Thursday, January 21, 2016


Heroin seems to be the drug of our time.

Last year, a newsmagazine published this graphic on the rise in US deaths deaths from heroin addiction and deaths per year, based on data from the Centers for Disease Control.  There is no indication the rate of deaths has dropped since 2013.

There seem to be several reasons why this is happening now.

More Prescription Opioids

In 1996, the painkiller OxyContin first hit the pharmaceutical market.

OxyContin was made of a highly addictive generic painkiller, oxycodone, that previously had been prescribed only for desperate sick people, typically those dying of cancer and in great pain.  The Oxy reformulation included a timed-release mechanism to frustrate abuse by spreading its painkilling effects over time and not in a single burst.

Purdue Pharma promoted OxyContin as a new, safer painkiller, and doctors began prescribing it for many more medical conditions.  It was a true blockbuster drug, with sales starting at $45 million in 1996, growing to $1.1 billion in 2000 and then to $3.1 billion by 2010.

Unfortunately, the addiction-blocking effects were oversold, and some people who were prescribed Oxy became addicted.  In addition drug enthusiasts learned to frustrate the delayed release function by crushing Oxy pills into powder that could be snorted and that yielded a high comparable to that of heroin.  A black market developed for Oxy, and addictions and overdoses followed.

After paying more than than $600 million in fines in 2007 for false advertising, Purdue re-engineered  Oxy to frustrate further street sales and abuse.  Its patent, which ended in 2013, was reset and the company was still selling about $3 billion of the stuff in 2014, when Forbes estimated the net worth of the company's family  owners at $14 billion.  (The article is up on

And Oxy was not the only popular painkiller on the street.  There others, including Vicodin, fentanyl and codeine.

(By 2007, the CDC reported, Americans accounted for less than five percent of world population but consumed 80 percent of prescription painkillers.  In that year, prescription opioids were involved in more overdose deaths than heroin and cocaine combined.  Use of these medicines had increased 400 percent in the previous 10 years.)

Here is an interesting chart circulated by the CDC about painkiller prescriptions written in each state in 2012.

The implication is not that people in some states suffer more pain but rather that doctors in some states wrote many more painkiller prescriptions.

There was a public debate during the period about whether painkillers were being overprescribed.  The pro-prescription people argued that pain itself was debilitating and that the mitigation of suffering was a reasonable medical goal.

Those opposed warned of addiction, and in fact a black market for Oxycontin and other prescription opioids had developed during the period.  Some users became addicted over the course of using  painkillers prescribed by physicians, others after buying the drugs on the street.

State and federal authorities began tightening the rules on painkillers and prosecuting doctors who appeared to be writing too many such prescriptions without justification.

More Heroin

In 1996, the same year that Oxycontin was introduced, California became the first state to legalize the use of marijuana for "medical" purposes.  This opened the door for more legalization, less enforcement of marijuana laws, more private cultivation of marijuana plants and wider availability of marijuana generally.

Unfortunately, this disrupted the business model of Latin American narcotrafficantes who for years had been growing and exporting marijuana to the U.S., and making good money at it.

So the Sinaloa Cartel, and others, sized up the market.   They recognized that there was solid demand in the U.S. for harder drugs.  The narcotics gangs cut back marijuana cultivation and started growing opium poppies instead.  The resin of the poppies was used to make heroin.

There were several pluses to this strategy:  First, the country already had a large number of prescription drug abusers -- recreational users as well as addicts who could satisfy their cravings with heroin.

Second, if exported at a certain scale, the heroin could be supplied more cheaply than Oxy -- at $4 a dose, say, compared with the street price of $40 for an Oxy pill.  In markets, the cheaper producer generally wins greater market share.

Third, at such a price, many more people could be induced to try heroin.  If all worked out, the new heroin customers would become addicted.  They would be much more regular customers than the old marijuana customers had been.

There were only two downsides.

The first was that turf battles among drug cartels and between cartels and law enforcement and citizens led to an estimated 100,000 killings in Latin America.

The second was that heroin could be laced with dangerous other substances, bad ones, that could sicken or even kill people.  (And there was always the problem of overdose deaths.)

But people who produce and sell illegal drugs generally aren't afflicted with high-minded scruples.

That is how you end up with charts like the one at the top of this article.

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