The United States is experiencing an epidemic. However, neither
bacteria nor a virus has caused it, and the number of people it has affected is
increasing at an alarming rate. This disease
is heroin addiction, and approximately 8,000 people overdosed on the drug in
2013 alone. Over the past five years, this
number has increased over
200%, and now, federal and state governments are attempting to find new
solutions to keep this epidemic under control.
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.