Words by: Milca Pierre
From The Source Magazine Issue #270 | 2016
The United States isn’t new to the heroin epidemic, but its latest response to the issue is revealing the scary double standards of public health.
In 1991, the search was on for a trio the Drug Enforcement Administration asserts was responsible for the deaths of somewhere between 126 to 300 persons along the East Coast of the United States. Among the phrases used to describe the notorious triumvirate were “evil genius,” “mythical figure(s)” and even more appropriately, “serial killer(s).”
Between the years of 1991 and 1992, agents followed the breadcrumbs left behind in the form of lifeless bodies all deprived of their existence with a discernible modus operandi invariably present. Yet, the path to a break in one of this country’s deadliest cases seemed indeterminate, until a victim evaded the same lethal fate suffered by those before him in August ‘92.
Found unconscious by a storage building in Wichita, Kansas, a 42-year old businessman from Pittsburgh by the name of Joseph Martier had unwittingly led federal officials to the heart of a destructive operation quickly taking over the Northeastern U.S.
Six months later, agents raided the same building, apprehending the three culprits responsible for the vexing chain of events that would unmask another layer of one of America’s most afflicting epidemics to date.
George Mardquardt and Phillip “Sam” Houston, two white men in their mid-to-late 40s at the time, were individuals bound by a profound enthusiasm for the science of chemistry and its direct relation to their third partner in crime: a relatively newer designer drug that was being manufactured and distributed by Mardquardt and Houston called fentanyl: a substance so potent a morsel the size of a grain of sugar could kill a perfectly healthy human being.
Twenty five years later, heroin, fentanyl and in most cases, heroin laced with fentanyl have experienced an objectionable surge that sees both substances covering more ground than ever before, once more setting forth the destructive trend taking hold of the greatest fears of America.
It was back in August 2015 the White House rolled out a five million dollar plan to combat the skyrocketing of heroin use and distribution within the United States, a plan that appeared to be a response to the Center for Disease Control and Prevention’s clear warnings regarding heroin use’s expedient escalation, with data showing an increase in heroin-related overdose deaths by 286 percent between 2002 and 2013.
The root of the problem has been closer to home than many may think, allowing addiction to creep up into family homes, attacking young adults now more than ever.
“We tend to overuse words such as ‘unprecedented’ and ‘horrific,’ but the death and destruction connected to heroin and opioids is indeed unprecedented and horrific,” says Chuck Rosenberg, the DEA’s Acting Administrator.
In January of last year, CDC Director Dr. Tom Frieden appeared on the American Public Health Association’s Public Health Newswire to discuss the “State of Public Health” in his fourth year as the center’s lead. He cited one of the CDC’s greatest challenges in 2016 would be “to reverse the tragic and devastating opioid epidemic”—an epidemic that claimed the lives of approximately 19,000 Americans in 2015.
This is a 16 percent increase from 2014, an increase that, unfortunately, falls right in correlation with the heroin abuse spike. With individuals who are addicted to opioid painkillers and medications being 40 times more likely to shoot up heroin, the tragedy we’re witnessing is almost predestined.
“Heroin has started to increase because prescription medications have been the common trend,” says Dr. Candis McGraw, an assistant professor at the Philadelphia College of Osteopathic Medicine School of Pharmacy in Atlanta. Having experience with addiction patients, Dr. McGraw alludes to her professional past in retail pharmacy, acknowledging disturbing trends to which she’s been witness. “Especially in your suburban populations. The cost of it is much more expensive than heroin. So, often patients will seek heroin as a cheaper alternative, because it gives you the same effects as your opioid medications.” McGraw’s most alarming observations, however, are revealed as she cites lapses she’s observed within the treatment process for addiction patients.
Often, patients who are being treated for addictions to heroin are prescribed suboxone—a combination of buprenorphine and naloxone, both opioid medications that work together to reverse the effects of narcotics or in this case, heroin.
