Greetings from the heroin overdose capital of the country. I went to Home Depot yesterday to find decorations to celebrate. H.D. has its Halloween stuff out, so I settled on a 7 ft. plastic skeleton of a horse. I think it glows in the dark. “And I looked, and behold a pale horse; and his name that sat on him was Death.” [Revelations, Ch. 6, v. 8.]  No, I’m not religious, but I try to be literate.

G Sallust[1]

[Hi, this is G. Sallust, and this post no doubt is a first. First and foremost, it’s the first time anyone here has quoted himself in an introduction. You may think that’s not particularly noteworthy; in fact that it’s a ridiculous case of unbridled narcissism, common in the blogosphere; but let’s face it: I’m the only one who’s put those words to paper and they are – really – quite good. It’s also the first time I’ve used a quote within a quote, something you certainly won’t see in the traditional media. That’s a nice touch, don’t you think? And, last but not least, it’s the first time anyone here has reacted directly to local news, rather than skating over the horizon to pursue more lofty goals. Although I’ll admit today’s story will wind up in Afghanistan before we’re done.]

The quote is based on current events; a week or so ago the papers in my area were full of news about an outbreak of heroin overdoses in my state, West Virginia. One small city reported 27 deaths from overdose in just 4 hours.[2] Heroin is not one of my areas of expertise, thank God; but even I knew this wasn’t normal. So I checked into the matter, and what I found is alarming. Heroin overdose deaths are on the rise nationwide, and, while the blight is everywhere, some areas suffer more than others.  Nevertheless, the count of 27 deaths in 4 hours is spectacular; a standout in a dismal field

Overdoses Rising

The Centers for Disease Control report that, as of the end of CY 2014, “… the rate of deaths from drug overdoses [since 2000] has increased 137%, including a 200% increase in the rate of overdose deaths involving opioids (opioid pain relievers and heroin).” [3] That is:

  • Nearly half a million people in the U.S. died from drug overdoses from 2000 to 2014.
  • In 2014 more people died from drug overdoses in the U.S. than in any previous year. Drug overdoses killed approximately 1.5 times more people than motor vehicle crashes.
  • Opioids, primarily prescription pain relievers and heroin, are the main drugs associated with overdose deaths. In 2014, opioids were involved in 28,647 deaths, or 61% of all drug overdose deaths; the rate of opioid overdoses has tripled since 2000. [4]

Also the 2014 data show “two distinct but interrelated” trends: (i) a 15-year increase in overdose deaths involving prescription opioid pain relievers; and (ii) a recent surge in illicit opioid overdose deaths, driven largely by heroin.[5]

What is Heroin? What are Opioids?

That part is easy. Opioids are, simply, drugs derived from or based on opium, or synthesized to emulate opium. They include pain relievers, such as oxycodone and hydrocodone,[6] which are legal if prescribed by a physician; and heroin, which is not.[7] So why do some people chase the opioid experience? Is their pain all that bad? Not necessarily, but opioids also affect the brain regions involved in reward, and can [and apparently often do] induce euphoria.[8]

Synthetic opioids, principally fentanyl and tramadol, are a big problem today. The pharmaceutical versions can be abused, and overdose can be fatal. Additionally there’s a non-pharmaceutical version of fentanyl, manufactured in illegal laboratories that can be toxic. Taken together, overdose deaths due to legal and illegal synthetic opioids “nearly doubled between 2013 and 2014.”[9]

According to the Centers for Disease Control, people who misuse prescription opioids often graduate to heroin, in large part because heroin is cheaper and more available on the street. So it should be no surprise that heroin overdose in the U.S. is rising. “The increased availability of heroin, combined with its relatively low price (compared with diverted prescription opioids) and high purity appear to be major drivers of the upward trend in heroin use and overdose.”[10]  Unfortunately the “trend” looks more like a moonshot than a gentle rise. “Heroin overdose death rates increased by 26% from 2013 to 2014 and have more than tripled since 2010, from 1.0 per 100,000 in 2010 to 3.4 per 100,000 in 2014.”[11]

West Virginia figures[12] indicate that, at the end of 2014, the overdose death rate in the county where I live was 52.3 per 100,000[13], while the rate in the county next door was 104.6 per 100,000.[14] In short, my neighborhood far surpasses the national average. On the bright side, the city I referenced earlier [the one that lost 27 people to heroin in 4 hours] is not in my area. Those 2016 numbers will not affect our local score. Nevertheless the local news isn’t good, and I’m not optimistic for this year.

Afghanistan

If you buy heroin on the street, what actually may kill you: the heroin, or the stuff it’s mixed with? The answer may be, that either can do it. It’s thought, for example, that the heroin responsible for the 27 deaths [in 4 hours] in West Virginia might have been “laced” with something that made it more deadly than usual. The matter was being studied as of mid-August.[15] So what might that substance be? My guess is the non-pharmaceutical version of fentanyl; that’s the illegal version, made for and peddled by drug dealers, and used to give an extra boost to plain, old heroin. But we won’t really know until the toxicology reports come out.

