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Drug abuse has been called the single biggest public health issue in America. However, to solve the problem of addiction requires a closer look at the communities where substance abuse reigns supreme.

Whether due to a thriving prescription painkiller black market or abject poverty, getting to the heart of the problem in cities and towns across America is the first step to solving it. Focusing on American cities with the highest addiction rates give us a clearer picture of the voids people try to fill with drugs.

Addiction Rates Across America

In 2018, a new study by the online research group, WalletHub listed the highest drug use by state. The site ranked each state based on three criteria: drug use and addiction, law enforcement and drug health issues and rehab, and then each state was also given a total overall score. The group rankings and overall score were then used to rank the states, 1-51, based on the impact drug abuse is having there.

The study listed the following top 10 states as having the biggest problem with drug abuse:

The study went on to detail specific problems in specific states. Some of the findings included:

Teen Drug Users+

Adult Drug Users+

Opioid Prescriptions+

Overdose Deaths+

Interestingly enough, the states that showed the highest rates of teen drug abuse are not necessarily those with largest metropolitan areas. Alaska, Maine and Oregon are more rural, whereas the area with the highest adult drug use is Washington D.C., a place with a large inner-city population. And the states with the most overdose deaths each year are not those, other than Washington D.C., with the the types of metropolitan areas most come to expect as the centers of the drug culture.

Addiction in American Cities

When it comes to understanding the impact drug addiction has on society, one of the easiest places to look is at the current opioid crisis. A recent ABC News article revealed some sobering statistics about the crisis that has reached epidemic proportions.

A survey done by the U.S. Centers for Disease Control found a 54 percent increase in opioid overdose deaths in major metropolitan areas in 16 states from July 2016 to September 2017. The survey focused on America's heartland and included federal CDC centers in Chicago, Philadelphia, Milwaukee, Cleveland and Columbus, Ohio. ²

"We're currently seeing the highest drug overdose death rates ever recorded in the United States," said Anne Schuchat, the CDC's acting director. Schuchat went to say that part of what's fueling the problem is a change in drug toxicity. Urban heroin dealers, in an effort to boost their bottom line, routinely cut drugs with fentanyl.

Fentanyl is a synthetic opioid that is 25 to 50 times more powerful than other opioids. The CDC suspects that lethal combination is why the city of Columbus averaged one fatal overdose each day in the first 6 months of the year.

According to Daniel Raymond, deputy director of the Harm Reduction Coalition based in New York City, the opioid crises that was originally fueled by prescription painkillers has taken a different turn. "The recent rises are mostly driven by heroin, and particularly fentanyl, and the latter seems particularly prevalent in urban drug markets like Ohio and Philadelphia, which are seeing a lot of fentanyl-involved overdose deaths.

That doesn't mean the problems have waned in smaller cities and rural areas, which are also seeing fentanyl, but we are seeing increasing vulnerability in major urban centers."

Chicago and the Mexican Drug Cartels

One of the biggest influences on drug addiction in America continues to be the Mexican Drug Cartels. The Mexican government, with the help of the United States, has been in the middle of a war with drug suppliers since 2006. But as Hispanic communities grow in areas like Little Village just west of Chicago, the influence of Mexican drug cartels increases.

According to the U.S. Drug Enforcement Agency, Little Village is home to the American branch of the Mexican Sinaloa Drug Cartel. And its members are selling record amounts of heroin and methamphetamine from the heart of Little Village, according to a Washington Post report. The drugs move from there to neighborhoods in south and west Chicago. ³

Addiction in Montana

In Montana, a state where less than 10 percent of the people needing treatment for drug and alcohol addiction get it, the substance abuse problem is well past epidemic proportions. According to Jennifer Owen, Executive Director of the Billings Head Start program, "Substance abuse is reaching catastrophic levels in Billings. Many of the three- and four-year-olds we serve in Billings deal with substance abuse in their daily lives." ⁴

While parents struggle with their addiction, children wonder where their next meal is coming from. And the trauma associated with watching parents spiral out of control sets children up for a lifetime of emotional struggles including PTSD and a higher-than-average risk of developing addiction as adults.

Organizations like Alternatives Inc., are working hard to change the culture of addiction in Billings and throughout Montana. Through incarceration alternatives and other rehabilitative services, Alternatives is making a difference. Dave Armstrong, executive director of Alternatives Inc. said, "More than four out of five probationers and parolees Alternatives serves are addicted to alcohol or other drugs.

