Out-of-Control Opioid Prescribing Turns into a Direct Path to Heroin
The Constantly Changing Face of Drugs and Addiction—Part II
In Part I of this series, we described how new drugs on the market caught some people off guard. When the public was not familiar with drugs like Spice or “bath salts,” a drug dealer could more easily convince people they were harmless. Sometimes they were even legal, too – for a while, until lawmakers passed new legislation.
The next shift not only caught the public unawares, it also tricked doctors and dentists into unwittingly creating more opioid addicts, simply by convincing these practitioners to change the way they handed out pain medication.
The overprescribing of painkillers
Before the mid-1990s, doctors handed out painkillers sparingly due to their addictive nature. But when Purdue Pharma broke new marketing ground with their patented time-release formula OxyContin, everything changed. Doctors were told that this new formula was not addictive (when it was, in fact, quite addictive). They were also pushed by patient advocacy groups (funded by pharmaceutical companies) not to ”undertreat” pain. Pain was now supposed to be treated as the “fifth vital sign” after blood pressure, temperature and so on. Doctors responded by expanding their use of this powerful painkiller.
Previously, use of OxyContin had been limited to short periods of use after severe injuries or surgery or for end-of-life pain. Doctors felt free to prescribe it for moderate pain and chronic problems like low back pain. This change in prescribing also carried over to other pain medications like hydrocodone and oxymorphone. A vast surge in painkiller sales was followed by an increasing number of people needing rehabilitation for addiction to painkillers.
The switch from painkillers to heroin
In 2010, Purdue Pharma released a modified version of OxyContin at the urging of the Food and Drug Administration. The original pill was simple to abuse but the new formulation would turn into a gummy goo if someone tried to crush or dissolve it. Anyone who had been abusing OxyContin suddenly had to look elsewhere to get the opioid they desperately needed. At the same time, in an effort to save lives, state legislatures established Prescription Drug Monitoring Programs to detect people going to more than one doctor to get enough pills to support their addictions. Doctors began to get nervous about having too many patients on high dosages of painkillers. Some began to refuse to continue to prescribe these medications.
By the time these changes were implemented, there were millions of people dependent on opioids like oxycodone, hydrocodone, morphine, oxymorphone and other pain relievers. The predictable result was a migration from painkillers to heroin that began in 2010. After all, heroin could be obtained without going to a doctor and it was only a fraction of the price of pills. Gradually, the number of people dying from heroin overdoses began to inch up as the number of people dying from painkiller overdoses began to fall. In a bizarre twist of fate, the next change to be covered, heroin delivery to areas outside inner cities, made this migration much easier.
Heroin delivery in the suburbs
Also around 2010, a particular group of heroin traffickers in Mexico developed an entirely new system of delivering heroin. Previously, the most common method had been the “open-air market” in inner cities. In other words, drug dealers would stand on corners, usually in sketchy neighborhoods, and when someone seeking heroin drove up and rolled down the window, a quick transaction would take place. Many people who were addicted during those years tell stories about driving to inner cities and being frightened of being in dangerous neighborhoods. A new method of distribution devised by the “Xalisco Boys” from a small town in Mexico eliminated that problem.
The managers of this new group of traffickers established a network of drivers with cell phones, focusing on areas with plenty of painkiller addicts or busy methadone clinics. They put the word out that all you had to do was text or call the cell phone of the driver and heroin would come to you. No more trips to inner cities. This certainly offered a solution to the suburban or small town individual who had become addicted to a painkiller but could no longer get a prescription. Heroin was now readily available and far less expensive. But heroin potency is totally uncontrolled. One dose might be weak and the next one potent. This greater access to heroin drove overdose deaths even higher.
In the next part of this series, you’ll learn how powerful synthetic painkillers from Asia began to invade America and how American attitudes about marijuana have gone through major changes as one state after another legalizes this drug.
Read Part I: The Constantly Changing Face of Drugs and Addiction. Click here.
Read Part III: New Drug Threats Arrive from Asia and are Also Found Within. Click here.
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