While I don’t know much about fentanyl, or where it’s made, I do know something about heroin. It’s made from opium, which comes from poppies, which mostly are grown in Afghanistan. You remember Afghanistan, don’t you? That’s the country that hosted Osama bin Laden while he planned the [successful] attack on the original World Trade Center. That was September 11, 2001. We and NATO attacked Afghanistan in October of that year, sided with indigenous forces and chased out bin Laden, and then stuck around for years trying to “reconstruct” the country and build a modern democracy there.[16] The direct cost, to us, of that adventure so far amounts to about $686 billion, but the total costs, counting money we haven’t spent yet on wounded veterans, replacement weapons, and so forth,  may be far higher, in excess of $1  trillion.[17]

So we [and NATO] were in Afghanistan for 11 – 12 years, and probably still have forces in the area. You know, “advisors,” “special” forces and so forth. In all that time we didn’t seem to reduce Afghanistan’s opium production. Perhaps it wasn’t a priority. Perhaps it was just too hard to do. Perhaps our leaders thought it was in our interest to let all of that stuff out into the world; but why would anybody think that? Ask the White House. The people there make those kinds of decisions.

Anyway, today Afghanistan is the premier world exporter of opium. Wikipedia reports, for example, that “Afghanistan’s opium poppy production goes into more than 90% of heroin worldwide.”[18] Isn’t that interesting? I wonder, when “reconstructing” Afghanistan did we pay for new roads to carry that deadly cargo out of the country?

There’s a lot of money in legal drugs, and apparently even more in the illegal ones. I’m sure lots of people made lots of cash off of Afghan poppies while we were there. It just frosts me that so many profited while our troops fought and died there. Who thought that was a good idea? Who benefitted? Does anybody know? If not, why not? Were there “consequences” for the profiteers, or did they just get rich?

Afghanistan leads the world in opium poppy production. In many ways we made that possible. Our reward, or part of it, is that we have a flood of heroin in the world, including here. That’s no reason for us, or the world, to love the Afghan people, or their political leadership.

[1] I’m quoting myself, and more specifically words from an email I sent to an artist friend who’s currently traveling. She was in Finland at the time.

[2] See CNN, Marco, West Virginia city has 27 heroin overdoses in 4 hours (August 18, 2016), available at http://www.cnn.com/2016/08/17/health/west-virginia-city-has-27-heroin-overdoses-in-4-hours/index.html

[3] See CDC Morbidity and Mortality Weekly Report (MMWR), Rudd, et al., Increases in Drug and Opioid Overdose Deaths — United States, 2000–2014 (Jan. 1, 2016), available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6450a3.htm?s_cid=mm6450a3_w Henceforth I’ll refer to this report as MMWR Heroin at __.

[4] See MMWR Heroin at Discussion. Note: Pages of this document are not numbered. Subtopics will be used.

[5] Id.

[6] For a list of other legal opioids, check out WebMD, Opioid Drugs: Dosage, Side Effects, and More Opioid Drugs: Dosage, Side Effects, and More Opioid Drugs: Dosage, Side Effects, and More Opioid Drugs: Dosage, Side Effects, and MoreOpioid Drugs: Dosage, Side Effects and More, at http://www.webmd.com/pain-management/guide/narcotic-pain-medications

[7] Id.

[8] See NIH, National Institute on Drug Abuse, Prescription Drug Abuse, at How do opioids affect the brain and body? available at https://www.drugabuse.gov/publications/research-reports/prescription-drugs/opioids/how-do-opioids-affect-brain-body

[9] See MMWR Heroin at Discussion. “Toxicology tests used by coroners and medical examiners are unable to distinguish between prescription and illicit fentanyl. Based on reports from states and drug seizure data, however, a substantial portion of the increase in synthetic opioid deaths appears to be related to increased availability of illicit fentanyl (7), although this cannot be confirmed with mortality data. For example, five jurisdictions (Florida, Maryland, Maine, Ohio, and Philadelphia, Pennsylvania) that reported sharp increases in illicit fentanyl seizures, and screened persons who died from a suspected drug overdose for fentanyl, detected similarly sharp increases in fentanyl-related deaths (7).§ Finally, illicit fentanyl is often combined with heroin or sold as heroin. Illicit fentanyl might be contributing to recent increases in drug overdose deaths involving heroin. Therefore, increases in illicit fentanyl-associated deaths might represent an emerging and troubling feature of the rise in illicit opioid overdoses that has been driven by heroin.”

[10] See MMWR Heroin at Discussion.

[11] See MMWR Heroin (before the Discussion).

[12] See WV Public Radio, Mistich, Data Viz: When Did West Virginia’s Heroin Problem Begin? Which Counties Are Hurting the Most? (May 22, 2015)

[13] That’s Jefferson County, WV.

[14] That’s Berkeley County, WV.

[15] See CNN, Marco, West Virginia city has 27 heroin overdoses in 4 hours (August 18, 2016), available at http://www.cnn.com/2016/08/17/health/west-virginia-city-has-27-heroin-overdoses-in-4-hours/index.html

[16] For a good timeline, see Council on Foreign Relations, U.S. War in Afghanistan (1999 – present), available at http://www.cfr.org/afghanistan/us-war-afghanistan/p20018

[17] See Time, Thompson, The True Cost of the Afghanistan War May Surprise You (January 1, 2015), available at http://time.com/3651697/afghanistan-war-cost/ . See also Harvard Kennedy School, Bilmes, The Financial Legacy of Iraq and Afghanistan: How Wartime Spending Decisions Will Constrain Future National Security Budgets (March 2013, RWP 13-006) available at https://research.hks.harvard.edu/publications/workingpapers/citation.aspx?PubId=8956&type=WPN

[18] See the Wikipedia entry on opium production in Afghanistan, at https://en.wikipedia.org/wiki/Opium_production_in_Afghanistan

 

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