A "doctor caused epidemic"

It's always interesting to look at how and why particular drug abuse problems start, and the resurgence of heroin in midwest America gets this explanation in The Economist:

The heroin epidemic in the Midwest is closely linked to the rampant opiate epidemic. As doctors prescribed opioid painkillers such as OxyContin more and more liberally, their abuse grew. Sales of prescription opioid painkillers have increased 300% since 1999, according to the federal Centres for Disease Control and Prevention (CDC), even though the amount of pain Americans report to their physicians has not changed.

 Three-quarters of heroin addicts used to take prescription drugs and switched to heroin, which is cheaper and more easily available on the black market. A gram of pure heroin costs less than half what it did in the 1980s, in real terms. “This is a doctor-caused epidemic,” says Tom Frieden, boss of the CDC. In states with higher prescription rate of opioid painkillers, such as Michigan, Ohio and Indiana, the number of heroin addicts is higher too.

In depressed areas in the Rust Belt, where poverty and unemployment rates shot up as factories shut down and jobs disappeared, the drug epidemic is ravaging once-idyllic communities. Indiana had a brutal wake-up call earlier this year when Austin, a small rural community just off the interstate between Indianapolis and Louisville, was the epicentre of the largest outbreak of HIV infections ever seen in the state. Nearly 200 people were infected in a population of just 4,200 because addicts injecting Opana, a prescription painkiller that delivers a potent high, shared needles, which is the fastest way for an infection to spread. “We have never documented anything like it,” says Mr Frieden.