America’s Epidemic: Heroin

After heroin was synthesized, Bayer Pharmaceuticals vigorously marketed the drug. However, physicians noticed in the early 1900s that patients were increasingly consuming cough medicines containing heroin. In 1914, the Harrison Narcotics Act was passed, outlawing the manufacturing and possession of heroin, and in 1971, President Nixon launched the official War on Drugs. The 1990s witnessed a surge in pain medication dependency, but many users abandoned these pills for a much cheaper option. The number of heroin users continued to climb through the 2000’s when the number of individuals reached alarming levels.

In 2011, Ohio’s Department of Alcohol and Drug Addiction Services published the Substance Abuse Monitoring Network report. The report divided the State by county and explained in great detail the common trends of Ohio’s drug users. All of the highlighted regions in Ohio noted the increased availability of heroin, and most stated that heroin was the most prevalent drug used amongst younger populations. The report further enumerated many who were addicted to prescriptions opioids, such as OxyContin®, progressed to heroin due to the ease of obtaining it and its affordability.

Ohio was not the only state experiencing an uptick in heroin overdoses and heroin related deaths. In Colorado, six teens died from heroin usage in the 12 years before 2012; however, in that year alone, five teenage boys died of overdoses. Illinois felt the impact near the suburbs where 46 individuals died in 2013, the youngest being a mere 15 years old. In Minnesota, admissions to treatment abuse centers grew from 450 to 4,519, and Connecticut reported 10,183 people in its licensed treatment programs.

This epidemic is still spreading at a rate that has politicians from both parties calling for drastic measures. Hillary Clinton called the addiction to heroin a “quiet epidemic,” and stated her team would go beyond standard policies and seek creative, forward-looking positions. Republican candidate Chris Christie signed a bill in his home state of New Jersey that established a statewide task force, and he expanded drug courts and access to the drug naloxone, which can reverse the effects of opioid overdoses. 

The Federal government announced $13.4 million in funding for High Intensity Drug Trafficking Areas (HIDTA), $5 million of which will be directed solely to reducing the trafficking, distribution, and use of heroin. Of this funding, $2.5 million will go towards the Heroin Response Strategy, a partnership among five regional HIDTA programs, that will address the epidemic through public health and public safety partnerships across 15 states. These five HIDTAs will select two Regional Coordinators to manage and implement Heroin Response Teams. The Public Health Coordinator will oversee the reporting of overdose information, both fatal and non-fatal, and will then issue relevant alerts associated to heroin-related threats to the health authorities. The Public Safety Coordinator will oversee the execution of public safety goals by ensuring case support is provided where needed, and facilitating the dissemination of intelligence to relevant law enforcement to disrupt the heroin supply. Beyond these efforts, a training curriculum will be developed for rural and municipal officers and first responders to be better prepared when responding to heroin incidents. The Heroin Response Strategy will also develop education and training to increase awareness and create linkages to available prevention and treatment resources.

Outside of the HIDTA efforts, the federal government is providing educational training and resources for health care providers. This training will be aimed at teaching the appropriate prescribing practices of opioid painkillers. The Affordable Care Act has expanded coverage to millions of Americans, and through this expansion, substance abuse benefits are provided for all newly covered individuals, as well as, broadened benefits to millions through the Mental Health Parity and Addiction Equity Act. Additionally, the federal government is expanding the use of Medication-Assisted Treatment (MAT), which is provided by the Substance Abuse and Mental Health Services Administration. MAT will combine behavioral therapy and approved medications to treat substance abuse disorders for those with a heroin addiction, along with all other substance addictions.          

State governments have also responded to this epidemic. Eighteen state legislatures introduced new heroin related bills that range from leniency for low-level heroin offenders to permitting easier access to naloxone. Massachusetts will spend $10 million for a court diversion system in order to provide treatment for non-violent drug offenders, and another $20 million to bolster the state’s drug treatment system. Ohio, the state that brought this epidemic to the forefront of conversations, has enrolled in the Medicaid expansion under the Affordable Care Act. States that have yet to address the crisis are encouraged to expand training on the administration of naloxone, and should ensure that the population has access to integrated prevention services, such as sterile injection equipment. 

Lana Smith is currently a 3L pursuing her law degree and a health law certificate from DePaul College of Law. She completed her undergraduate degree from the University of Michigan in International Studies - Comparative Cultures & Identities. Lana is the Co-Director of Outreach & Recruitment of the Jaharis Health Law Institute Student Board, and an active Health Law Fellow. She would like to focus her career on health policy and medical ethics after her graduation.​