A Plan to Stop a Silent Killer
By Senator Edward J. Markey
Heroin and prescription drug addiction is an equal-opportunity destroyer of lives and families across Massachusetts are struggling with the recent scourge of overdoses that are claiming lives at an unprecedented pace. Today, drug overdoses are the leading cause of injury deaths, surpassing car accidents nationwide.
This dramatic rise in addiction to heroin and prescription drugs, collectively known as opioids, is nothing less than catastrophic. And the magnitude of the harm that our communities are suffering is nothing short of an epidemic. Families across the Commonwealth are experiencing the daily tragedies of addiction that are playing out in cars, in parking lots, in emergency rooms, and all too often silently in homes across our state. In Massachusetts, approximately 65,000 people are currently dependent on opioids—50,000 of whom need treatment but aren’t currently receiving it.
There is no doubt that the current opioid overdose crisis has been primarily driven by the health care system. In the past decade, the number of prescriptions written has increased by 400 percent. In 2012, health care providers wrote 259 million prescriptions for opioid painkillers, enough for every American adult to have their own bottle of pills. The United States makes up only 4.6 percent of the world’s population, but consumes 80 percent of its opioids — and 99 percent of the Vicodin, one of the more popular prescription opioids.
These statistics are deeply disturbing. While there are legitimate uses for these prescriptions in the treatment of chronic pain, the excess pills that are flooding our homes and sitting stagnant in medicine cabinets are only fueling the current crisis. Once an individual is addicted to prescription pain pills, they may be driven to use illicit substances that have similar effects, most notably heroin. Data collected by the Substance Abuse and Mental Health Services Administration (SAMHSA), has found that four out of five heroin users started abusing prescription drugs first.
We need to prevent this rampant addiction before it takes hold. And we need to do it in a balanced way that ensures that people who need prescription pain medication have access to it while minimizing the negative consequences associated with the misuse and abuse of these pills.
Unfortunately, many of our jails are serving as de-facto detox centers, but we know that sending an addict from prison into the community without adequate support is like throwing a baby into a swimming pool — we should expect they will sink. The rates of drug related recidivism are high. We cannot simply arrest away this problem. And treatment for opioid addiction should not be harder to access than the actual heroin and prescription drugs destroying our communities.
There is no one silver bullet to a disease as complex as opiate addiction. It will require a comprehensive solution that brings together, science, medicine, public health and law enforcement on the federal, state and local level. Solving this problem will take multiple policy changes that all work in unison.
Over the last 6 months I have met with first responders, victims and health experts across the Commonwealth, holding roundtables with constituents and experts to discuss the issues that are causing the current crisis of addiction and craft solutions to address the problem.
Today I released my comprehensive federal strategy to address the heroin and prescription drug abuse epidemic based on the ideas and insights gained from these roundtables.
My plan is based on three major principles:
1. Preventing new addictions before they take hold;
2. Expanding access to multiple treatments that work and can help those who are dealing with a substance use disorder achieve recovery;
3. Reducing drug related recidivism in our jails and prisons.
Fortunately, Massachusetts is already ahead of the curve, with a new law that will improve monitoring on the use of prescription opioids and increase treatment access. I know we still have much more work to do to be able to address this emergency that is tearing our communities apart and robbing our children of the greatest gift they are given – the opportunity to maximize their God-given abilities.
Some people call heroin and prescription drug abuse a silent killer. But we cannot be silent any longer.
There are fortunes made in selling heroin and opioid painkillers. Prohibition of alcohol led to fortunes made by crime syndicates. History repeats. We can mount education programs, treatment centers, and all the rest but the financial incentives in areas plagued with low paying jobs is all too great to stop the cycle of markets, vendors, wars over market share, and constant drug pushing to replace customers who have died or are in prison. Clearly we cannot and ought not legalize heroin, but there has to be a way for addicts to come forward without threat of imprisonment or denigration and receive free treatment even if that means free heroin (carefully monitored under a doctors care, of course) , thereby removing them as a profit center for the drug pushers.
and it’s very difficult to stop the spread. Grandma gets some for end of life treatment and grandson pockets the bottle after she’s gone.
