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In modern times, American policymakers have loved to declare war against a social or medical problem. In 1964, President Lyndon Johnson declared a war on poverty. In 1971, President Richard Nixon declared simultaneous wars against cancer and illicit drugs. And President George W. Bush declared a war on terrorism after the September 11th attacks. Fighting an idea or a long-term problem usually opens policymakers up to criticisms that such wars are unwinnable and unfairly raise public expectations. The war on drugs is a case in point, as the United States has committed billions of dollars over the last forty years to halt the use and smuggling of illicit drugs. In fact, prior to September 11th there were concerns that American forces would become involved in the Colombia civil war between its government and the FARC, a group of communist rebels that use the drug trade to bolster their coffers. The war on drugs has been criticized for punishing low-level offenders, which has had a disproportionate impact on minority males, and largely failing to solve America’s drug problem. Recently, heroin use in the United States has become a significant problem as the federal government has cracked down on prescription drug abuse and two weeks ago, on March 10th, Attorney General Eric Holder stated that the United States facing an “urgent public health crisis” concerning heroin. The death of Academy Award-winning actor Philip Seymour Hoffman last month due to an overdose of heroin and other drugs has also contributed to raising national awareness about this issue.
This topic brief will explain the history of heroin use in the United States, the reasons given for the recent surge in heroin usage, and policy solution (some of which are controversial) that may help federal and state authorities reduce heroin use and overdoses.
Readers are also encouraged to use the links below and in the related R&D to bolster their files about this topic.
The History of Heroin Use in the United States
Live Science on March 12th provides a good overview of heroin’s beginnings and how it works. The drug is an opiate from morphine and is obtained from the opium poppy plant, which thrives in dry, warm climates. This makes Afghanistan the world’s largest opium poppy producer because of a drought that has devastated the country for decades and ruined the country’s vegetable industry (Afghanistan was one of the top five vegetable producing nations in the 1970s). The United States has tried to crack down on the cultivation of opium in Afghanistan for public health and security reasons (because militants and warlords acquire a sizable amount of income from it), but farmers get more money from it than other crops like wheat and American efforts have largely failed.
Live Science indicates that opium poppies were used in the ancient world, as the Sumerians of Mesopotamia, Egyptians, Greeks, Minoans, and other early civilizations have recorded reference to its uses as a drug that could produce an intoxicating high. In 1803, morphine, a painkiller, was extracted from opium and became popular among medical officials working with national armies (in fact it became too popular and some soldiers in the American Civil War became addicted it). In 1898, chemist Felix Hoffman accidentally created heroin in his attempt to make a less addicting form of morphine. When he combined morphine with acetic anhydride he accidentally discovered a substance that was more potent than opium (heroin) and while the drug company now known as Bayer tried to sell heroin in the early twentieth century as a safe painkiller, it was soon discovered that the opposite was true and the United States classifies it as a Schedule I narcotic, meaning that the U.S. sees heroin as having no medical benefit and that it could be used.
Heroin typically comes in a white-powdery form and can be smoked or snorted. Live Science points out that other users take the acid in lemon juice and with water create a liquid form of the drug that can be injected, thereby producing a longer-lasting and more-intense high, which comes from the drug binding to opioid receptors in the brain and spinal cord.
In the late 1960s, the United States had a very minor heroin problem and the only way users could get the drug was through a shady street corner dealer. The New Republic on March 19th notes that the drug had a devastating effect on young African American men in Washington D.C., especially among those who had criminal connections. American soldiers in Vietnam also became aware of a purer form of heroin called Golden Triangle heroin (the Golden Triangle is one of the world’s most extensive opium producing areas and is made up of territory in Burma, Laos, and Thailand). Some of the heroin is this area of the world was later imported into the United States and a generation of addicts was created. Still, cocaine, marijuana, and prescription drugs replaced heroin as illicit drugs of choice for most American drug users and heroin use was limited until recently.