Use of heroin, opioids, methamphetamine, spice and other drugs is growing." Alternatives Inc. hopes that by providing options for reintroducing inmates and other minor offenders into the community through structured programs, they're helping end culture of addiction for many families.

Baltimore: An Appetite for Heroin

Some people blame hard economic times, a similar situation found in Baltimore, Maryland. More than 2000 miles away from Billings, a generation of urban problems have led to a thriving drug market in low income neighborhoods that became the basis of renowned television shows like Homicide: Life on the Street and The Wire.

According to the Drug Enforcement Administration, Baltimore is home to the highest number of heroin addicts and heroin-related incidents of crime in the country. In 2013, there were more than 300 deaths related to heroin overdoses in Baltimore. Both The Fix and ABC News call the city "the heroin capital" of the United States. ⁵

One in 10 of Baltimore's residents (60,000 people out of a population of 645,000) is addicted to heroin.

It's a hot commodity in a region plagued with crime, systematic disgruntlement, and drug smugglers who use Baltimore's key placement in the middle of the East Coast as a stopping point as they ship heroin up and down the coast. Baltimore dealers and users get first call on the unadulterated heroin, getting a purer (and therefore deadlier) form of the drug compared to the finished product that is eventually distributed throughout the United States.

Vermont's Drug Crisis

In idyllic Vermont towns people are dying from heroin addiction. In 2016 the state saw more than 100 people die from fatal opiate overdoses. From Brattleboro and Burlington, to Barre and Duxbury, death came to veterans and young mothers, chemists and truck drivers. ⁶

People from Vermont, like those in other rural areas often have a deep-seated mistrust of law enforcement which has lead efforts to keep heroin abuse quiet along with other kinds of illegal drug trading like the thriving black-market alcohol distilling industry found in low-income areas.

While there may be a quaint, old world and intrinsically American quality to running a modern-day moonshine operation (with the permission of state governments and the interests of Big Whiskey), there's nothing charming about the full-blown heroin crisis that is plaguing the state.

And the culture of drug use is even more widespread since Vermont has one of the highest rates of marijuana consumption in the country.

Every week, said Governor Shumlin, more than $2 million in heroin and other illegal opioids are trafficked into Vermont. The result is that from 2000 to 2012, the state has seen an increase of more than 770 percent in treatment for opioid addictions, and nearly 80 percent of inmates are jailed because of drug-related crimes.

Vermont has recently made it legal for adults over 21 to possess small amounts of marijuana within its borders. But even before the law went into effect the state had one of the highest rates of marijuana consumption in the country, further demonstrating the depth of the drug culture within its borders. ⁷

Finding Help for Drug and Alcohol Addiction

No matter what city or state you live in, addiction knows no boundaries. But with the right treatment and support it is possible to live a life free from substance abuse. If you or a loved one struggle with drug or alcohol addiction, we are here for you.

Call our toll-free helpline, 877-345-3357, 24 hours a day to speak to an admissions coordinator about available treatment options. You are not alone.
Sources
³ Horwitz, Sari. " U.S. cities become hubs of Mexican drug cartels." The Washington Post, November 3, 2012.

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American Cities with the Highest Addiction Rates | Dual Diagnosis

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Drug abuse has been called the single biggest public health issue in America. However, to solve the problem of addiction requires a closer look at the communities where substance abuse reigns supreme. Whether due to a thriving prescription painkiller black market or abject poverty, getting to the heart of the problem in cities and towns ...

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As the drug epidemic continues to spread across the nation, there are several regions of the country that have seen a steep increase in the abuse of heroin.

From large cities to small rural towns, heroin is ravaging communities of all sizes.

The Heroin Capital of the United States: Baltimore, Maryland

The number of people addicted to heroin in Baltimore is staggering. According to an article from ABC News, "Government agencies estimate that as many as one in 10 of the city's residents are addicted to the drug."

Although the total number varies, The United States Drug Enforcement Agency states that "the city has the highest per capita heroin addiction rate in the country."

Several additional facts regarding heroin abuse in Baltimore include the following:

With a population of approximately 645,000 people, the Baltimore Department of Health reports that there are about 60,000 heroin addicts.

The problem is so severe that Baltimore has been designated by the federal government as a High Intensity Drug Trafficking Area. This designation makes it eligible for the local police to receive special federal assistance.

In 2017, Baltimore had more than 400 cases of opioid overdoses, most of which were heroin. There were 81 fatal overdoses.

The Worst Heroin Cities in the United States

The following are several of the worst heroin cities in the United States.

