A Perfect Storm – The Rise in Heroin Addiction in the Middle Class

 

In the last five years, there has been an explosion in heroin addiction in the United States. According to the Substance Abuse and Mental Health Services Administration, the number of people who have used heroin in the last month has more than doubled from 2007 to 2012. The reasons for this increase are two-fold: (1) The crackdown on over-prescribing prescription pain medication and (2) an upsurge of heroin production in Mexico that has made the drug cheaper and more available than any time in history.

Opioid abuse was deemed an epidemic by the Centers for Disease Control in 2011, and the bulk of this abuse was centered on prescription pain medications such as OxyContin. OxyContin (the brand name for Oxycodone) is a synthetic form of morphine, but is twice as strong, and usually prescribed to people in the late stages of cancer, following surgery or to ease chronic pain. The pain-killing drug became widely prescribed, in part because it was thought to be part of the solution to the abuse of opioid drugs. OxyContin was designed to be released into the system slowly, thus avoiding the immediate high that drug users were seeking. But those wishing to abuse the drug soon learned they could bypass the time-release mechanism by crushing the pills and inhaling the powder, or by dissolving the pills in water and injecting the solution, resulting in large amounts of oxycodone entering the system all at once.

Prescription painkillers accounted for over 16,000 deaths in 2013—nearly 40% of fatal drug overdoses in America. As the toll grew, many states tightened their laws regarding prescription painkillers. In many states doctors must now check databases to make sure the patient has not already received a prescription from another doctor, and prescriptions have been cut to as little as a single pill, in order to reduce the supply. Pain Management Clinics that once churned out prescriptions with no questions asked have been shut down.

Drug manufacturers have also taken steps to make OxyContin harder to abuse. In 2010, a new version of the drug was released containing a substance that turns the pill to a gel when crushed, making it difficult to impossible to inhale or inject. This caused a shift away from prescription medications and onto heroin, which had become much more available and cheaper to purchase due to increased production from Mexico and Central America.

Policy changes in America – specifically the decriminalization of marijuana in many states – have led Mexico’s drug farmers to switch from growing marijuana to opium poppies. The price for marijuana has dropped so low there is little incentive to produce it. Also, the Mexican army, which used to spend much of its time eradicating drug crops in rural areas is now battling drug cartels in border cities such as Ciudad Juárez, allowing the increased opiate production to continue and expand. Mexico is now the world’s third-largest producer of opium, after Myanmar and Afghanistan.

America’s police have witnessed firsthand the effects of this increase in production. According to the U.S. Drug Enforcement Administration’s National Drug Threat Assessment Summary for 2014, seizures of heroin at the U.S.-Mexican border have risen from approximately 2540 kilos in 2009 to approximately 4761 kilos in 2013. Smugglers have become more aggressive as well. The average size of a heroin seizure has increased as well. In 2009, the average seizure was 0.86 kilograms; by 2013, it has climbed to 1.56 kilograms. The cost of the drug has also dropped, with the average dose decreasing from $20 in the 1990s to as low as $4 in some places today.

This combination of low price and increased availability has caused the face of heroin use in America to drastically change. According to a study published by the Journal of the American Medicine, heroin addicts in the 1960s and 1970s were mostly male, African American or Hispanic, and usually began their use at a very young age (the average age of first use was 16). Most users were poor, and lived in inner-city neighborhoods located in large cities. Today, nearly half of all heroin users are women, and 90% are white. The drug has crept into the suburbs and the middle class, replacing OxyContin and other prescription opiates and opioids. According to a study led by Theodore Cicero of Washington University in St Louis, most first-timers are in their mid-20s.

Now that many middle class families are caught in the grip of this devastating addiction, attitudes are beginning to change. New policies are being put in place to combat the rise in heroin use in the US. The Obama administration’s national drug strategy, published in July, criticized “the misconception that a substance-use disorder is a personal moral failing rather than a brain disease.”

 

MAP data is in line with what others are reporting. Heroin use is second only to alcohol in MAP clients’ reported drug of choice, and has become two times more common than other opiate and opioid addictions. The largest age group reporting heroin as their drug of choice is between the ages of 21-25, but there are reports of heroin use in all age brackets (12.5% of those aged 50+ years report heroin as their primary drug of choice). Heroin addicts are coming to MAP at increasingly young ages, and helping them maintain recovery is challenging.

According to the DSM 5, 20% – 30% of individuals with opiate use disorder eventually achieve long-term abstinence. As the number of heroin addicts continues to grow, it is imperative that we develop systems to improve those numbers. Long-term post treatment support is a vital component in helping this young, volatile population find recovery.

Even with the additional support the MAP Program provides, some will experience a lapse in sobriety. As MAP continues to work with each of them through this process, MAP Specialists are able to help them examine their experience and help them regain and recommit to their sobriety, avoiding another long foray into active addiction. It is this sort of ongoing proactive support that is needed to break the cycle of relapse and allow the addict to gain a solid foundation in recovery.