Chasing the Dragon in the Shadow of the OX

The numbers are in and it is official: deaths from heroin overdoses in much of the United States have doubled in the past two years. Whether the heroin was injected or smoked ("chasing the dragon"), there is some evidence that, in many places, heroin has increased in both availability and purity in the same time period.

How to explain this?

One school of thought — I'll call it the opiate demand substitutability school of analysis — tracks the increase in heroin's popularity to the increased difficulty addicts are reported to be having in accessing oxycodone ("OX") in light of state and federal efforts to reduce prescription drug abuse. The street value of OX has increased (at least the street value of original formulation OX has increased, while the street value of OX in the resistant to crushing and snorting format has actually gone done) and there is anecdotal evidence from treatment centers for injectable drug users that the migration from OX to heroin is well underway.

Another school of thought — I'll call it the progression of addiction through the population school of analysis — is that prescription drug abuse, particularly in the 18-25 age group, is still rampant but the increase in heroin overdose fatalities demonstrates a cohort of aging opiate addicts moving through the progression of addiction, seeking an ever cheaper and more powerful high.  This might explain the high demand for heroin of a purity previously not well known in the United States.

Whichever theory you ascribe to — and some thoughtful addiction specialists subscribe to both— the increased death rate from opiate overdose is data playing out as the back story to our ongoing debate over the wisdom and utility of providing naloxone (the antidote for heroin overdose) for emergency use. Some states have now approved the training of and distribution to  first responders and lay people of naloxone for just this use.

But we are conflicted. Is naloxone a step toward condoning use? If the overdose death rate is lower where heroin is both safe and accessible, is naloxone's arrival just a further expression of our own ambivalence about treatment for addiction?

 x-posted at PrawfsBlawg

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