Over on Wonkblog, there's a lengthy discussion between Stanford addiction expert Keith Humphreys, PhD, and Harold Pollack, PhD, on drug overdoses, the recent death of actor Philip Seymour Hoffman, and ways to prevent others from dying. The entire piece is worth a read, but a few parts jumped out at me:
HP: Many people don't realize that overdose is the leading cause of accidental death in the U.S. I gave a talk about five years ago in Chicago, and I mentioned that we had more overdose deaths than traffic fatalities. My audience literally did not believe me. People were absolutely convinced that I had mis-transcribed the numbers. Every year, America loses a little over 32,000 people in auto crashes, and something like 38,000 from overdose deaths annually.
KH: Yeah, it's remarkable if you compare overdoses to AIDS, which at its peak was taking about the same number of lives. The difference in reaction is really startling. We appropriately became galvanized about HIV/AIDS, and implemented much better public policy to prevent HIV-related deaths. It's much harder to get traction on the overdose issue, or even to get people to believe how prevalent the problem actually is.
HP: Just to note the numbers, in 1999 there were about 4,000 prescription opiate overdoses. In 2010, there were about 16,000. By comparison, there are about 10,000 gun homicides in the United States.
KH: It is pretty amazing. Many people are focusing on the return of heroin and saying, "It's all the fault of criminals." You've got to remember, 4 in 5 of people today who start using heroin began their opioid addiction on prescription opioids. The responsibility doesn't start today with the stereotypical criminal street dealer. We basically created this problem with legally manufactured drugs that were legally prescribed. This really flies in the face of the argument that if we just had a flow of legal drugs, the harms would be minimal.
HP: Can I ask you an embarrassingly basic question? If someone like Philip Seymour Hoffman presumably had access to all sorts of prescription opioids, why does he end up injecting heroin?
KH: That's actually a good question. Cost drives many people to heroin. It's more expensive to buy oxycodone than it is to buy heroin. Presumably that was a less pressing concern for Mr. Hoffman. Perhaps the intensity of the rush of injected heroin was more reinforcing to him than opioid medications were. The prescription medications have a longer, slower cycle of action in the body. His heroin use could also be the result of habit. He had experienced a heroin problem before, many years ago. It could be that that was the drug that he knew best or was available in the networks of dealers he used. I'm speculating about somebody I don't know, but those are some possible reasons.
For most people it's cost. Add one other thing; when people lose their health insurance, they may need the opioids to manage their pain. People sometimes end up buying street drugs including heroin to manage their pain because they have lost the insurance that used to cover their pain medication.
Previously: A reminder that addiction is a chronic disease, Is it damaging to refer to addicts as drug “abusers?”, Breaking Good: How to wipe out meth labs, How police officers are tackling drug overdose, Do opium and opioids increase mortality risk? and How to combat prescription-drug abuse