Heroin: A Growing Epidemic Spreads Across the United States

Tuesday, February 04, 2014

Homeless woman Joan Kimball, 37, prepares to injects herself with heroin beneath the Manhattan bridge where she lives November 20, 2001 in the Brooklyn borough of New York City. (Mario Tama/Getty)

The death of actor Phillip Seymour Hoffman has brought an epidemic to light. 

According to the 2012 National Survey on Drug Use and Health, the number of people aged 12 years or older who identified as current heroin users rose to 335,000, up from 281,000 in 2011. By contrast, in 2002 about 166,000 people admitted to being current heroin users. Additionally, the data shows that in 2012, the number of people addicted to heroin rose to 467,000—twice the number in 2002 (214,000).

Some researchers tie the rise in heroin use to tighter restrictions on prescription opiates like Oxycotin and Vicodin. The epidemic has hit  New England  particularly hard. Vermont Governor Pete Shumlin devoted his entire State of the State address to the topic, last January. 

"In every corner of our state, heroin and opiate drug addiction threatens us," Governor Shumlin said. "It threatens the safety that has always blessed our little state."

Dr. Anand Veeravagu, Senior Neurosurgery Resident at Stanford University School of Medicine and former special assistant to the Secretary of Defense, examines the rise of heroin addiction in the United States, and explains how restrictions on prescription opiates may relate.

Guests:

Dr. Anand Veeravagu

Produced by:

Jillian Weinberger

Editors:

T.J. Raphael

Comments [16]

B

It's difficult to understand self-destructive addiction if you have not experienced it, tough to draw analogies with other experiences.

What makes it more confusing is that the same substance can relieve pain as well as result in it (longer-term).

It's a big step forward that we are speaking of this as a medical condition (both mental and physical) rather than in moral or ethical terms as was common not too long ago.

Feb. 06 2014 06:24 AM
KE from SF Bay Area

Very timely discussion. There is no doubt that prescription medications can be destructive even with the best of intentions. And there is no doubt that abuse of prescription meds and street drugs goes hand in hand.

Doctors that adamantly defend aggressive prescribing practices usually believe chronic pain is the real epidemic and almost everyone is undertreated- those are usually ED physicians with very transient patient relationships. It is easy for an "expert" to dole out dilaudid and send someone on their way. But some of us have always questioned if you should give opioids for chronic nonterminal pain.

In the last decade we went through the era of pain being the fifth vital sign, and suddenly patient satisfaction surveys became more important than outcomes. So we began prescribing more and more. That was the real hysteria. It wasn't conjured up by a political action committee. We did it to ourselves. Now time to pay the piper. Ask the DEA which is a bigger problem- chronic pain or heroin addiction?

Feb. 06 2014 12:04 AM
Mike C from philadelphia, pa

Opioid abuse is very difficult for even the most experienced physicians to manage. With the increasing focus on patient satisfaction in the outpatient setting as well as reduced time physicians can devote to each patient it is enormously difficult to determine if a patient is abusing pain medication while also managing the patients acute and chronic pain. LIke the guest speaker said, further education is necessary if we are to make real strides in combating this from the health provider standpoint. thank you for the enlightening discussion

Feb. 05 2014 11:36 PM

As a surgeon myself, I know this is a complex topic. Great to see someone with first hand public health policy and medical knowledge tackle the subject. Given the limited time, I think it is important to understand that this interview only begins to scratch the surface of the problem and opens the door to more discussion. Looking forward to longer/in-depth discussions with Dr. Veeravagu. Would be interesting to hear more talk about heroin policies in other countries, as this is a global problem with a long history. What has worked/what has not?

Feb. 05 2014 11:33 PM
tc

A great discussion on an interesting and difficult topic. The attacks ad hominem on the guest seem a bit misplaced, particularly given that neurosurgical training requires constant triage and treatment of emergent situations that are at times caused by drug abuse as well as require narcotic use after surgical treatment for pain control.

Feb. 05 2014 10:07 PM
Policy Star from San Ant. Texas

Interesting that all the emergency physicians are "experts" - judging by the speakers bio, not only did he work on drug policy in the administration, but also has a long line of research work dedicated to addiction and deep brain stimulation targets. I actually thought it was well presented for the public.

Feb. 05 2014 06:55 PM
Sharon MD from Portland, OR

I do not know why a resident in neurosurgery was used as the "expert" in this field, when there are so many other more appropriate choices. Even the language used (referring to "narcotics") and the basic information was often mis-stated. I can't imagine why this show was aired with such clear deficiencies, though the scope of this problem is indeed tremendous. Taking the time to find an appropriate expert and do the basic research would have been well worth it.

As an emergency physician, I treat pain every day. I also see the effects of prescription opioid misuse, abuse and diversion every day. The data has been very clear that there is a public health crisis of prescription opioid misuse, abuse and diversion (see SAMHSA website, Drug Abuse Awareness Network). Deaths from prescription opioid overdose are greater than deaths from heroin and cocaine combined. These medications are dangerous, and they are addictive. This doesn't mean the medications shouldn't be prescribed, but that they only be prescribed with a full evaluation of the risks, benefits and alternatives. There does appear to be a correlation between increase in heroin use with possible decrease in opioid prescribing, but there is no evaluation of any causal relationship. We should be looking at the underlying causes of ALL opioid addiction (and other addictions), and provide increased understanding, compassion and treatment, while addressing the underlying causes.

Great topic, very poorly presented.

