We need to change the way we think about the opioid crisis

The way Americans are starting to get addicted to opioids has changed in the last 10 years, according to a new study published in Addictive Behaviors. As Dylan Scott explains on the October 13 episode of The Weeds: “In 2005, 80 percent of people who were dependent on opioids started with painkillers and 10 percent started with heroin. In 2015, that had shifted to about 50 percent of people started with painkillers and 33 percent started with heroin.”

Dylan, Sarah Kliff, and Matt Yglesias also discussed new findings on the opioid crisis and Trump’s decision to cut off some Obamacare subsidies, as well as the latest executive order on health care

This shift in the starting points of opioid addiction, with more people starting to use heroin first, is a challenge for lawmakers. “When starting with prescription drugs we know the policy levers to pull. There’s continuing medical education and prescribing deadlines. The policy levers with reducing the number of people starting on heroin seem more challenging,” Sarah said.

Dylan agreed, and said that members of the Senate Health Committee are focused mainly on prescription drugs, not heroin. “You go down to Capitol Hill and when the Senate holds a hearing on this, there seems to be a lot of talk of, ‘OK if we turn this lever, if he just make it harder for people to get a hold of prescription painkillers, then that will fix the problem,’ and this fundamental shift towards heroin proves that is not true,” Dylan said.

Here’s Dylan and Matt discussing the challenges of attacking heroin addictions:

Dylan: A repeated frustration that I have heard in talking to folks who work on this issue is that we focus almost entirely on the supply side of things, and whether that’s Donald Trump’s wall on the Mexican border or whether that’s better prescribing practices to preventing opioids from getting on the street, we don’t spend nearly as much time on how do we drive down the demand among a certain percentage of our population to want to abuse drugs.

Matt: This is a really bad situation. When the move was made to crack down on pill suppliers, I think policy makers were aware that there was a risk that you were going to see a lot of people diverting into the heroin market. I think they did not fully understand the fentanyl situation. But they knew that this was going to take the stock of addicts and actually put them at greater risk for overdoses, and they decided that they had to make that call. That the only way to cut off the flow of new addicts was to make this choice.

I think what you are seeing with the heroin initiations is that this sort of strategy to cauterize the wound and sacrifice a cohort of addicts to the streets and the black market but to cut off the new addicts, that that has not worked. That instead, this old stock of addicts has moved to heroin, and then the heroine dealers have now established a whole new pipeline into addiction that has nothing to do with the prescription drug market that the FDA can’t do anything about. Basically the whole discussion that we have been having is obsolete.

Dylan: I went out to a city in southern Indiana last year that had a terrible HIV outbreak because of needle abuse. And you talk to people there and they are like, we need to change this on a cultural level, on an economic level. It is a really holistic problem that is not tailored to neat and tidy solutions like prescription drug monitoring programs.