More than one truth

All the recent attention to heroin and opiate use has brought about backlash from policy pundits.

• There was a JAMA Psychiatry study on the shifting demographics of heroin use over the last half century. In the 1960s, heroin was an urban phenomena and was 50% white and 50% black. Today, it’s shifted to suburban and rural areas and 90% of new users are white.
• Last year, the CDC reported on a 5 fold increase in female opioid overdose deaths over a 10 year period.
• This week, the White House held a summit on the opioid epidemic.

Not surprisingly, the media coverage has lacked nuance. A while ago, I shared a Washington Post piece that observed recent coverage had focused on white addicts and was unusually sympathetic. In response, I pointed to Bill White’s themes in chemical prohibition. These themes include overt and covert racial themes, including associating the substance with a hated subgroup.

Radley Balko summarizes the backlash. These pundits are frustrated over myths that work their way into these stories and truths that go unrecognized. However, these attempts to expose these problems risk giving their own false impressions.

For example, some have expressed frustration that they give the impression heroin use is far more common that it actually is. This is true. However, they obscure other important truths:

• Heroin use may not be as prevelant as the media suggests, but the number of users is up by 53% over 10 years.
• Heroin overdoses went up 45% over 1 year–from 2010 to 2011.
• This focus on heroin misses the bigger issueofnonmedical use of prescription opioids.
  • Use of these drugs is associated with heroin initiation.
  • Misuse of these drugs is very common, especially by people young people.
  • Overdose death rates are way up and have overtaken motor vehicle accidents as a cause of death.

Another example is frustration over the “white women in peril” theme. There’s also truth to this. However, this also obscures the fact that overdose deaths by women are up by 400% over 10 years. Isn’t this worthy of attention and concern?

Finally, they express frustration about misperceptions of the racial demographics of heroin users. Yes. This has long been a problem. Heroin and other opioid addiction has been present in white communities for a very long time and their refusal to acknowledge it has been frustrating and a barrier to improving care and policy. On the one hand, they’ve been blind to the problem in their own backyard. On the other hand, there have been real and large demographic shifts. Isn’t it a good thing that this is changing? Isn’t this something to applaud, while also providing a history check?