We’ve been programmed in our society to talk about this as a moral failing,” he said earlier this month. “As long as we continue to do this we’re going to treat this differently than other diseases.”

That mirrored his remarks to his own state legislature during his January 12 State of the State address: “There are few things that I’ve worked on harder as governor or that I believe as strongly as this,” he said. “Drug addiction, just like cancer, is an illness. It can strike anyone, from any station in life.” And at a speech at the New Hampshire statehouse last week, Christie focused his remarks almost entirely on the drug crisis: “Here’s the only pitch today that I’ll make to you about myself,” he said. “I’ve done it. We’ve done it in New Jersey.”   

Numbers are not available yet, but Christie says that heroin-involved deaths dropped in 2015 for the first time in five years. If so, it may be partly attributable to aggressive action on the part of the governor and the legislature over the past two years to expand opioid-abuse treatment and education programs and expand the use of naloxone (which is credited with saving hundreds of lives in the state).

In his State of the State, Christie encouraged reopening a closed state prison as a drug rehabilitation center for prison inmates. Whether this will make a difference at the voting booth is anyone’s guess. The RealClearPolitics poll average has Christie in fifth in New Hampshire (although just five points out of second place, which currently belongs to John Kasich), and the presumptive winner of the Republican primary, Donald Trump, has breathed nary a word about the situation.

But what is happening in New Hampshire is happening across the country. There is a quiet crisis on, and it promises to remain in the headlines long after the ballots are cast.

Heroin is a dangerous drug that wreaks havocs on the lives of those who use it. It is highly addictive, easy to overdose on, increases the risk of contracting contagious diseases like HIV, and, like other types of drugs, can destroy relationships and lives.

There has been an increase in the use of heroin across the country, largely blamed on the epidemic of addiction to narcotic painkillers. Because it is cheaper, and often easier to access, many prescription pill addicts are turning to heroin. What could make the situation even worse is the presence of black tar heroin on the market. Brought in mostly from Mexico, this cheaper and more dangerous form of the drug could increase the number of deaths among heroin users.

What Is Heroin?

Heroin is a substance that is made synthetically, but is based on morphine, a natural compound from the opium poppy. It was first made in the late 1800s and was used as a painkiller and a cough suppressant. It was effective, but also, as was soon discovered, extremely addictive. Heroin is now a Schedule I controlled substance and illegal for most people to have.

Most abusers inject heroin, but it can also be smoked or injected. It is typically sold as a powder that contains fillers, sometimes dangerous and harmful ones. In the short-term, heroin makes the user feel a euphoric rush, or a high. It also causes dry mouth, drowsiness, flushing of the skin, poor mental functioning, slurred speech, vomiting and constipation. Overdose is possible, even on the first try. With long term use, heroin causes collapsed veins, heart infections, liver disease, pneumonia and addiction.

What Is Black Tar Heroin?

Black tar heroin is a more dangerous form of the drug that poses a real public health threat as the number of heroin users rises. Black tar heroin is attractive to addicts because it costs so little. The low cost is due to the fact that this type of heroin can be produced without much equipment. The result is an unrefined product. It does not necessarily contain less heroin than other products, but it does contain more contaminants that are costly to remove.

Compared to regular heroin, which is a white to yellowish powder, black tar heroin is brown or black in color, and has a sticky feeling. In addition to being cheaper, black tar heroin is also more dangerous. Because of its sticky texture, this type of heroin causes veins to collapse much more quickly. Users have to switch injection sites often, destroying veins as they go. To avoid ruining their veins, some users may inject black tar heroin subcutaneously. This practice can lead to dangerous infections.

Most black tar heroin is produced in Latin America and comes into the U.S. through Mexico. For the last decade, most of the product has been seen in Western states, where it is sold by drug dealers looking to make money on a new, cheaper product. In recent years, however, black tar heroin has been spreading eastward. It is seen in rural areas in the Midwest, in particular, where heroin addicts are in search of a cheaper high. The U.S. Drug Enforcement Agency sees black tar heroin as a rising threat. The agency reports that the product is expected to continue moving east into new markets.

The continued rise in abuse of prescription painkillers and heroin is a major problem in the U.S. The influx of black tar heroin will only make it worse as addicts look for better access to cheaper products. Unfortunately, many will eventually pay the price.

Danger of Black Tar Heroin from Mexico.