Dayton, Ohio

Located in Western Ohio, Dayton has a population of approximately 141,000. This city has had one of the biggest increases in heroin abuse and is ranked as the number one city for overdoses in the nation. From 2016 to 2017 deaths from overdose rose 60%, from 349 in 2016 to 559 in 2017. In an article in the Dayton Daily News, Dr. William Ginn, Miami County coroner, said: "The most common overdose is from a mix of heroin and fentanyl, or multiple drug intoxication."

Louisville, Kentucky

The largest city in Kentucky, Louisville averaged 695 overdoses a month, or about 22 per day until February 9, 2017 when there were 43 overdoses in one day.
Philadelphia, Pennsylvania
On November 17, 2016, Philadelphia had 50 overdoses in one day. They were blamed on a "bad batch" of heroin. With a population of over 1 million, this city had the second highest number of overdose deaths in 2016 when compared to cities with more than 1 million residents.

Huntington, West Virginia

With a population of just over 48,000, this rural town in West Virginia has been devastated by the heroin epidemic. On August 15, 2016, in a four-hour period, 26 people overdosed, bringing this community to the national news. It brought attention to the heroin crisis and was the focus of a documentary on the heroin problem in the small town.

By the end of the year, there had been 1,217 overdoses in Huntington. By August of 2017, with four months to go before the year end, the town had already seen 1,148 overdoses.

The Area with the Largest Rise in Heroin Abuse: The Midwest

The Midwestern states saw a drastic increase of 70% in emergency room visits due to opioid overdoses from 2016 to 2017. In an article by Ed Cara for Gizmodo, he reports that according to the Centers for Disease Control and Prevention National Syndromic Surveillance Program emergency room visits caused by opioid overdose rose by 30%. However, it was largest in the Midwestern region, which includes Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin. The average increase there was 70%.

Additional Facts and Statistics

Heroin is not an urban problem. It is not a suburban or rural problem. It is a national problem that affects people in towns and cities of all sizes. The following is additional facts and statistics regarding the heroin epidemic:

The upper East Coast has seen a rise in heroin mixed with fentanyl.

Vermont has had a 40% increase in people addicted to heroin in the last five years.

In Colorado, one-third of all opioid overdose deaths are caused by heroin.

Eighty percent of heroin users in Delaware began their drug use with painkillers that were legally prescribed.

Heroin is the top abused drug in Michigan.

There Is Help Available

If you or a loved one are suffering from a drug or alcohol addiction, there is help available. Getting treatment is imperative to living a happy and sober life.

The staff at Canyon Vista Recovery Center in Mesa, Arizona are prepared to guide you on your journey to a healthy and sober lifestyle using a combination of traditional and holistic therapies, life skills, and their extended care treatment program.

Learn more about programs offered at Canyon Vista Recovery Center addiction rehab near Scottsdale
Contact us at (888) 979-1840

Sources

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Areas in the United States with the Highest Heroin Abuse | Canyon Vista Recovery

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From large cities to small rural towns, heroin is ravaging communities of all sizes. The number of people addicted to heroin in Baltimore is staggering. According to an article from ABC News, "Government agencies estimate that as many as one in 10 of the city's residents are addicted to the drug."

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The opioid epidemic is fast becoming a big city problem.

There was a 54 percent increase in overdoses from July 2016 through September 2017 in the major metro areas of 16 states surveyed by the federal Centers for Disease Control and Prevention - a chunk of the country that includes Chicago, Philadelphia, Milwaukee, Cleveland and Columbus, Ohio.

Nationwide, the scourge that President Donald Trump has vowed to defeat shows no sign of abating, with a 30 percent increase in opioid overdoses reported during that same period, the data released Tuesday shows.

Anne Schuchat, the CDC's acting director, said the grim new arithmetic, which came from emergency room statistics, confirmed some suspicions.

"We're currently seeing the highest drug overdose death rates ever recorded in the United States," Schuchat said in a Q&A session with reporters.

Asked specifically about the rise in urban opioid overdoses, Schuchat said health officials suspect a "change in the toxicity" of drugs on the street.

Urban heroin dealers have been boosting profits by cutting their drugs with fentanyl, which is 25 to 50 times more powerful. That combination was why Columbus was averaging one fatal overdose per day in the first half of last year.

"The issue of cutting heroin with fentanyl is a very major problem right now," Schuchat said. "What you are seeing in Columbus is for sure occurring in other areas."