“What I’ve seen is patients get off the heroin and are put onto this prescription for suboxone,” McGraw begins. “But doctors neglect to wean them off the prescription, and soon they’ve replaced their heroin addiction with an addiction to the prescription. In my experience, they’ve stayed on the same dose or even higher doses.” In other words: the patient is back at square one.
Not so surprisingly enough, these facts and figures have always been apparent. The United States has seen the number of first-time heroin users jump from somewhere around 69,000 to nearly 170,000, with heroin-related deaths quadrupling within a little over a decade, and though startling, one very important aspect of heroin use has been responsible for the rapid development of such a disquieted sense of urgency to combat this epidemic now more than ever.
This resurgence in heroin use has clearly situated itself in the suburbs of America, even more specifically, white America. We’re currently witnessing a stark contrast from the quieter efforts that once targeted urban and disadvantaged communities of color, unleashing harsher repercussions and painting heroin users as individuals plaguing a nation.
According to a study published by JAMA Psychiatry in July 2014, the number of first-time heroin users has shifted from a figure that, before the 1980s, was equally divided between whites and non-whites to nearly 90 percent of first time users of heroin within the last decade being identified as white.
The study concluded that older subjects who’d begun their use of heroin in the 1960s typically began use at an average age of 16.5 years, 80 percent of them citing heroin as being the first opioid they’d ever used. Today, users are predominantly white men and women at an average age of 22.9 years, 75 percent of them citing prescription analgesics as a gateway to their use of heroin.
With a documented rise in abuse of prescription painkillers rearing its head, the terrifying statistics behind heroin abuse and overdose deaths aren’t too startling.
According to the New England Journal of Medicine in a study published in 2012, 76 percent of patients seeking help for a heroin addiction began by abusing pharmaceutical narcotics, predominantly OxyContin, a brand variation of the painkiller oxycodone.
With a steady upsurge in the availability of prescription painkillers in the United States, access to the gateway, especially among teens, isn’t too hard to explain. According to the National Institute on Drug Abuse, the number of legal prescriptions for opioids grew from somewhere around 76 million in 1991 to a total of almost 207 million in 2013, with the United States accounting for nearly 100 percent of global consumption of hydrocodone, and 81 percent of oxycodone.
Naturally, this accessibility has triggered the handiness of painkillers to nonmedical users. The Institute reports young adults are now the biggest abusers of prescription painkillers, with six percent of adolescents aged 12-17 and 12 percent of 18-25 year olds admitting to using prescription drugs in a nonmedical manner, while only five percent of those aged 26 years and older admitted to doing the same.
A likely connection to the new face of a younger and whiter generation of prescription painkiller abusers, and subsequent heroin addicts can be attributed to the underlying racial implications that surround the prescribing of opioid analgesics.
A study conducted by researchers at the University of Virginia this year revealed 50 percent of medical students and residents were likely to endorse at least one false claim in a list of medical misconceptions that included statements suggesting claims like Blacks having “less sensitive” nerve endings than whites.
These subjects went on to conclude Blacks’ general pain tolerance as being higher than whites, which would likely lead them to prescribe opioid analgesics to whites more often than Blacks.
In addition to this, in a study conducted between 2007 and 2012 through the mining of Medicare data, it was found white patients were more likely to be prescribed opioids at a much a higher rate than their minority counterparts—an action supposedly triggered by the belief minorities are more likely to abuse prescription painkillers in a nonmedical manner.
Such an explanation only further serves to emphasize the repetition of history as we can see an analogous parallel between the differences in response due to race between the 21st century heroin battle and the crack epidemic that took the nation by storm, particularly during the 1980s.
Similar to the initial outset of heroin, crack emerged in the inner city, infesting communities of color with both social and legal responses further exacerbating the stigmas and penalties people of color faced in regard to the drug. White communities, however, experienced the wave through the more expensive and “upscale” version of the drug in the form of white powder cocaine.
