As the heroin crisis grows, doctors prescribe enough painkillers for every person to have a bottle
Every year in the United States, there are enough opioid painkillers prescribed to give one bottle to every adult in the country. Officials believe the over prescription of painkillers has contributed to the heroin epidemic that lives on every street, neighborhood and city. Student athletes, mothers, fathers and beloved celebrities have all fallen victim to the grips of the addiction.
America's appetite for heroin has grown stronger, with more 28,000 opioid- and heroin-related overdose deaths in 2014, according to the CDC, with numbers only increasing year by year. In response to the epidemic, the Obama administration is treating it as a public health crisis,calling for an allocation of $1.1 billion in new funding to help expand treatment for those seeking it.
Instead of trying to prosecute its way out of the problem, the government is now viewing the crisis through mental health, behavioral, medicinal and public health lenses.
Recommendations also include educating doctors on the possible effects of prescribing powerful opioids, like oxycodone, hydrocodone, codeine, morphine, and fentanyl.
The gateway drug for 80 percent of heroin users is prescription opioids, according to Baltimore City Health Commissioner Dr. Leana Wen.
"We're beginning to develop this culture of a pill for every pain. There is a culture of access that we have to change," said Wen, who spoke alongside President Obama in March about what can be done to combat the opioid crisis in the United States.
The CDC links the spike in overdoses to fentanyl, a drug 50-100 times more powerful than heroin.
America's appetite for heroin has grown stronger, with more 28,000 overdose deaths in 2014, according to the CDC, with numbers only increasing year by year.
Fentanyl is increasingly being used to cut heroin before it's sold on the streets.
"In the ER, I would prescribe [fentanyl] to someone who had just been in a terrible car accident and their hip is out of joint and they're screaming in pain," Wen told Rare. "If somebody is using heroin and they don't know that fentanyl is now mixed in it, they're going to overdose and die, which we're seeing nationwide."
The role of fentanyl in overdose deaths took center stage after the April 2016 overdose death of megastar Prince. The medical examiner from Prince's home county in Minnesota ruled the death was due to a self-administered accidental overdose of fentanyl.
Faces of heroin abuse:
The drug was first introduced under the name Sublimaze in the 1960s and was initially only administered through a needle, but it is now available through pill form, patches, injections and even in lozenge form.
Many users don't know they're buying heroin laced with fentanyl.
In Baltimore, where more than 20,000 people are known to be using heroin, the health department has issued a "Don't Die" campaign with fliers that instruct users on how to avoid an overdose. One of the directives on the releases is to pay attention to any changes in color and texture of the drug and to inject slowly if a change is noticed.
The skyrocketing rate of heroin-related overdose deaths has also increased the usage of Naloxone, also called Narcan. It's a prescription drug that can stop an overdose. Some high schools are now stocking Narcan so staff can respond to an overdose if necessary. It can prevent death if administered within 3-5 minutes of an overdose.
The use and importance of Naloxone is not new — the World Health Organization placed the drug on its list of essential medications in 1983.
U.S. public health officials are pushing its efforts to make Narcan available to the masses. In Baltimore, for instance, Wen has issued a blanket prescription for Narcan so every resident of the city can access it.
The White House announced in March that the Substance Abuse and Mental Health Services Administration (SAMHSA) is releasing a new $11 million funding opportunity to states so they can purchase and distribute Naloxone and train first responders and others on its use.
Now that the face of addiction has changed, so has the response.
Heroin overdose antidote:
Once Obama, Congress and even health officials joined the chorus asking for "compassionate" care in confronting this crisis, it marked a drastic change in tone from the United States' long-running "War on Drugs" — which disproportionately affected minorities, specifically black men — often characterized by zero tolerance rules and stiff prison sentences.
Now that the conversation has become less about "junkies" who have made a criminal choice and more about everyday Americans getting hooked on prescription drugs, the national calculation has focused on the system leading to drug abuse. The use and overdose deaths due to opioids, including heroin and fentanyl, can be traced back decades, when physicians began to change the way they were prescribing opioids. Between 1991 to 2013, prescriptions for opioid painkillers increased from 76 million to 207 million per year in response to patient's pain concerns.
Opioid painkillers can be highly addictive, with users 40 times more likely to become addicted to heroin. The transition from abusing opioids to heroin can also be linked to money — one 30mg tablet of oxycodone can cost around $50, while a bag of heroin can be purchased in some places for $5.
An estimated 25,000 Americans die annually from opioid overdose, and the numbers are projected to keep rising.
"We are seeing more people killed because of opioid overdose than from traffic accidents — I mean, think about that," Obama said at a March meeting of the National Rx Drug Abuse and Heroin Summit. "It has to be something right up at the top of our radar screen."
Rare political reporter Yasmeen Alamiri and videographers Tolleah Price and Dan Yar spent months researching and reporting this series — traveling to Maryland, New Hampshire and other heroin-torn places while talking and listening to users, police officers, public figures and devastated families all torn apart by the heroin epidemic. See the full series at on.rare.us/HeroinInAmerica.