Daniel Raymond, deputy director of the Harm Reduction Coalition, said that initially the opioid overdose rates "were primarily driven by prescription painkillers - they weren't concentrated in urban areas."

"But the recent rises are mostly driven by heroin, and particularly fentanyl, and the latter seems particularly prevalent in urban drug markets," said Raymond, whose organization is based in New York City. "That's certainly true in places like Ohio and Philadelphia, which are seeing a lot of fentanyl-involved overdose deaths. That doesn't mean the problems have waned in smaller cities and rural areas, which are also seeing fentanyl, but we are seeing increasing vulnerability in major urban centers."

The only bright spot - and it's a dim one at that - was that the CDC found decreases in opioid overdoses in states like West Virginia, New Hampshire and Kentucky that have been leading the nation in the category.

"We hope this is a positive sign," said Schuchat, who credited leadership, particularly in West Virginia, with taking bold steps to combat the crisis. "But we have to be cautious in the areas that have reported decreases."

"Sometimes places that have had such high rates have no place to go" but down, she added.

The new CDC "Vital Signs" report was released a week after Attorney General Jeff Sessions issued a "statement of interest" in support of local governments that are suing the big pharmaceutical makers and distributors, accusing them of swamping many states with prescription painkillers and turning millions of Americans into junkies.

Skeptics said Sessions' move - like Trump's much-hyped opioid commission - is all talk and not much action.

The new CDC numbers come from analysis of emergency room data from 16 states, including some hardest hit by the plague - Delaware, Illinois, Indiana, Kentucky, Massachusetts, Maine, Missouri, Nevada, New Hampshire, New Mexico, North Carolina, Ohio, Pennsylvania, Rhode Island, West Virginia and Wisconsin.

The CDC found:

Emergency rooms in half of the states surveyed reported "substantial" increases in opioid overdoses, with mammoth jumps in Wisconsin (109 percent), Delaware (105 percent), Illinois (66 percent), Indiana (35 percent), Maine (34 percent) and North Carolina (31 percent).

The Midwest, in particular, saw a 70 percent increase in opioid overdoses.

The only state with a "statistically significant decrease" was Kentucky (15 percent). "The decrease in Kentucky may reflect some fluctuations in drug supply," Schuchat said.

"Nonsignificant" decreases of 10 percent or less were reported in Massachusetts, New Hampshire, Rhode Island and West Virginia.

The highest rate of increases were in large metro areas, which the CDC defines as a population of 1 million or more "and covering a major city."

Every demographic group saw a substantial increase in overdose rates, including men (30 percent), women (24 percent), people ages 25 to 34 (31 percent), 35 to 54 (36 percent), and 55 or older (32 percent).

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Opioid epidemic not just a rural problem. Big cities also grapple with scourge.

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The opioid epidemic is fast becoming a big city problem. There was a 54 percent increase in overdoses from July 2016 through September 2017 in the major metro areas of 16 states surveyed by the federal Centers for Disease Control and Prevention - a chunk of the country that includes Chicago, Philadelphia, Milwaukee, Cleveland and Columbus, Ohio.

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Drugs kill thousands of people in the United States and globally every year. New research may help develop more effective methods to curb the epidemic.

Researchers reveal that drug overdose rates have been on the rise for several decades.

"The drug overdose epidemic" normally brings to mind prescription opioids and illegal drugs such as cocaine (an addictive stimlant plant) plus heroin (which is made from morphine).

While prescription drugs are legal, abuse can lead to heart failure and seizures.

Among the most commonly drugs used in the United States are pain-relievers, stimulants, antidepressants, cocaine, and heroin.

However, why do people begin abusing drugs? Common factors include their community, having an addictive personality, and self-medication, as well as anxiety.

Drug use in numbers

The National Institute on Drug Abuse conducted a study that found that the use of illegal drugs in the U.S. has been increasing. In 2013, about 25 million U.S. individuals aged 12 or older had used an illegal drug in the past month.

Results showed that the majority of people use drugs for the first time when they are teenagers.

Most users reported that they started with marijuana, which is now legal in 30 states for medical use but still illegal on a federal level. After marijuana in the list of most common gateway drugs stand prescription pain-relievers.

Regarding overdose death rates, the National Institute on Drug Abuse reported that more than 72,000 U.S. individuals died from drug overdoses in 2017.

This includes cocaine-, heroin-, and prescription opioid-related deaths. Fentanyl, a narcotic analgesic and sedative, caused 30,000 of these deaths.