Feb. 05 2014 12:53 PM
Thomas Castonguay from Kelliher, MN

My little broken neck incident(C3 through C5)and the lengthy & complex surgery that followed led to PAIN!!! I was prescribed a very powerful, highly controlled narcotic (& a full neck brace). The MD & his PA warned me that the both would be needed for 3 months or more -- they were correct. The more local clinic began harassing me at the second refill -- they just knew that I was hooked.
The side affects were awful -- I cannot understand why anyone would take narcotics voluntarily. This was my first narcotic experience -- I hope to never have another. Some people really need POWERFUL pain relief, not everyone that is on pain meds is junkie.

Feb. 04 2014 04:21 PM
Frank Day, MD from SF Bay Area

How did you ever come to believe that a RESIDENT in NEUROSURGERY could possibly be an expert in addiction or the literature/science on opiods/addiction. The number of people who become addicted to opiods after being prescribed opiods to treat pain is TINY, about the same as those who become addicted to opiods after eating Cheerios for breakfast. The fact that someone sees A then B does not mean A caused B. All that this "scare mongering" of prescription pain killers does is cause millions of people to suffer from inadequate pain treatment. The bigger addiction problem is alcohol, followed closely by nicotine, if we are talking societal scourges. This is the kind of stuff Fox news does. Shame on you.

Addiction is a medical condition and opiod addiction is a tiny part of the big picture. It all should be treated as such and not just a tiny portion of it criminalized, including criminalizing doctors who try to treat pain.

Feb. 04 2014 04:18 PM
Frank Day, MD from SF Bay Area

How did you ever come to believe that a RESIDENT in NEUROSURGERY could possibly be an expert in addiction or the literature/science on opiods/addiction. The number of people who become addicted to opiods after being prescribed opiods to treat pain is TINY, about the same as those who become addicted to opiods after eating Cheerios for breakfast. The fact that someone sees A then B does not mean A caused B. All that this "scare mongering" of prescription pain killers does is cause millions of people to suffer from inadequate pain treatment. The bigger addiction problem is alcohol, followed closely by nicotine, if we are talking societal scourges. This is the kind of stuff Fox news does. Shame on you.

Addiction is a medical condition and opiod addiction is a tiny part of the big picture. It all should be treated as such and not just a tiny portion of it criminalized, including criminalizing doctors who try to treat pain.

Feb. 04 2014 04:16 PM

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Feb. 04 2014 03:48 PM
Larry Fisher from Brooklyn, N.Y.

Not everybody has the intestinal fortitude to grind out this mess we call life.
Here are a couple of follow up questions.

1. What drug rehab programs work best for addicts?
2. Where is the heroin coming from? Is it Afghanistan?

Feb. 04 2014 01:53 PM
CAROLINE from NJ USA

My heart goes out to those who have fought addition and then, through an accident, end up in the hospital with a broken arm or leg. This happened to me. My leg was badly broken, dislocated at the ankle, YET I had very little pain. I kept my foot up in the air,(it did look weird) to help swelling.
Nurses kept asking me if I was in pain. "No. It really doesn't hurt" I kept saying. But, after waiting around 5 hrs for a doctor to read X-rays and set it, a nurse talked me into taking something. "It's going to really start hurting, and it would be better to take something before you get it set." Well, whatever she gave me made me sick. An aspirin would have been enough, but I spent the next 4 hours throwing up. I was never asked if I had a past addition. I was sent home with a prescription for oxiecondon/oxiecontin high mg.
I do not know why I was given such a strong drug. Actually, being alert for myself I broke the pills into quarters, and didn't take except at night, but used ibuprofen, and naproxen 220 mg. when I got home.
I also wrote a detailed description for the hospital at my release of their questionable overuse of pain medication, and patient safety.
Doctors, dentists and nurses should become aware of the real down-side of strong pain drugs. Who is the responsible party, doctor or patient?

Feb. 04 2014 01:11 PM
Mary from St. Louis

Check the doc's facts regarding Vicodin being taken off the market. There have been rumors of this for years but an online check shows that combo meds with more then 325mg of acetaminophen will be removed from the market. I suspect that simply means the Vicodin formula will change.

Feb. 04 2014 12:30 PM
Donna Fuller from Warren, Michigan

My marriage of 33 years ended in divorce recently because of my ex-husband's prescription drug dependence - though he tells it differently. His psychiatrist has prescribed a combination of heavy duty psychotropic drugs for him for many years, and on top of that, various doctors prescribed narcotic pain drugs for him. He is also alcoholic, in AA recovery 20 + years. He was in treatment for the pain meds, but ended up getting more from his dentists. He lied about this and hid one of the empty pill bottles. When I discovered this and confronted him, his explanation was that he was only taking what was prescribed for him! After many bad and distressing and frightening experiences related to his addictions, I decided I couldn't continue to live with this, nor was he willing to seriously commit to change. We had many discussions and arguments, of course, but getting nowhere, I told him I had an appointment with an attorney to begin divorce proceedings. He then beat me to it (without telling me, of course) and was the one to file for divorce against me! Although I know that in the end, I am better off, the emotional and self-esteem wounds are deep. I am in the long-term process of healing, as are our many family and friends affected by this. This is, unfortunately, only one of so many similar stories, stories of lives disrupted by prescription drug addiction. So very sad.

Feb. 04 2014 10:23 AM
David C Fung-Cap

It's not like drug use is a war that we will ever win so then we should try to give people more education. How many of our own people do we lock up in the u.s for non criminal drug use? (more then any other country) How much of our taxes go into to locking up citizens of the U.S. it's about 26-30k depending on where you live. Especially for weed use that's stupid in my humble opinion if anything for hard drug user's we should give them treatment if they would like it and if not your a freeman so do what you chose. People will use and having been using drugs in some form since the start of recorded history. If the popular opinion is addicts have a disease then they need help not jail if they have committed no other crime then simple possession because if you have a bag in your car with residue your going to jail

Feb. 04 2014 09:41 AM

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