People get started using the expensive prescription med and switch to heroin because it’s cheaper.
Tragedy results.
I have been hearing about this problem since about 1970, with only the injection of other drugs (cocaine, Quaaludes, crack, Ecstacy, Meth) as a so-called “bigger problem.”
I heard a guy on NPR once talking about drug addiction. “Why do people take drugs?” the interviewer asked.
“Because life sucks for a lot of people. Stop life sucking, and you’d have less people addicted to drugs.”
I have no idea what the answer is. More treatment? Ever watch the show Intervention? People go to treatment again and again. This is like saying we need more mental health treatment to prevent mass shootings. How much more? Clearly to get us to levels that would make a difference it would be a whole lot more than we are going to (or even able to) spend.
One area is wealth disparity. I recommend the book “The Spirit Level” by Kate Pickett & Richard Wilkinson. There is a clear correlation between cultures with wide wealth disparity and increased illegal drug use. When wealth disparity grows, those on the bottom feel increased hopelessness and those on the top feel increased guilt. These feelings, for many, lead to attempts at self medication.
As well as suburban kids. Andover is in a semi-tizzy over heroin in town.
But wealth disparity is one cause. That’s why one solution won’t work. Treating all people addicted to drugs as immoral, irresponsible individuals who need a wake up call is not working.
End of life and long-term chronic pain is what the new generation of opioids were for (with the slow release). But Dr.’s are writing opioid scripts for everything. The “balance” between pain management for minor surgery and the social costs of the current opioid epidemic (more people in the MA die of opioid od’s than car accidents…) is way out of whack.
Also, we do need more education and prevention…if grandma is taking opioid for end of life care, someone needs to be securing her pills and counting them, because pills stolen from the medicine cabinet is the #1 source of a first time teenage opioid user. And if there are pills left over after grandma passes…dispose of the pills. What is so hard about that? This would save lives.
Finally, we need a different approach to treatment. I agree, the current treatment system of 10 or 30 day treatment is crazy. Like mental health, the disease of addiction MUST BE treatment like ALL OTHER CHRONIC DISEASES. Do we treat diabetes for 30 days and tell the person they are cured? Day we give a cancer patient 30 days of chemo and never check on the disease again? Until we recognize the physical nature of addiction and mental health–they are brain diseases–we’ll never “treat” substance abuse.
Kids have had access to adults’ drugs since forever.
What people should do, and what they actually do, is obviously the root of the problem.
People need vices. Weed is pretty tame compared to alcohol and heroine. Maybe if we had more accessible, less harmful vices, people might back off or avoid starting stuff like heroine?
I literally have nothing to back this up, just thinking out loud.
Saw a kid in a tough urban neighborhood interviewed on TV. It’s about 1985.
“Why do you smoke crack?” the TV reporter asks.
‘Can’t get any weed” the boy replies.
Sometime it is that simple. I don’t know, but we can ring our hands until I’m dead (currently projected for sometime in the second half of this century) and it’s not going to change.
I could beat up Sen Markey’s plans but what’s the point? He puts it out there but unlikely any of these points is getting near to being implemented.
I hate to sound like I give up on people, but in the long term, prevention is always better than reactionary measures – whether drugs, climate change, or anything.
Great. So how do we prevent the social and emotional and behavioral triggers that lead to drug addiction?
Drugs are symptomatic of larger problem. But I think less damaging alternatives would help.
I think we need to refocus our vision of drugs; they are not so much a problem as they are a symptom of a problem. They are the visible sign of the hopelessness that people are facing in this state (and country).
I have relatives who have gotten hooked up on drugs. Relatives in their late teens and early twenties, who did not have a life plan that included college. They got out of high school, dabbled in Community College a bit, but education was not their bag. So there they are, 20 years old, sometimes jobless, sometimes doing odd jobs at odd and unpredictable hours. Their lives were not appealing.
