CDC Reports Changes in the Profile of Heroin Addicted Individuals

While it was no surprise to addiction treatment professionals, the latest CDC update on heroin addiction in this country raised more than a few eyebrows. Most significantly, the report identified a new cohort of the addicted--better educated, with higher incomes, and from upper strata socio-economic groups. While use and overdose deaths are surging in all demographic groups, there were dramatic increases in use by women (100% increase!), a doubling of use in the 18-25 age group, and a 60% increase in groups covered by private insurance and those earning more than $50,000. This changing profile has awakened America to what is widely considered to be an opiate epidemic. Overdose deaths now exceed traffic fatalities, and more than 40,000 died last year alone, over 1,000 in Massachusetts. But this is not only a crisis in America; it is global. Overdose deaths now exceed traffic fatalities in the UK, there have been more than 70,000 overdose deaths in European Union countries; and a 250% increase in Ontario.

What has spawned this crisis? Well, first the “crisis” has been nearly twenty years in the making. As management of pain became the pre-occupation of healthcare providers (driven in part by new regulations that determined pain assessment to be the “fifth” vital sign) and pharmaceutical companies responded by developing new, stronger, and “better” pain management medications, the stage was set for a surge in addiction to these products. The knowledge that even relatively short term use of opioid analgesics can produce dependency seemed to be left by the wayside. It defies credulity to know that, while Americans constitute 5% of the world’s population, we consume 80% of the pain meds in the world; last year 250 million prescriptions were written.

What perplexes people is, how an individual using prescribed medication could migrate so quickly to heroin. The answer to that is too much for this column but suffice it to say that the literal “hijacking” of brain reward and memory pathways is so profound and powerful, it will drive individuals to any lengths to sustain use of the drug.

In Massachusetts, after four months of work, Governor Baker’s opioid task force released its findings and recommendations on June 22nd. The many hours of testimony and public opinion culminated in a report that distilled information into 65 recommendations in four broad categories--Prevention, Intervention, Treatment, and Recovery Support. The report is available for review at http://www.mass.gov/eohhs/gov/departments/dph/stop-addiction/recommendations-from-the-governors-opioid-addiction-working-group.html

The Governor proposed a number of initiatives including a major public awareness campaign, comprehensive education programs, significant actions to improve prescriber practices regarding narcotic pain medication, increased distribution of Naloxone, the overdose reversal drug; additional treatment beds, pilot programs to test new models of care, improved data systems to track trends and improve access to care, and improved screening for substance use in general medical settings.

The reframing of addiction as a health problem and the public pronouncement that it is a chronic brain disorder carries with it the promise that, at long last, our society will focus efforts on creating an addiction treatment system that is consistent with how we treat other chronic conditions. This means prevention, early intervention, and long term recovery management, not just cycling in and out of detox and rehab programs. The benefits to our communities will be manifold. Let’s stay tuned for the periodic updates the Governor has promised as his administration takes on this daunting task.