On Tuesday, the U.S. Drug Enforcement Agency released its annual National Drug Threat Assessment, which aggregates data from law-enforcement agencies nationwide to pinpoint trends in American drug abuse and trafficking.
What the report indicates is that the opioid epidemic continues to grow at an alarming rate, and the availability of most all drugs of abuse is widespread. On the opioid front, heroin overdose deaths have tripled over the last five years, even as more departments outfit their officers with Narcan to allow overdose reversal when responding to calls. Further, when considering all drugs, overdoses now kill more Americans every year than firearms or motor vehicle crashes – it is the leading cause of injury death in the United States.
Prescription drug abuse is both part of the opioid epidemic and a problem in and of itself. Over the last ten years, there have been more deaths attributable to controlled prescription drugs than cocaine and heroin combined. Slightly less than half of overdose deaths in the U.S. are from controlled prescription drug abuse. While controlled prescription drug abuse has declined slightly over the last few years, those individuals are not ceasing their drug use – they are merely moving to other drugs, most notably heroin.
Interestingly, the DEA attributes the growth in overdose deaths in the U.S. to the increase in illicit fentanyl availability and use. Most illicit fentanyl is made in Mexico and China and is combined with heroin or other prescription medications to increase potency, often without the user’s knowledge. Due to fentanyl’s potency – far greater than heroin – a user’s normal dose can be fatal, as the effects of fentanyl overpower the individual.
While the prescription drug epidemic certainly has detrimental effects similar to street drugs like heroin, its acquisition and use patterns look significantly different. Unlike street drugs, the vast majority of prescription drug abusers either get their drugs from their primary doctor or from someone they know – a friend or a relative. Those friends and relative get their drugs from their primary doctor in over 80 percent of cases, as well – much of the abuse we see is from the use of leftover or unneeded drugs that were legitimately prescribed at one point. Just four percent of prescription drug abusers used a dealer as their primary source of acquisition. However, those numbers increased among frequent or chronic users – one in four self-described chronic pain reliever users bought their drugs second-hand from a friend, dealer or online.
Heroin continues to be incredibly deadly in practice, especially as fentanyl penetrates the U.S. market – and the number of heroin users continues to rise. The deadliness of this drug is reflected in the overdose numbers – while prescription painkiller users outnumber heroin users 10 to 1, the number of prescription painkiller overdose deaths is only twice that of heroin overdoses. Simply put, heroin is roughly five times as deadly as prescription painkillers in practice in the U.S. Nearly half of the DEA’s field units named heroin the #1 drug threat in their area. Production has continued to grow in Mexico, significantly increasing heroin’s availability in the U.S. over the past decade. Even as use and demand have increased, costs have decreased, which continues to create further demand for the drug. As demand and supply for heroin have increased, so have seizures of the drug at the border – DEA seizures have more than doubled since 2010, totaling over 6,000 kilograms in 2015. It’s no wonder, then, that more people have been admitted to treatment for heroin abuse than any other drug in recent years.
Due to the increase in heroin use nationwide, some states have started allowing or requiring law enforcement officers to carry naloxone with them to reverse overdoses when responding to an overdose call. However, the availability of naloxone to law enforcement is not widespread, especially in the west and upper midwest; states leading the way in naloxone availability include New York, New Jersey, Massachusetts, Pennsylvania and Ohio.
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