I think that drugs offered an escape to them. The drugs became the most important thing in their life because nothing else was important. A few wound up in jail, primarily for burglaries to support their habits. One wound up a lot worse. Once out of jail, their record followed them, keeping them on the same path of futility.
Their parents cared about them, but there were no options. Without a college education, you have little chance at a good job. The paths just don’t exist in this state, especially considering how our housing is so economically separated – because communities use income levels (set by housing affordability) to screen residents out.
That is what we should be addressing. Yes, we should work to reform our view of drug addiction as a crime, and yes, we should provide more money for treatment, but without an alternative, without jobs, careers, and an attractive life, drugs will continue to take hold in our state.
people are going to sell them. Society thinks that’s bad so we punish them severely. However, many people sell to support their addiction. Are they somehow better?
Many people because of the nature of their problem can’t hold a job. So they commit crimes to support their habit. Better than a regular criminal? We punish them the same.
You could give every one a job in the US and there would still be a drug problem. Lots of people have jobs and are still alcoholics. Drugs are just another option.
I think one of the reasons people drink is because of their spouses and/or children. Try solving that problem. (joke alert for those that don’t seem to get me).
…and the pass we give to the drug companies who lie through their teeth about the dangerous products they peddle.
One from Judy Foreman, who was a Globe health reporter for years. http://thedianerehmshow.org/shows/2014-02-10/judy-foreman-nation-pain-healing-our-biggest-health-problem
One from a retired state police officer, a courageous insightful proposal for ending heroin prohibition http://www.bostonglobe.com/opinion/2014/08/24/end-prohibition-heroin/GRq3TO2RwX3IWDYTjY8UPO/story.html
I worked in a private drug treatment office for 3 years, and have also visited programs in this state, and in Vermont. You can not stop addiction. It strikes people much like diabetes. Both are chronic conditions.
I have seen all sorts of clever, but destructive ways its users use to obtain drugs. An addict I knew was part of a “drug bank” where drugs are collected and doled out to its participants as needed.
Lying and deception is an important mainstay to continue a habit. It is part and parcel of the disease, and has the unfortunate fallout of making its victims persona non grata. Stealing and the violence that accompanies addiction also isolates them from their family and the public at large.
However what is true is that you can not arrest or prevent your way out of this problem. There is also another reality. Treatment will help many, but it will not make the problem disappear. There will be new generations who will succumb to drugs. Hopefully future research will lower the number of individuals who fall into this category.
Another major component of addiction is dual diagnosis. Half of addicts suffer from serious mental illness.
So what is needed?
After detox, close follow up and outreach is necessary. This is a most vulnerable time for addicts since their tolerance to their previous levels of drug use is now life threatening.
Counselors must be skilled in proper interviewing technique, and be able to handle or make referral to professionals to deal with psychiatric issues. Health problems in general should not be overlooked.
The court system should be a strong source of referral for those who can be most successfully rehabilitated. Every attempt must be made to keep people in treatment with frequent visits. One of the treating institution must take full responsibility to see that all aspects of recovery continue. Proper education by knowing people’s talents and strengths, should steer those in recovery to decent jobs, or return them to jobs they were good at.
Towns must be more accepting of treatment centers realizing it is their friends, relatives, or neighbors that have the disease. Restoring an addict to responsible citizenship is a plus for a more healthy community.
All this takes a hunk of taxpayer money to accomplish, but a year’s incarceration of an addict costs $50,000 versus $5 to $10 thousand a year in treatment. The priority should be on what works, not what someone thinks should work.
The lure of drugs is strong enough that restricting prescriptions will not make much of a dent in the problem. The medical profession should just make sure they are not the ones who started a person’s habit. When it does happen through other means, medical professionals will be a more credible source to get the afflicted person to proper treatment.