There was also the crack cocaine epidemic of the 1980s and 1990s. This one was particularly ugly not just for its pernicious social damage but also its dark political implications. Myths about the drug abounded. Crack was said to cause instant and total addiction, destroying (mostly inner) cities and driving users to desperate acts of crime and violence. This is not to say that crack wasn’t terrible: It had a catastrophic effect on many lives and expanded the illicit drug business and other crime on city streets.
Why Drugs Get Popular
Drug trends run in cycles. Much of this has to do with awareness. A low price – as happened with crack cocaine in the 1980s and heroin in the 2000s – doesn’t hurt either, especially among entry-level users. Still, overall, a drug’s popularity has less to do with overzealous drug peddling and more to do with word of mouth from the users themselves. This is also how drugs lose their popularity. Word on bad experiences, health consequences, overdoses, and other dangers will spread and, eventually, reach a kind of critical mass. This happened to crack and cocaine in the 1990s. It happened to cocaine and heroin in the 1920s.
And, it could be beginning to happen with heroin and opioids now.
An Epidemical Eclipse
What has been particularly egregious about this latest epidemic is how quickly it came to be. Use and abuse opioids has been the worst drug crisis in American history. From prescriptions painkillers alone, each day 46 Americans die from overdose1. The AIDS epidemic of the 1990s – globally, the deadliest epidemic in the human history – is becoming eclipsed by opioids in the U.S. Car crashes, which caused twice as many deaths as fatal drug overdoses in 1999, are also being eclipsed: Overdoses exceeded car crashes by almost 40 percent in 20142.
With the surge in overdoses also came a dramatic spike in the use of prescription painkillers. At the same time, the production of heroin by Mexican and Columbian drug cartels also increased – by more than six-fold from 2005 to 2009 alone. With an increase in production came a significant drop in prices: in a period of 20 years street prices for heroin dropped by 81%, cocaine by 80%, and cannabis by 86%3. At the same time potency and purity increased and global efforts to stem the supplies failed.
What’s Behind the Drug Epidemic
Efforts to control the abuse and accessibility of prescription opioids by manufacturers, medical providers, and regulation have met with some success. Non-medical use of prescription opiates has slowly decreased. Abuse of methamphetamine and cocaine have also fallen. Yet, with drops in use of these drugs has also come a rise in the use of heroin. Consider this: In 2012, 259 million prescriptions for opioids were written4 – that’s more than the total number of adults in the U.S. And there is a correlation to heroin use: Four in five of new heroin users began by misusing prescription painkillers. For those who become addicted, an overwhelming number – 94%, according to a survey5 – say they move on to heroin because it is cheaper and easier to acquire.
More abuse means more overdoses. And while the trend still seems to be at present rising, it may be reaching its limits. Last year a study done by a group at Columbia University projected that rates of overdose by 2017 could fall back to rates last seen in the 1980s. Their projection was made on the theory that epidemics usually follow a symmetrical type bell-shaped curve, rising quickly at first, slowing to an apex, and then inevitably falling again. The theory is called Farr’s Law. There is one major difference between a drug epidemic and one involving a contagious disease: unlike nature, industry has a profit motive. With a profit motive, it can be difficult to control or eliminate the epidemic’s source. The supply of drugs, whether illicit or prescription, despite law enforcement efforts has been limited in any significant way.
The Culture of Pills
And the way addiction begins is changing. Addiction used to more often be a progressive progress, often starting with marijuana or alcohol and moving onto harder drugs. Now, with drugs like OxyContin and other opioids around the house, kids sneak drugs they find at home and quickly become hooked. Or, as often happens, people become hooked on opioids simply in the course of using them as directed. In the U.S. we live in a culture of pills: More prescriptions are being written than ever, there is a growing social acceptability of drugs as a solution to every problem and ailment, and the relentless marketing by pharmaceutical all contribute to the epidemic.
A Cultural Change
Thankfully, this culture may be changing. While the number of prescriptions over the last two decades have nearly tripled6, within the last three years – 2013, 2014, 2015 – there has been a drop, this according to various sources. Two of the sources, the consultancy and research firms for the healthcare industry IMS Health and Symphony Health Solutions, reported declines in national opioid prescriptions by 12% and 18% respectively. Of the data, it was found that prescriptions had fallen in 49 states since 2013, and most significantly in West Virginia – the nucleus of opioid epidemic. A change in regulations by the federal government of hydrocodone and acetaminophen in 2014 may have had something to do with it. According to a JAMA Internal Medicine survey that within the first year of the regulation change, the number of prescriptions dispensed fell by 22% and pills by 16%7.
These reductions give us a reason to be optimistic about the future of the epidemic. However, it is also important that a balance is found between an attempt to control abuse and allowing prescription medications to be accessible to those people who need to manage their pain. Medical marijuana may also have a role to play: For those 13 states that have passed laws allowing for the use of medical marijuana, 25% fewer people die from opioid overdoses annually8. Drug use, including tobacco, is also down among teenagers9 – a very encouraging indicator. But more than any specific policy, regulation, or law, as we – hopefully – begin the retreat of the drug epidemic, it will be public disapproval and a lack of social acceptance that beats back the enemy.
As bleak as the drug picture has been for decades, we may now have at last a good reason for hope.
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