Causes of the Recent Heroin Crisis
So why is it that America has experienced what some medical professionals are explaining as a surge in heroin use? Some experts link the increased use of heroin to the federal government’s crackdown on prescription drug abuse, a problem that began to grow at the end of the twentieth century. Prescription drug abuse according to The Washington Post on March 6th, kills more than 16,000 Americans a year and Americans abuse prescription drugs for the euphoric high they receive from them, which is a similar high that heroin produces. The New Republic previously cited explains that in 2000, the Joint Commission on Hospital Accreditation found that doctors were not effectively treating patients that were experiencing chronic pain and in response, pharmaceutical companies provided a wave of new opiate drugs that doctors prescribed to their patients. Some of these patients became addicted to the euphoria experienced from the use of these new opiate drugs and taking advantage of a lack of government oversight they “doctor shopped” (which means they went to a host of different doctors in different parts of their state or region) to get multiple prescriptions for the same drug. Since 2007, doctors have written more than 200 million prescriptions for opiod painkillers, which is amazing considering the fact that there are 240 million adults in the United States. One of the drugs that alarmed policymakers was OxyContin, a pain reliever that the Food and Drug Administration (FDA) approved of in 1995. The drug helped millions of pain sufferers, but those Americans who became hooked on painkillers started snorting or injecting the drug after smashing or melting tablets. The Washington Post previously cited explains that the Clinton administration and George W. Bush administrations began to crack down on prescription drug abuse, with states encouraged to implement monitoring programs and anti-drug task forces receiving more funding and resources. Federal arrests of prescription drug abuse rose by 900% between 2001-2007 and although the Justice Department’s drug intelligence wing warned as early as 2003 that cracking down on prescription drugs might drive people to heroin, since heroin produced a similar high and was remarkable cheaper than prescription drugs, this advice was seemingly ignored. As a result, between 2007-2012 heroin use rose by 79% nationwide and 81% of these first-time heroin users, about four in every five, were former prescription drug abusers.
The increased demand for opiates by segments of the population nationwide has also facilitated the growth of heroin outside of the inner cities. Traditionally, the heroin problem was largely confined to inner city communities, which were overwhelmingly poor and minority. However, the new heroin problem is much different. Al-Jazeera on March 16th writes that heroin is now devastating communities in the Northeast as heroin traffickers move their drug out of New Jersey and New York City and into rural, isolated communities in this part of the country. Maine has seen heroin overdoses quadruple between 2011-2012. New Hampshire had a single digit number of heroin overdoses prior to 2012, but then had thirty-seven that year and sixty-three last year. PolicyMic on February 10th explains that Vermont has seen a doubling of the number of deaths from heroin overdoses from 2012 levels, as its geographic position on an interstate that links Montreal, Boston, New York City, and Philadelphia is giving heroin smugglers easy access to the state, where they can acquire higher profits due to the isolation of many of the addicts they serve. The New York Times on February 27th writes that a heroin dealer can buy a bag of heroin in New York City for $6 a bag and then sell it in Vermont for $30, which creates a profit incentive to continue to smuggle the drug into the state. Authorities estimate that as much as $2 million worth of heroin is smuggled into Vermont each week. Due to these problems, Vermont Governor Peter Shumlin devoted this year’s State of the State speech to the state’s heroin problem, which he calimed was a “full-blown” crisis. The New York Times on January 8th writes that Shumlin wants to expand state aid to treatment center, assist rapid intervention programs that can help the newly addicted stop their bad habits before they become hardened criminals and users, and enact heavier penalties on those smuggling heroin into the state. As the reach of the heroin trade has grown in the Northeast, the demographics of the drug’s users has changed. The New York Times on February 10th reports that victims of heroin are becoming whiter and younger and that 88% of those who died of heroin overdoses in 2010 were white and half were younger than thirty-four (nearly 20% were ages 15-24). The problem is also becoming more of a middle-class problem than a poverty problem as well, which, as sad as it is to say, will likely lead to more national coverage and attention towards the issue since issues that affect more affluent communities tend to attract more attention from politicians due to the financial power of these communities and their tendency to vote more often than the poor.
