My wife and I went to a town hall meeting in Carroll County, Maryland, yesterday. The meeting was about the opiate drug abuse epidemic and what different agencies and people were doing about it. The keynote speaker was an agent with the Drug Enforcement Agency (DEA). He gave the usual statistics on number of deaths and overdoses, and what his agency has been doing to counter them. He also talked about how most of the heroin being used in Virginia, Maryland, Pennsylvania and West Virginia flows from Baltimore on what is called “the heroin highway.” (Of course, he clarified that heroin and other opiates are being illegally imported from Mexico.) We then got to hear from people in the community who run different intervention programs. Included in those presentations was one by the local hospital. It went “dilaudid-free” this year, and they’ve seen the number of “seekers” go down along with an increased positive response about pain control from other patients. In essence, not everyone needs dilaudid — a powerful opiate-based analgesic — for things like sprained ankles or strained backs.
People from the local and state health departments also spoke about their agencies’ efforts to curb the epidemic. Locally, they’re raising awareness about the link between abusing prescription painkillers and getting hooked on heroin. They’re also using recovering addicts to talk to peers about prevention. And, of course, they’re distributing Narcan to friends and family of people abusing opiates and heroin in order to prevent deaths from overdoses. Statewide, new rules are coming online to keep track of what opiates and how many are being prescribed. In that vein, a lot of finger-pointing was done at dentists who give prescriptions for 30 days of OxyContin for tooth extractions or installation of braces. A lot of the attendees — many of them parents whose children were prescribed these opioids for “simple” procedures — said that it seemed to them that prescribers (e.g. dentists) didn’t want to deal with a complaint about pain, so they just prescribe the strongest thing in their arsenal.
Most painful of all were the stories of parents whose children died recently from heroin overdose. One parent, a pharmacist, talked about a “pill mill” not far from our location. He wanted something done about that because his child started off addicted to OxyContin. Another parent said that she still has some heroin from her child at the home, and she wanted the local sheriff to take it and analyze it to see if they could trace it back to the source. (Something that is very difficult, if not impossible, to do.) Other parents gave similar stories of otherwise “normal” children who fell into opioid drug abuse and then moved onto heroin, which is easier to acquire and quite cheap.
I say that these stories were painful not only because of the loss of life, the loss of their children. It was painful because it was obvious that they wanted answers, they wanted someone to pay the price for their loss. But there was no one to blame, at least not in the room. For the parents who wanted the drugs analyzed in order to maybe find a dealer, it’s probably not going to happen. And, even if they do track down the dealer, the chance of the dealer being charged with their son’s death are low. And I can see how that must be incredibly frustrating. Someone, somewhere, made the conscious decision to manufacture and sell poison to their kids. Someone profited from their deaths. Even if the chances of people “in the game” are likely that they’ll get killed or seriously hurt for being in it, someone is getting away with hurting those who overdose and/or die.
However, the answers to the epidemic are almost as varied as the drugs that are being used. You can seal up the border to keep heroin from coming in through Mexico, but you’ll have it come in from Asia via Canada. Or you’ll have designer opiates (like all the Fentanyl variants) being made here in the US. And, of course, you’ll have prescription opiates being handed out like candy by people who don’t want to hear your whining about your broken leg. Or could severely restrict prescriptions, piss-off the pharmaceutical industry, and have people move to heroin as they can’t get their pills. Then you could do both, but the underlying social and mental health issues that drive people to addictions are not addressed and they go to other dangerous/illicit drugs (or some licit ones like alcohol and marihuana in several states).
In a perfect world, you would dismantle drug cartels by taking away the demand for drugs. You’d take away the demand by solving social problems that lead people to want to escape their situations by abusing heroin and other drugs. You’d also have mental health readily available to help people who have something happen in their life that leads them to want to escape. Or, if they’re there already, you’d have recovery services ready to help. You’d also have clean needles to prevent infections and people from dying, or Narcan in every public place (like Automated Electronic Defibrilators are now) and in the hands of every addict and their immediate circles in order to keep them alive.
Of course, there are other things that work which I might be forgetting.
While some at the meeting were being optimistic that maybe the epidemic was subsiding, I’m not as optimistic. Looking at the trends, this thing is happening in waves. As Baltimore and other major cities get “dangerous” during the summer, people turn to other drugs to fill their needs. Then they go back to buying heroin once things calm down in the cooler/colder months. Heroin overdoses seem to wax and wean like that, just like almost everything else in epidemiology. I certainly hope that it is calming down. I hope that more parents aren’t looking for more answers. But I don’t know… I just don’t know.
René F. Najera, DrPH
I'm a Doctor of Public Health, having studied at the Johns Hopkins University Bloomberg School of Public Health.
All opinions are my own and in no way represent anyone else or any of the organizations for which I work.
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