Joe Tharakan | Overlooking Opioids

Cup o' Joe | We need to pay more attention to the heroin epidemic

By Joe Tharakan 09/14/16 10:04pm

Opioid dependency — and subsequent heroin addiction — has skyrocketed over the last 15 years. Yet there has been relatively little coverage when compared to the scope of the problem.

This crisis predominantly affects people outside of the Penn sphere — mostly ages 25-59 and those without any college education. We are too young and, by virtue of even attending university, too educated to be the main demographic affected. You may not even know about it — but you should, because its effects are causing the whole country to suffer.

Opioids are a class of drugs with analgesic effects, aka painkillers. They include both legal and illegal drugs, such as oxycodone (OxyContin), hydrocodone (Vicodin), morphine and heroin. They are arguably the most addictive drugs that exist, with severe withdrawal symptoms.

Although this problem cannot be traced to a single cause, a major factor in creating this epidemic was overprescription. Due to pharmaceutical pressures and systemic issues in health care delivery, there has been a tendency for doctors to liberally recommend painkilling drugs which are highly addictive.

The statistics are alarming. Information from the Centers for Disease Control and Prevention shows the number of legal painkiller prescriptions has increased by over 300 percent, yet the amount of “pain” to “kill” has not significantly changed, let alone quadrupled. Since 1999, the amount of overdose-related deaths have quadrupled. Opioids are involved in 61 percent of overdose deaths.

Some pharmaceutical companies are to blame. The manufacturer of OxyContin, Purdue Pharmaceuticals, knowingly hid evidence that its alleged 12 hour delayed-release pill faded sooner than expected in order to protect profits. With instructions to take every 12 hours and the effects fading sooner, patients suffered withdrawal. When someone develops opioid dependency and runs out of legal means, they turn to illegal means, e.g. street heroin.

The drugs they use as alternatives in the United States are almost exclusively provided by Mexican and South American drug cartels, who are not held to the rigorous safety standards that legal pharmaceutical companies must follow.

Thus, cartels are free to engage in dangerous practices, such as mixing in compounds like fentanyl, a version of heroin 50 times more clinically potent, or carfentanyl — better known as elephant tranquilizer — approximately 5,000 times more powerful. These drugs create a more intense high, but at increased risk of overdose, such as in the recent high-profile death of the musician Prince.

The New York Times released an infographic showing the geographic spread of overdose deaths, of which opioids are the primary cause. Once isolated to a small pocket in Appalachia, over the last 15 years it has permeated the rest of the nation as well. According to the Philadelphia Department of Public Health, the number of overdoses has doubled since 2003 in Philadelphia County. In addition, the proportion of Emergency Department visits attributable to overdose has risen from 40 percent to 67 percent.

This problem has also created a collateral AIDS epidemic. HIV can be transmitted by the needles involved in heroin use. This is most egregious in places such as Austin, Ind., a town of 4,000 with 190 confirmed HIV+ cases, most of which were transmitted within the last two years.

However, there are solutions to combat this problem — but we have to work to implement them. First and foremost, we cannot continue to treat drug addiction as a crime.

Pharmacies like Walgreens and CVS have taken a necessary step by allowing naloxone, the antidote for opioids, to be available over the counter without a prescription in many states. States must make it easier to access the antidote.We can also consider the policies that other countries who have faced similar problems, like Switzerland, Portugal and Uruguay, have implemented. Plans such as supervised injection sites or opioid substitution therapy with methadone (a weaker, longer lasting version of heroin that can curb withdrawal) can prevent unnecessary deaths.

Finally, we must attack the barriers addicts face in getting treatment. There is a massive stigma in even discussing the issue, let alone admitting you have a problem and seeking help. Furthermore, there are few clinics that specialize in treating heroin addiction, and oftentimes patients do not have the resources, such as reliable transportation, to consistently go to such health care centers.

Nonetheless, overcoming this problem will take time, effort and significant commitment. Even if we implement all of these solutions, it appears as though it is going to get worse before it gets better. But we cannot continue to sit on our hands as this problem rages on.

JOE THARAKAN is a College senior from the Bronx, in the Biological Basis of Behavior program. His email address is jthara@sas.upenn.edu. “Cup o’ Joe” usually appears every other Saturday.

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