Due to the high profits that can be gained from heroin smuggling, younger Americans are being enticed to try the drug, which can create a lifetime addiction problem. The Huffington Post on March 11th writes that heroin dealers are tricking young people into trying the drug by claiming that it is another illicit substance. There have also been cases where teens have convinced their friends to try the drug so that they can do it in the company of others, which is little different than teens getting other teens to begin smoking. The article goes on to explain that the Substance Abuse and Mental Health Services Administration claims that there has been an 80% increase in the number of teens seeking treatment for heroin abuse over the past decade.
A final cause of the recent heroin problem the country is facing is that federal authorities were slow to respond to it. By focusing their attention on prescription drug abuse, authorities discounted the rise of heroin addicts that could come from their crackdown and President Obama’s “drug czar” (the official title is the Director of the Office of National Drug Control Policy) Gil Kerlikowske admits that he could have done more to raise public awareness of the nation’s heroin problem. Attorney General Holder’s address about the urgency to confront heroin signals a policy shift towards cracking down on heroin abuse while the government continues to go after the traffickers of illicit prescription drugs. The Washington Post on March 10th writes that Holder has argued for combining enforcement and treatment to solve the crisis and the Drug Enforcement Agency (DEA) has opened more than 4,500 heroin-related investigations since 2011. Therefore, federal authorities are playing catch up with the current heroin problem, but the fact that they are beginning to recognize it is a good sign.
Solutions for America’s Heroin Problem
One of the more interesting solutions that extempers can bring to the table in a speech about heroin abuse is the distribution of a drug called naxolone to first responders and/or family members and friends of heroin users. Naxolone, according to The Huffington Post on March 5th, can be injected or delivered through a nasal spray to a heroin overdose victim and save their lives by inducing a painful, immediate withdrawal and can restore breathing to an overdose victim whose breathing is slowing due to the opiate qualities of heroin. Wilkes County, North Carolina had a drug overdose rate that was four times the national average in the mid-2000s, but their experiment in widely distributing naxolone to first responders of heroin-related medical emergencies and those related to drug users successfully cut overdose deaths in the county by 50%. The New Jersey Courier-Post on May 1st writes that a Massachusetts study showed that naxolone was 98% effective in attempts to revive a person that had overdosed (evidence suggests that the drug has saved more than 10,000 lives since 2001) and this information led New Jersey to enact a law last year that allows members of the public to carry the drug after being trained. Ten states currently allow the drug to be prescribed to a family member or friend of a drug user and seventeen states and the District of Colombia now allow medical personnel to carry the drug. While the drug can’t stop heroin users from using and will not cure their addiction, widespread distribution of the drug has the potential to cut down on the number of heroin deaths in the United States, which The New York Daily News on March 10th reported was 3,038 in 2010 (an increase of 45% from 2006 levels). Nevertheless, social conservatives have serious questions about the distribution of naxolone, which they feel will encourage drug users to take more risks since they have a drug near them that can revive them. Maine Governor Paul LePage, a Tea Party favorite, has used this argument to oppose a wider distribution of naxolone. However, extempers should not make the case that all Republicans or all conservatives oppose naxolone. Ohio Republican Governor John Kasich, who used to fill in for Bill O’Reilly on Fox News and had his own show for a time, signed legislation two weeks ago allowing for naxolone to be carried by first responders. Also, The Washington Post on March 10th adds that Utah and Tennessee are considering similar measures and both states are bastions of social conservatism. A good parallel for the naxolone debate is what is seen with regards to the distribution of contraceptives and birth control information in public schools. Doing so has the ability to reduce harm (such as a drug overdose or a teen pregnancy), but creates debate because some conservatives believe that attempts to reduce harm may increase the behaviors such policies try to solve (in this case lead to more drug overdoses or more sexual behaviors among youth because they see harm reduction policies as making risky behaviors safe). Nevertheless, while it is true that abstinence from drugs is the best way to avoid overdosing on them or becoming addicted, it is somewhat unrealistic to assume that all Americans will never use heroin and as a result, naxolone and similar policies may be one weapon to save the lives of drug users in conjunction with education programs that emphasize avoiding drugs.
