Planting the Seeds of a New Heroin Epidemic

In our recent discussion at Washington Post’s Wonkblog, Harold Pollack and I talked about the astonishing scale of prescription opioid consumption in the US, which has no parallel anywhere else in the world. Americans consume 99% of world’s supply of hydrocodone, with the rest of the human race accounting for only 1%. Each year, U.S. health care professionals write more prescriptions for opioids than there are adults in the country.

Some of this prescribing has unquestionably been a blessing to people in pain. Some of it has however been highly destructive. Sally Satel highlights one of the adverse consequences of flooding the country with prescription opioids:

According to the 2012 National Survey on Drug Abuse and Health, four out of five new heroin users had previously abused painkillers.

The recent surge in heroin use is thus fundamentally different from its 1970s precursor. Its seeds were planted not in Southeast Asia but in doctor’s offices, emergency rooms and pill mills all across the country.

As policy makers focus attention on the resurrection of heroin in American life, they should remember that it remains a small problem compared to the painkiller addiction epidemic that fomented it and is still doing so: Deaths from legal prescription opioids exceed those from heroin by a factor of five. If we want a lower prevalence of heroin addiction five years from now, we should be looking upstream at policies that will combat the mis-marketing, mis-prescribing, diversion and abuse of prescription opioids.

Author: Keith Humphreys

Keith Humphreys is a Professor of Psychiatry at Stanford University. His research, teaching and writing have focused on addictive disorders, self-help organizations (e.g., breast cancer support groups, Alcoholics Anonymous), evaluation research methods, and public policy related to health care, mental illness, veterans and drugs. He is the author or co-author of numerous books and scholarly articles, and has written for the New York Times, Wall Street Journal, Washington Post, The Guardian (UK), the San Francisco Chronicle and other media outlets. When he is not in the San Francisco Bay Area, he is usually in London, where he is an ad hoc policy adviser to the national and city government, an honorary professor of psychiatry at Kings College, a senior editorial adviser to the journal Addiction, and a member of The Athenaeum. When he is not in the San Francisco Bay Area or London, he is usually in Washington D.C., where he serves as a frequent science and policy advisor to federal agencies, and where he has served previously as an appointee to a White House commission and several Secretarial task forces. From July 2009-2010, he served as Senior Policy Advisor at the White House Office of National Drug Control Policy. When he is not in the San Francisco Bay Area or London or Washington D.C., he is usually in the Middle East, where since 2004 he has volunteered in the international humanitarian effort to rebuild Iraq’s mental health care system. This work has taken him to Turkey, Egypt, Iraq, Jordan and Lebanon to teach and consult with Iraqi health professionals and policy makers.