Origins of the Opioid Crisis: A little more

Earlier today Jason Schwartz provided an interesting post about the origins of the opioid crisis. It brought to mind some related thoughts I decided to share.

  • I remember in the early 2000’s, in the city where I was working at that time, we began to see 18 year olds presenting for treatment (especially methadone maintenance) who had a history of 5 years of physical heroin dependence and had never touched a needle. Although that was new at that time we were not surprised. The street heroin that had been very low purity for many years had become dramatically higher in purity. This meant less money was needed to get an intense effect, and snorting would suffice. New customers were abundant, and they avoided the traditional stigma of injection drug use that was a barrier. Heroin seemingly shifted in some ways to resemble crack (cheap, powerful, no needle) in terms of marketing.
  • A quick check of NIH/NIDA data shows 47, 600 deaths in 2017 from overdose involving any opioid.
  • A quick check of NIH/NIDA data shows 480,000 deaths annually are attributable to cigarette smoking.
  • That same NIH/NIDA report states that cigarette smoking is the leading preventable cause of premature death in the USA.
  • Lastly, I wonder from time to time, “Where did the crack epidemic go?” I wonder about the factors that might inform the answer, and the potential applicability of those, similar, or other factors to what we face now.

Having entered the field in 1988, this question about the crack epidemic occurs to me regularly – especially as we:

  1. watch the wave form of the current opioid problem
  2. compare the historical responses to 1980’s/1990’s era crack-related deaths and crack-related problems, with the recent responses to opioid deaths
  3. compare the responses to both the crack and opioid epidemics with the responses to the current death rate associated with cigarette smoking.