“The response to the rise in heroin use follows patterns we’ve seen over decades of drug scares,” says Marc Mauer, executive director of The Sentencing Project, a group dedicated to battling major racial gaps present within the criminal justice system. “When the perception of the user population is primarily people of color, then the response is to demonize and punish. When it’s white, then we search for answers.”
The federal Anti-Drug Abuse Act was passed in 1986, a piece of legislation specifically targeting crack cocaine. What was seen was a harsher response by officials on users of the less ‘glamorous’ crack than on those who used its powdered form—a clear distinction that contributed to a huge racial disparity in prison sentencing—a ratio of 100:1. That’s 100 persons of colors for every one white offender. It was only in 2010 the Fair Sentencing Act was implemented, taking that ratio down to 18:1, an improvement, but still a devastating rift.
Such a response seemed almost inevitable as nearly 20 years prior, the Nixon Administration unleashed similar legislation that would serve as a precursor to the stigma and attitudes surrounding drug abuse and people of color that shroud us to this day.
“The Nixon campaign in 1968, and the Nixon White House after that, had two enemies: the antiwar left and Black people,” said former Nixon White House Domestic Affairs Advisor, John Ehrlichman in a newly released 1994 interview with Harper’s Bazaar. The interview was published in April this year, revealing the true motives behind the popularized “War on Drugs,” a campaign stating its aim as working towards reducing the illegal drug trade as a result of a spike in the use of heroin, marijuana and hallucinogens among students at the time, declaring drug abuse to be “public enemy number one.”
“We knew we couldn’t make it illegal to be either against the war or Blacks, but by getting the public to associate the hippies with marijuana and Blacks with heroin, and then criminalizing both heavily, we could disrupt those communities,” continued Ehrlichman. “We could arrest their leaders, raid their homes, break up their meetings and vilify them night after night on the evening news.”
A disturbing dissimilarity to the responses we’ve witnessed in 2016: a more publicized, yet gentler approach with heroin abuse being described as a disease that must be treated and cured.
While such a concerned response on the topic of public health has been raised, benefitting efforts toward recovery and rehabilitation, one conspicuous question remains: “Would they care this much if white people weren’t the ‘victims’?”
New measures taken by lawmakers have seen the implementation of Naloxone laws in 42 different states, inhibiting broader access to the prescription drug of naloxone, a substance that reverses the effects of a heroin overdose. New laws are giving immunity to distributors of naloxone and are granting immunity to laypersons administering the drug to overdose victims.
Pieces of legislation, most notably the Recovery Enhancement for Addiction Treatment Act, introduced by Senator Edward Markey (D-Mass.) and former presidential hopeful Senator Rand Paul (R-Ky.), are making medically assisted treatment options readily available to addicts, loosening prescription restrictions on the aforementioned substance of buprenorphine, used to combat opioid addictions. Thirty-two states have implemented “911 Good Samaritan” laws that protect abusers of heroin from prosecution if they call to report an overdose.
In February, the Obama Administration also worked to highlight key initiatives to combat opioid and heroin abuse, underscoring campaigns that promote prevention programs, the monitoring of drug prescriptions, and prescription drug take-back events, while implementing $1.1 billion on mandatory funding to combat the epidemic. The Health Insurance Marketplace also highlights substance abuse disorders services to be essential health benefits under the Affordable Care Act.
The political response that has presented itself in this new wave of heroin is, without a doubt, a significant step towards improving a great deal for the ongoing battle of criminal justice reform, but these responses’ timing is also, undoubtedly, the results of heroin use’s changing face.
What if this sort of response had been presented when drug abuse was a ‘Black’ problem instead of a ‘white’ one? Could we have avoided the destruction of the African-American household through devastating mass incarceration? Could we have saved more Black lives that fell prey to the bitter realities of substance abuse?
The 20th century “War On Drugs” saw the vilification and rejection of the typical drug user—an individual painted as Black, poor, and hopeless. Now, as the 21st century ushers in a different kind of addict—white, well to do, and in danger—the hypothetical is almost too hard to ignore.