I’m of two minds about this:
Baltimore health officials are launching a public awareness campaign to make drug users aware that the heroin they’re using may be laced with the much more potent, and potentially deadly, fentanyl.
“Fentanyl-laced heroin is killing individuals in our city,” Dr. Leana Wen, Baltimore City Health Commissioner, said in a statement. “Nearly every day in Baltimore, one person dies from drug overdose. This is a public health emergency. It is our obligation to educate and save lives.”
On the one hand, yes, it’s critically important to let the opioid-dependent community in Baltimore and surrounding areas know that there’s a big batch of lethal fentanyl-laced heroin going around because it’s going to kill many of the people who unknowingly take it and even many who are aware of the fentanyl and want it precisely for that reason.
But, on the other hand, this gives the misimpression that regular old heroin and prescription opioids aren’t lethal enough on their own. Most people who are opioid dependent and don’t have substantial chronic pain are eventually going to stop breathing while under the influence of some combination of drugs. Some might speedball out, like the Grateful Dead’s Brent Mydland and comedian/actor John Belushi. Others might misjudge the strength of the heroin they’re taking, even if all they’re taking is heroin. What you might not realize is that most people who die from opioids do it taking prescription drugs. Here’s the Center for Disease Control and Prevention:
In 2010, nearly 60 percent of the drug overdose deaths (22,134) involved pharmaceutical drugs. Opioid analgesics, such as oxycodone [Oxycontin], hydrocodone [Zohydro ER, Vicodin], and methadone, were involved in about 3 of every 4 pharmaceutical overdose deaths (16,651), confirming the predominant role opioid analgesics play in drug overdose deaths.
Here’s a tip you need to know about hydrocodone: “the International Narcotics Control Board report[ed] that 99% of the worldwide supply in 2007 was consumed in the United States.”
Think about that for a little bit.
Vicodin is hydrocodone and Tylenol, and the Tylenol component makes it unattractive for an opioid addict who wants use large quantities. That doesn’t mean Vicodin doesn’t kill plenty of people, because it does, but it is at least formulated in a way that discourages abuse. Not so, however, for Zohydro ER. It never should have been approved over the objections of the FDA’s Anesthetic and Analgesic Drug Products Advisory Committee, and only now are some pharmaceutical companies coming up with creative solutions to make it difficult to spike into your veins.
Meanwhile, we’ve already been through several rounds of trying to figure out how to provide oxycodone (Oxycontin) to people in need without causing widespread addiction, abuse, and death. Unfortunately, the drug companies can make promises and then get the government to say that they never made any promises.
Let me quote from the letter the FDA wrote to Purdue Pharma L.P. in 2010 when they approved their new “re-constituted” OxyContin drug. You tell me whether this sounds like Purdue Pharma was supposed to conduct studies about the safety of their drug as a condition of its approval.
The FDA “now says these studies were never required, giving Purdue the option of presenting its data on the actual abuse-deterrence of its reformulated product — for which it had already earned abuse-deterrent labeling in 2013.” And, given the option, Purdue is bailing:
Citing a need for additional analyses of data on the product, the company formally withdrew the sNDA one day before agency staff would have released their evaluation of the application, prior to an advisory committee meeting scheduled for next week.
And, why not? They already got their stamp of approval in 2013 without actually fulfilling their obligations to study the effectiveness of their abuse deterrence efforts, and if the study isn’t going to support their case, withholding the findings makes good business sense.
Now, here’s another tip. Almost no one picks up heroin without first trying less stigmatized opioids. Some raid their parents’ medicine cabinets to get high, but others get hooked simply by being prescribed post-operative painkillers. A not insignificant subset of the population cannot use opioids safely because they are physically predisposed to become addicted to them. When you prescribe these medicines in huge quantities to deal with non-chronic pain, you are essentially just accepting that you’re going to create opioid addicts in more than in one in twenty patients. There’s no precise number because it’s a tough subject to study, but I’ve seen pretty consistent estimates that somewhere around eight percent of people will react to opioids differently from the rest of us and become instant addicts. These people are currently treated like collateral damage in our pain management protocols.
Many more people will become addicted more slowly, but still only as a result of taking pharmaceuticals, whether prescribed or recreationally. These folks make up the vast majority of people who die from opioids, no matter whether the ultimate death-blow comes from pills, heroin, or fentanyl-laced heroin.
Heroin is really no different than these other opioids and fentanyl is really no different from heroin. Some are legal, some are not. Some are made in clean well-regulated factories, and some are made in filthy basement laboratories or overseas. But they all addict you in the same way and they all can kill you in the same way. The withdrawal symptoms are basically the same in all cases.
And don’t think this is killing a bunch of obnoxious ne’er-do-well teenage losers, because it’s actually killing you mom:
More women are dying from prescription painkiller overdoses than ever before, highlighting what the Centers for Disease Control and Prevention calls a growing public health epidemic.
The CDC study shows that while men are still more likely to die of overdoses, the number of deaths among women increased five-fold in the last decade, four times more than deaths in women from cocaine and heroin combined, says CDC director Tom Frieden…
…Women may be more prone to overdoses because they’re more likely to have chronic pain, be prescribed painkillers, have higher doses, and use them longer than men, said Linda Degutis, director of CDC’s National Center for Injury Prevention and Control…
…Women between 45 and 54 had the greatest increases in drug overdose deaths, likely because of dependence on prescription drugs to ease chronic pain, experts said.
A jump was also seen in visits to hospital emergency rooms. Painkiller-related ER visits by women more than doubled between 2004 and 2010, the CDC found.
Near the top, I said that most people who die from opioids are not actually suffering from chronic pain, but that’s obviously a little too simplistic. It’s more accurate to say that opioids are less likely to kill you if they have some actual physical pain to fight in your brain. In the absence of pain, the drugs will tend to shut down your breathing. But everything is relative, and once hooked on these drugs a person will take them whether they’re feeling pain or not. They may combine them with other sedatives or take way more than the prescribed dose. Accidental overdoses are very common, especially in nursing homes and among the elderly who can forget whether they’ve already taken their daily medication.
So, yes, it’s a problem that there’s a nasty batch of fentanyl-laced heroin going around Baltimore, killing people by the dozens already. By all means, the public should be educated about this. But the public needs a lot more education than that. Obviously.
