Last week Sen. Chuck Schumer (D-N.Y.) asked for “an emergency $100 million surge” in federal funding to “to quickly combat the fact that New York City has become the hotbed for the East Coast heroin trade.” Schumer declared that “heroin trafficking and usage are at epidemic levels,” adding that “seizures of heroin in New York City in 2014 have already surpassed those of any previous year since 1991, which demonstrates an alarming trend that we must nip in the bud.”
Depending on how you define epidemic, you may or may not agree with Schumer’s description of the problem. But it is abundantly clear from a century of efforts to suppress the heroin trade that his solution—more spending on supply-side measures such as seizing heroin and prosecuting heroin dealers—is doomed to fail.
Since 2002 the National Survey on Drug Use and Health (NSDUH) has asked a nationally representative sample of Americans who are 12 or older whether they have used heroin in the previous month. According to that survey, the number of past-month users rose from 166,000 in 2002 to 335,000 in 2012. That’s an increase of about 100 percent over a decade, which looks big. But it’s a lot smaller than the increase of more than 200 percent detected by the National Household Survey on Drug Abuse (NHSDA), the predecessor to NSDUH, between 1993 and 1996. And as a percentage of the population, the number of past-month users is still very small: 0.3 percent in 2012, up from 0.2 percent in 2002. For drug warriors like Chuck Schumer, any increase in drug use (real or imagined) qualifies as an epidemic. But if epidemic refers to a phenomenon that is pervasive or at least widespread, heroin use does not qualify and never has.
One important caveat about those survey numbers: Both NSDUH and NHSDA miss a substantial number of heavy heroin users. Exactly how many is anybody’s guess. According to an estimate by Beau Kilmer and other researchers at the RAND Corporation, there might have been as many as 1 million daily heroin users in 2010. Such estimates are highly uncertain because they rely on indirect evidence and many debatable assumptions. But even if Kilmer and his colleagues are in the right ballpark, heroin addicts still represent less than 0.5 percent of the population 12 and older, which helps put Schumer’s “epidemic” in perspective.
Whatever you call the recent increase in heroin use, it seems quite unlikely that spending more money on supply control will have a noticeable impact on it. Supply reduction efforts tend to be ineffective because traffickers have a strong incentive to bypass them and many ways to do so. While interdiction imposes costs on traffickers, those costs generally are not big enough to raise retail prices by much or for long. “With few exceptions and despite increasing investments in enforcement-based supply reduction efforts aimed at disrupting global drug supply,” a 2013 study reported in BMJ Open concluded, “illegal drug prices have generally decreased while drug purity has generally increased since 1990. These findings suggest that expanding efforts at controlling the global illegal drug market through law enforcement are failing.” Looking specifically at heroin, the authors found that the purity of that drug in the United States rose by 60 percent from 2000 to 2007, which is not what you would expect if drug warriors were succeeding.
A study reported in JAMA Psychiatry last week confirms that anti-trafficking efforts have failed abysmally. The researchers, led by Washington University psychiatrist Thomas Cicero, surveyed about 2,800 heroin addicts entering treatment across the United States. Among the 88 subjects who began using opioids in the 1960s, 80 percent said they started with heroin. Among the 1,613 subjects who began using opioids in the first decade of this century, by contrast, 75 percent started with prescription narcotics and later switched to heroin. In follow-up interviews with 54 heroin users whose histories fit the latter pattern, 94 percent “indicated that they used heroin because prescription opioids were far more expensive and harder to obtain.”
That’s right: Despite all the efforts aimed at disrupting the heroin market since 1914, the drug is much cheaper than its legal competitors. Does that seem like a problem that another $100 million in anti-trafficking money can fix?
Cicero et al.’s sample may not be representative of heroin addicts in general, let alone the broader group of people who use heroin less often than daily. Many people who started using heroin in the 1960s, ’70s, and ’80s have since stopped, so they would not show up in a survey of people entering treatment. Still, the study provides support for the impression that heroin users are more likely to be white today than in past decades: 90 percent of the subjects who began using opioids this decade were white, compared to about half of those who started in the ’60s and ’70s. The more recent initiates were also more likely to be female: While 83 percent of the subjects who began using opioids in the 1960s were male, the subjects who began in 2010 or later were about evenly divided between men and women. Both of these trends may be related to the fact that the more recent initiates typically started with prescription painkillers and switched to heroin after a crackdown on nonmedical use made pills harder and more expensive to obtain. Evidence of that pattern also can be seen in the NSDUH data: The number of past-month heroin users rose from 281,000 to 335,000 between 2011 and 2012, while the number of past-month OxyContin users fell from 434,000 to 358,000.
Since prescription painkillers, unlike heroin, are legal and regulated, the government has a lot of influence on the market. It decides how much should be produced to meet medical needs, requires a doctor’s written approval for each sale, and monitors prescription practices, threatening doctors with civil and criminal penalties if they seem to be excessively generous. By tightening those restrictions, the government can reduce nonmedical use of these drugs, but there’s a cost in terms of reduced access by legitimate patients and potentially dangerous substitution effects. In effect, the government has been encouraging nonmedical opioid users to switch from pharmaceutical-quality pills that come in precisely measured doses to a black-market product that varies widely and unpredictably in potency and quality. If the aim is to reduce the harm associated with drug use that does not seem like a very smart policy.
6/06/2014 @ 3:18PM3
The Newhawks Crew
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