The Obama administration’s drug czar acknowledged Tuesday a growing problem with opioids like heroin and prescription painkillers and the need for a coordinated public health response, just over a week after Oscar-winning actor Philip Seymour Hoffman died of an apparent heroin overdose.
Cautioning against a solution too heavily weighted toward law enforcement, R. Gil Kerlikowske, who heads the Office of National Drug Control Policy, called for a more public-health centered approach. The administration’s plan includes reducing the availability of prescription drugs through take back programs to get drugs out of homes, and reducing deaths by treating addiction and overdose more effectively.
“We cannot arrest our way out of the drug problem,” Kerlikowske told reporters on a conference call. “Drug addiction is a disease of the brain—a disease that can be prevented, treated, and from which one can recover.”
While the use of prescription painkillers has remained relatively stable over the past few years, the number of overdose deaths from opioids increased by 21 percent from 2006 to 2010. There are now more deaths by drug overdose—mostly driven by prescription painkillers, Kerlikowske said—than from homicides or traffic crashes. In 2010, roughly 100 Americans died from overdose every day and more than forty percent of the deaths that year, roughly 16,600, involved prescription painkillers. Heroin was involved in roughly 3,000 deaths.
Hoffman’s death earlier this month, which coincided with a string of some 50 deaths in Pennsylvania, Michigan and Maryland from heroin laced with the painkiller fentanyl, put a spotlight on the uptick in heroin use, from 373,000 past-year users in 2007 to 669,000 in 2012. The demographics of heroin have also changed, moving beyond poor urban areas into rural and suburban communities. Law enforcement officials attribute some of the spike in heroin use to increased availability and cheaper prices, thanks to more heroin supplied by Latin American cartels coming over the southwest border.
But the administration attempted to refocus concern on broader opioid use on Tuesday. ”It is impossible understand heroin problem without nature of prescription drug abuse epidemic,” Kerlikowske said.
The first prong of the administration’s proposed response is to reduce the availability of prescription drugs by utilizing take-back programs that get unused prescription pills out of medicine cabinets and by cracking down on things like doctor shopping, in which users seek out doctors who will give out prescriptions. The Drug Enforcement Administration has declared April 26 National Prescription Drug Take Back Day, when people can return unused prescription pills to law enforcement. Forty-one percent of chronic abusers of painkillers got them from a friend or a family member for free or without asking, according to the most recent study from the Substance Abuse and Mental Health Services Administration.
The second prong looks at using various available drug therapies to treat addiction and prevent overdose death. The administration encourages local law enforcement around the country to carry naloxone, a drug, delivered nasally, that can prevent overdose. Thanks in part to funding from the administration’s drug police office, a precinct in New York City is carrying Naloxone as part of a pilot program, which the administration said allowed an officer to save a life two weeks ago in Staten Island. Boston Mayor Marty Walsh will soon equip city firefighters and police officers with the drug, Kerlikowske said.
Drugs like buprenorphine and methadone, which bind to the same receptors in the brain as heroin but reduce cravings, can also play an important role in treating addiction, said Dr. Wilson Compton, deputy director of the National Institute on Drug Abuse.