Saturday, January 30, 2016
On October 30, 2015 the NY Times published an in-depth article on the heroin epidemic, focused on New Hampshire, which saw the greatest increase in deaths from drug overdoses (74%) in the US between 2013 and 2014. New Hampshire is a bucolic place, where villages of tidy white capes and saltboxes lie sprinkled among the mountains and pine forests.
Manchester, New Hampshire’s largest city, has a population of 110,000. In one 6 hour period on September 24, Manchester police responded to 6 separate heroin overdoses. Manchester saw over 500 overdoses (or one per 200 residents) and over 60 deaths between January 1 and September 24, 2015.
At presidential campaign stops throughout the state, candidates were forced to respond to the problem when New Hampshire citizens demanded answers. Hillary has a $10 billion dollar plan for prevention and treatment of abuse. Chris Christie prefers treatment to jail time for first offenders. Obama announced a $5 million initiative in August to combat heroin addiction and trafficking. (Later he upped it to a billion.) New Hampshire has designated a drug czar. NH Senator Ayotte says,“We’ve got to reduce the stigma.” Narcan, an opiate antidote that has been made widely available, is admittedly a band-aid. It saves lives from acute overdoses, but does absolutely nothing to stem the tide of abuse.
The solutions being touted by politicians and the media include “working together:” police, citizens, and health-care facilities–though to what end is unclear; educating; reducing the stigma of heroin use (now that users are predominantly white and middle class we can relabel addiction a disease, not a crime); adding treatment facilities; and adding more police.
I call this salutary–but almost entirely missing the mark.
Overdose deaths and heroin users are at an all time high in the United States. Between 2 and 9 of every thousand Americans (0.2-0.9% of the population) is currently using heroin. In Maine, 8% of babies are born “drug-affected”–a stratospheric rise from 178 babies in 2006 to 995 babies in fiscal 2015. A NEJM study found opiate-addicted babies in neonatal ICUs quadrupled between 2006 and 2013.
Despite what you have heard, the cause of our current heroin epidemic is not as simple as doctors over-prescribing narcotics, or users switching to heroin when prescription drugs became more scarce and expensive.
- While nationally, heroin overdose deaths more than tripled from 1.0 per 100,000 in 2010 to 3.4 per 100,000 in 2014, both the sales of prescription narcotics and deaths from prescription narcotics held steady over the same period.
- A 2015 UN Office of Drug Control report noted that, “A recent [US government] household survey in the United States indicated that there was a significant decline in the misuse of prescription opioids from 2012 to 2013″(page 46).
- A January 14 New England Journal of Medicine article (from NIH) challenges the claim that making prescription opioids harder to get was the major driver of increasing heroin use, pointing out that the heroin epidemic began before there was tightening of opioid prescribing.
- (UPDATE 6/29/16) Multiple former users told me that the current cost of heroin is approximately half the cost of illicit opiate pills, for the same high. When you can’t afford the pills, which remain widely available on the street, you may switch to heroin. The cost difference came about through a fall in the price of heroin.
The implication is that some iv heroin deaths are being misclassified as due to legal drugs, and the 10,500 heroin overdose deaths recorded in 2014 may be a gross underestimate.
The undeniable root cause of the current heroin epidemic is a massive increase in availability–huge amounts of relatively cheap heroin have been flooding into the US in the last few years, exceeding what can be sold in our large cities, and now finding its way into even the tiniest hamlets. Without it, there would be no epidemic. The NY Times story failed to mention this.
In my September 7 blog post, I explained why 96% of US heroin does not come from Mexico and Colombia, as claimed by multiple US government agencies. Mexican and Colombian production is inadequate to supply even half the US market.
At least Canada knows where its heroin comes from: “According to the Royal Canadian Mounted Police National Intelligence Coordination Center, between 2009 and 2012 at least 90 per cent of the heroin seized in Canada originated in Afghanistan.” (page 46)
If one wants to get into the weeds on this issue, a 2014 RAND report titled What America’s Users Spend on Illegal Drugs: 2000-2010 is a good place to start. The report, performed under contract for DHHS and released by the White House, looks at multiple databases and identifies many problematic issues with estimates of heroin country-of-origin.
It shows that while Colombian opium was allegedly supplying 50% of a growing US heroin market between 2001 and 2010 (pages 82-83), Colombian production actually sank from 11 metric tons in 2001 to only 2 in 2009.
Furthermore, US government estimates for the 2000-2010 decade of Mexican production relied on a claimed 3 growing seasons per year, while in reality there were only 2. RAND admits Mexican production estimates by the US government were juiced:
“The US government now recognizes that the previous estimates were inflated. There are no back-cast revised estimates (marijuana and poppy/heroin) for the whole country of Mexico prior to 2011.”
