The heroin resurgence

There's a very interesting article up at the Christian Science Monitor about the resurgence of heroin use in the US. 

It notes:

The rise is being driven by a large supply of cheap heroin in purer concentrations that can be inhaled or smoked, which often removes the stigma associated with injecting it with a needle. But much of the increase among suburban teens, as well as a growing number of adults, has also coincided with a sharp rise in the use of prescription painkiller pills, which medical experts say are essentially identical to heroin. These painkillers, or opioids, are prescribed for things such as sports injuries, dental procedures, or chronic back pain. Yet in a disturbing number of cases, experts say, they are leading to overdependence and often to addiction to the pills themselves, which can then lead to heroin use.

The report spends a fair bit of time on the 'gateway' pathway which it says is pretty common - alcohol, marijuana, prescription painkillers (often obtained on the street) and heroin.  (Although I guess some might suspect that this paper might be one particularly inclined to note the 'pathway' aspect of marijuana use, I don't know there is any strong reason to doubt it.  Certainly, the current experiment in legalisation in the US will be one to watch for future use of other drugs.)

Anyhow, the story puts a lot of the blame on the rise of OxyContin and its relatively liberal use by American doctors: 

The global production of oxycodone, marketed as OxyContin in the United States, increased from two tons in 1990 to 135 tons in 2009. More than two-thirds of that supply was manufactured in the US, which, according to the United Nations Office on Drugs and Crime, increases the risk of its subsequent overprescription and diversion into illicit channels.

Experts trace the rise of painkiller misuse in the US to 1996. That's when the pharmaceutical company Purdue Pharma introduced OxyContin, a narcotic and derivative of opium. Andrew Kolodny, chief medical officer of Phoenix House, a national nonprofit treatment agency, describes OxyContin as essentially a "heroin pill." It was made of oxycodone, a narcotic used to treat pain at the end of life. But the new pill would allow the company to reach a much wider audience.

"[Purdue] wanted a product that would be prescribed for common, moderately painful chronic conditions," says Dr. Kolodny, who is also president of Physicians for Responsible Opioid Prescribing, an advocacy group.

At first, the medical community balked. Using opioids for chronic problems seemed too risky given the nature of the pills' highly addictive properties. But Purdue Pharma launched an aggressive marketing campaign arguing that it was a compassionate way to treat patients and, because of its extended-release characteristics, would be less prone to abuse.

But before long, numerous cases of addiction to the painkillers began to surface. In 2007, Purdue Pharma pleaded guilty in federal court to misleading doctors and the public about OxyContin's risks and paid a $600 million penalty.

 And look at the number of deaths prescription painkillers cause:

•Nearly 3 out of 4 drug overdose deaths are now caused by prescription painkillers. In 2008, some 14,800 deaths were attributed to the pills – "more than cocaine and heroin combined."

•More than 475,000 emergency room visits were directly linked to prescription painkiller misuse or abuse in 2009, roughly double the number of five years earlier.

That's extraordinary.   And, I think, it is pretty strong evidence against the libertarian idea that legalising even the strongest drugs would lead to safer usage of them by those who have an addiction.  These deaths and emergency room visits are caused by "safe" (that is, not impure) drugs, and ones for which many of the users have been legitimately prescribed and so have proper information about dosage.   Doesn't help much, does it?