Epidemic: heroin addiction … again. What will it take this time?
This epidemic is different. The response must be different, too.
A Historical Perspective on Opioids
Heroin is an opioid drug derived from the poppy plant. It has no medical use and is typically injected to produce a time-limited high. It also produces a rebound withdrawal sickness in those who become addicted to it. Heroin is no longer a drug that is just abused in cities. Overdose deaths and new cases of addiction are particularly prominent in some of our most rural states, such as Vermont, Indiana, and New Mexico.
Taking a New Approach
This time the federal response is different as well, coming from the director of the CDC - our major public health office – and not just the directors of Homeland Security or Justice. Frieden called for "an all-of-society response – to improve opioid prescribing practices to prevent addiction, expand access to effective treatment for those who are addicted, increase use of naloxone to reverse overdoses, and work with law enforcement partners like DEA to reduce the supply of heroin." This says a lot to me – particularly that our country has begun to take a full-fledged public health and public safety approach to the epidemic of opioid use problems. I agree with Dr. Frieden: "it is time we use all the resources we have."
Opioid epidemics will continue to occur with increasing regularity in this country unless we get serious, get scientific and get organized. But the good news is that this and future drug epidemics can be effectively faced and stopped. We have the means; we just haven't used them:
Better physician training combined with broader use of existing technology can reduce improper prescribing of opioids. That's one part of the problem.
States and communities can stop ineffective, uncoordinated prevention and implement tested, cost-effective programs that will alert, educate and equip families, schools, law enforcement, and healthcare agencies with the tools they need to prevent or intervene early at signs of any drug problem. That will help too.
But healthcare providers and insurers must also stop willfully ignoring the addiction problems throughout healthcare settings and decide to finally provide the research-derived medications, behavioral therapies and therapeutic monitoring that can make recovery an expectable result of treatment for opioid addiction.
These latest calls from the CDC suggest that we have finally begun to move past an ideological approach to drug abuse and towards policies based on the best science. Maybe soon we will also find the public and political will to demand the full complement of our public health and public safety tools to combat these deadly epidemics.
A. Thomas McLellan, PhD, founder and chairman of the board of the Treatment Research Institute in Philadelphia, is a former deputy director of the White House Office of National Drug Control Policy.
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