Another step that states have taken to deal with the rise of heroin overdose deaths is to provide a degree of legal amnesty to those who call in an overdose. The Washington Post on March 6th reports that many overdose deaths in the country could be prevented if someone called 911 or took a victim to a hospital. However, people who are around an overdose victim have a tendency to not immediately report the incident for fear of having their drug use or complicity in facilitating the drug use exposed and investigated by authorities. New Jersey currently provides legal immunity to drug users that report an overdose and other states are looking into similar measures.
To help heroin addicts overcome their problem, it may also be wise for states to invest more money in treatment facilities. One of the arguments made by Vermont Governor Peter Shumlin for more state investment in treatment centers is that it only costs the state $123 a week for someone to attend a state-financed center versus putting them in jail for a week, which costs the state $1,120. The Boston Globe on March 15th reports that demand is outstripping the supply of beds available for those seeking voluntary treatment in Massachusetts, a state that has seen 185 suspected heroin overdoses between November 1st and February 24th of this year. The state has increased its funding on substance abuse programs by nearly 27% ($104 million currently), but this covers just 63% of the costs of helping a patient each day, so some facilities are having a hard time paying personnel and running their operations. Also, insurance does not pay for long-term treatments in these facilities, so the state has to pay for them. Therefore, as states grapple with their respective heroin problems they need to direct more funds to ensure that treatment facilities can accommodate a higher number of addicts and, hopefully, reduce the number of heroin users down the road.
A more controversial solution, reported by The Economist on February 8th, might warrant some investigation by extempers, but I should warn that advocating these solutions in a round may open you up to criticism and/or problems in cross-examination due to the unlikelihood that America will adopt these measures in the short-term. The Economist argues that Switzerland and the Netherlands have adopted “Heroin Assisted Treatment” (HAT) programs that have safe sites where heroin users can inject themselves with the drug under the supervision of medical personnel and that free heroin is being given by these governments to addicts that refuse treatment. The HAT programs began in the 1990s on a trial basis and have now become permanent. Spain, Great Britain, Germany, and Canada have looked into these programs, which the Swiss and Dutch argue have reduced HIV infections since addicts are using clean needles to inject themselves with the drug, reduced property crimes that are tied to drug use, and have even cut into the illegal market for heroin since those markets cannot compete with “free” government heroin. Still, it is hard to see American states going this route in the near future since it would invite a host of federal-state problems related to drug regulation (in this case having an American state becoming the primary distributor of what the federal government deems an illegal narcotic) and could spark a backlash from voters, who might find government sanction of heroin users behavior distasteful and not want their tax dollars to go towards the purchase of drugs.
Is There a Crisis?
When discussing the heroin problem, extempers should be careful not to oversell the issue too much. After all, The New Republic article previously cited shows that only 0.14% of Americans are addicted to heroin (although one could make the case that is still 0.14% too many). The Huffington Post on March 14th provides an interesting counterpoint for this brief when it points out that Columbia University psychology professor Carl Hart says that only a fraction of heroin users the government claims are addicts actually need help because only 20-25% of the heroin users in government statistics say that they are dependent upon the drug. Hart also argues that most overdose cases (75%) occur when heroin is laced with another drug or combined with other drugs, as was the case with Hoffman’s overdose, so those statistics are also unreliable. Hart would contend that Holder’s statement that heroin is an “urgent public health crisis” is irresponsible rhetoric, but even if his claims are correct (and they are disputed by other academics and policy analysts) it does not dispute that America should monitor its heroin problem and work to get treatment for addicts, reduce the number of heroin deaths each year, and clamp down on the smuggling of the drug across state lines and its national borders.