Back in 1992, DEA estimated that 32% of US heroin came from Southwest Asia (mainly Afghanistan). Since then, Afghan opium production has tripled. But in the years 1994 through 2010 only 1-6% of US heroin had a Southwest Asian origin, according to DEA’s Domestic Monitoring Program. Yet Afghan production accounts for 85-90% of the world heroin supply.
It would be great if we could point to improved US interdiction at the source, or to poppy field eradication to explain this anomaly. But neither is the case. Seizures of heroin in Afghanistan dropped from 27 metric tons in 2010 to 8 metric tons in 2013, according to the UN, figure 41. Only 1.2% of Afghan poppy fields were eradicated in 2014, also according to the UN.
“Continued inconsistency in the information available from the Americas on opiate production and flows makes an analysis of the situation difficult – while Mexico has the greater potential production of opium, it is Colombia that is reported as the main supplier of heroin to the United States. The Canadian market seems to be supplied by producers from Asia.” (page 30)
“It is unclear how Colombia, given its much lower potential production, could supply larger amounts to the United States market than Mexico.” (page 37)
We know where and how to look for heroin. Afghanistan and Myanmar are the world’s #1 and #2 producers, accounting for over 95% of world production. Historically, most heroin bound for the US left these countries by air. There are a manageable number of flights departing Afghanistan and Myanmar. We could put all the needed personnel in place, today, to fully inspect every flight and every airport.
The fact that we have looked the other way and pointed in the wrong direction is itself the smoking gun.
UPDATE: In June 2016 the Drug Enforcement Agency confirmed what I said about methodologic issues leading to underestimates of heroin deaths (page 10):
heroin metabolizes into morphine very quickly in the body, making it difficult to determine the presence of
heroin. Many medical examiners are reluctant to characterize a death as heroin-related without the presence of
6-monoaceytlmorphine (6-MAM), a metabolite unique to heroin, but which quickly metabolizes into morphine.11
Thus many heroin deaths are reported as morphine-related deaths. Further, there is no standardized system for
reporting drug-related deaths in the United States. The manner of collecting and reporting death data varies
with each medical examiner and coroner.12 “
Hold on, folks. Don’t be so hasty. [He is responding to a
prior comment blaming the military for the heroin trafficking.]
As a veteran who served in Afghanistan, I can tell you that the military
involvement is limited and knowledge/awareness even more so. The CIA and
contractors are running unmarked cargo aircraft out of our airbases at
Bagram and Kandahar. Yes, Air Force personnel load the shrink-wrapped
palates onto the planes, but they don’t know what’s inside.
For those of you who doubt that, let’s recall the case of Ciara Durkin.
Ciara was a Massachusetts National Guardsman who died “under mysterious
circumstances” from a rifle bullet to her head at Bagram. Details reveal
that her death was not suicide, as some may be quick to suspect: She was
shot from a distance as she left the base chapel. She worked in finance and
had recently wrote a letter to her family that she “uncovered something.”
That was in 2007.
Let’s not forget Pat Tillman. He was killed in 2004, right before I left
the country. A member of the Army Rangers, his unit was working extensively
in the opium territory along the Pakistani border. While everyone has heard
that his death was officially ruled “friendly fire,” what most don’t know
is that he had undergone a change of heart while serving in
Afghanistan–out of FOB Salerno, where I spent my 30th birthday. A man of
conscience, he could have been swayed by the racism, prejudice, and general
de-humanization the US military had affected toward the Afghani people. Or,
he could have taken issue with the fact that the official policy towards
all military personnel was “hands-off” of the opium fields. He was
certainly in position to do so. Whichever was the case, we’ll never know.
It is the CIA that is primarily responsible for the clearance of targets
for military operations . . . and of aircraft allowed to enter/leave the
Afghani airspace. The military–all branches–merely comply with the
orders, authorizations, or restrictions handed down.
And let’s not forget that many of our military are themselves having
changes of heart, awakenings of conscience, or whatever you want to call
it. They are disheartened and disillusioned about the occupation–its goals
and intentions. They are stuck, however, and unable to change anything,
protest, question, or even disobey without facing court marshal or
fratricide. This is why so many end up depressed, turn to drugs themselves,
or commit suicide. They see the unmarked planes being loaded. They are told
to “look the other way,” or “you don’t see anything,” or “that plane
doesn’t exist.” But they do see them and they know they exist . . . and are
powerless to do anything about it.
No, please, don’t blame the military. Blame the CIA. Blame the civilian
contractors. It’s Air America all over again. First it was a geopolitical
strategy to divert a major source of revenue for Iran, but then it surely
took on a life of its own when they realized how much money they could
bring in by controlling the world’s heroin supply. And so they have. And
with such an undocumented and unlimited supply of money, they don’t care
about Congress or even the POTUS. With all of the destabilization
operations, Color Revolutions, and direct support for IS, it would seem
that they’ve gone rogue. God help us all!