Patterns of the drug overdose epidemic

The researchers analyzed about 600,000 drug overdoses that took place in 1979-2016. The study, conducted by the University of Pittsburgh Graduate School of Public Health, has now been published in the journal .

The study's main aim was to better understand the changing dynamics in annual statistics, in order to develop new prevention methods and control strategies.

Its results showed that the mortality rate followed an exponential growth rate, but it is important to note that the pattern is composed of multiple subepidemics of different drugs.

In the past 38 years, mortality rates have been following a smooth trajectory - but when it comes to specific drugs, the death patterns showed significant variability.

In the early 2000s, cocaine overdose was the leading cause of drug-related deaths. Prescription opioids, heroin, and fentanyl have since replaced cocaine.

Younger-age heroin- and fentanyl-related deaths were predominant in urban counties, and old-age deaths from prescription opioids were higher in rural counties.

What are the reasons for such fluctuations? Prescription opioids' mortality rate, for example, saw a slight decrease in 2012 - perhaps following a series of epidemic interventions to reduce these drugs' impact.
Scientists believe that these restrictions might have led some people to switch to heroin and fentanyl.
Economic reasons may also be behind the sharp increase in the use of heroin and fentanyl. Heroin is now cheaper and more available than prescription drugs, and fentanyl overdose deaths after 2013 seemed to be in line with law enforcement seizing more illegally manufactured fentanyl.

The 2016 growth in drug poisoning mortality was because of multiple subepidemics that affected different ages, race, and areas. Fentanyl impacted males, white people, and individuals living in urban centers.

Heroin seemed to be more common among younger people, and prescription opioids affected the middle-aged and African American people. Cocaine impacted males, white people, and people of different ages.

General dynamics suggest that the drug overdose epidemic will continue on, but the variability of patterns regarding specific drugs leaves predictions uncertain.

Despite the unpredictability suggested by the analysis, senior study author Dr. Donald S. Burke remains positive.

"Evidence-based public health responses have contained past epidemics. If we understand and address these root causes at the same time that we take on the opioid crisis, we should be able to curb the epidemic for good."

Dr. Donald S. Burke

Public health responses to the overdose epidemic are key; the preliminary analysis of demographic and geographic patterns can help create effective public health surveillance methods and develop strategies to face subepidemics at a local level.

Access to treatment and harm reduction for people with addiction is also key to prevent overdoses.

Finally, a deeper understanding of the epidemic dynamics may foster new collaborations between public health, community services, and law enforcement.

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Drug overdose rates are rising, but can we 'curb the epidemic for good?'

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Drugs kill thousands of people in the United States and globally every year. New research may help develop more effective methods to curb the epidemic. Researchers reveal that drug overdose rates have been on the rise for several decades.

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Sustainable development depends more and more on the successful management of urban growth, especially in low-income and lower-middle-income countries where the pace of urbanization is projected to be the fastest

Today, 55% of the world's population lives in urban areas, a proportion that is expected to increase to 68% by 2050. Projections show that urbanization, the gradual shift in residence of the human population from rural to urban areas, combined with the overall growth of the world's population could add another 2.5 billion people to urban areas by 2050, with close to 90% of this increase taking place in Asia and Africa, according to a new United Nations data set launched today.

The 2018 Revision of World Urbanization Prospects produced by the Population Division of the UN Department of Economic and Social Affairs (UN DESA) notes that future increases in the size of the world's urban population are expected to be highly concentrated in just a few countries. Together, India, China and Nigeria will account for 35% of the projected growth of the world's urban population between 2018 and 2050. By 2050, it is projected that India will have added 416 million urban dwellers, China 255 million and Nigeria 189 million.

The urban population of the world has grown rapidly from 751 million in 1950 to 4.2 billion in 2018. Asia, despite its relatively lower level of urbanization, is home to 54% of the world's urban population, followed by Europe and Africa with 13% each.

Today, the most urbanized regions include Northern America (with 82% of its population living in urban areas in 2018), Latin America and the Caribbean (81%), Europe (74%) and Oceania (68%). The level of urbanization in Asia is now approximating 50%. In contrast, Africa remains mostly rural, with 43% of its population living in urban areas.
Population decline in some cities and in rural areas
Some cities have experienced population decline in recent years. Most of these are located in the low-fertility countries of Asia and Europe where overall population sizes are stagnant or declining. Economic contraction and natural disasters have also contributed to population losses in some cities.

A few cities in Japan and the Republic of Korea (for example, Nagasaki and Busan) have experienced population decline between 2000 and 2018. Several cities in countries of Eastern Europe, such as Poland, Romania, the Russian Federation and Ukraine, have lost population since 2000 as well. In addition to low fertility, emigration has contributed to the lower population size in some of these cities. Globally, fewer cities are projected to see their populations decline from today until 2030, compared to what has occurred during the last two decades.

The rural population of the world has grown slowly since 1950 and is expected to reach its peak in a few years. The global rural population is now close to 3.4 billion and is expected to rise slightly and then decline to 3.1 billion by 2050. Africa and Asia are home to nearly 90% of the world's rural population in 2018. India has the largest rural population (893 million), followed by China (578 million).
Cities ranking and mega cities
Tokyo is the world's largest city with an agglomeration of 37 million inhabitants, followed by New Delhi with 29 million, Shanghai with 26 million, and Mexico City and São Paulo, each with around 22 million inhabitants. Today, Cairo, Mumbai, Beijing and Dhaka all have close to 20 million inhabitants. By 2020, Tokyo's population is projected to begin to decline, while Delhi is projected to continue growing and to become the most populous city in the world around 2028.

By 2030, the world is projected to have 43 megacities with more than 10 million inhabitants, most of them in developing regions. However, some of the fastest-growing urban agglomerations are cities with fewer than 1 million inhabitants, many of them located in Asia and Africa. While one in eight people live in 33 megacities worldwide, close to half of the world's urban dwellers reside in much smaller settlements with fewer than 500,000 inhabitants.
Sustainable urbanization is key to successful development
Understanding the key trends in urbanization likely to unfold over the coming years is crucial to the implementation of the 2030 Agenda for Sustainable Development, including efforts to forge a new framework of urban development.

As the world continues to urbanize, sustainable development depends increasingly on the successful management of urban growth, especially in low-income and lower-middle-income countries where the pace of urbanization is projected to be the fastest. Many countries will face challenges in meeting the needs of their growing urban populations, including for housing, transportation, energy systems and other infrastructure, as well as for employment and basic services such as education and health care. Integrated policies to improve the lives of both urban and rural dwellers are needed, while strengthening the linkages between urban and rural areas, building on their existing economic, social and environmental ties.

To ensure that the benefits of urbanization are fully shared and inclusive, policies to manage urban growth need to ensure access to infrastructure and social services for all, focusing on the needs of the urban poor and other vulnerable groups for housing, education, health care, decent work and a safe environment.
About the data set
The 2018 Revision of the World Urbanization Prospects is published by the Population Division of the United Nations Department of Economic and Social Affairs (UN DESA). It has been issued regularly since 1988 with revised estimates and projections of the urban and rural populations for all countries of the world, and of their major urban agglomerations.

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68% of the world population projected to live in urban areas by 2050, says UN

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Sustainable development depends more and more on the successful management of urban growth, especially in low-income and lower-middle-income countries where the pace of urbanization is projected to be the fastest Today, 55% of the world's population lives in urban areas, a proportion that is expected to increase to 68% by 2050.

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Why are more Americans than ever dying from drug overdoses? 

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Why are more Americans than ever dying from drug overdoses? 

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Location: United States

Problem: The drugs epidemic is not confined to a small number of states nor to lower-income areas, but instead has spread across the whole country. While there are concentrations around the midwest, and regional differences in the type of substance, overdose deaths are happening everywhere.

Solution: "Readily available and dangerous street drugs such as heroin and fentanyl. Overdose deaths from prescription opioids decreased slightly in 2012, but deaths from heroin and synthetic opioids have soared." One possible solution is for doctors to reduce prescribing opioids so readily.

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Why are more Americans than ever dying from drug overdoses?

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Deaths from drug overdoses in the US reached staggering new heights in 2017, according to newly published figures. Trump called the crisis a "national shame and human tragedy" - but what is fuelling it?

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Biological Control of Undesirable Plants

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Biological Control of Undesirable Plants

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Read "Feasibility of Using Mycoherbicides for Controlling Illicit Drug Crops" at NAP.edu

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Read chapter 2 Biological Control of Undesirable Plants: The control of illicit-drug trafficking and drug use is a difficult and complex process that invo...

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international relations and national security

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Read CNN's Fast Facts to learn more about how the Mexican government has been fighting against drug traffickers since December 2006.

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Drug Policy and Sustainable Development Goals

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Drug Policy and Sustainable Development Goals

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Evaluating the economic impact of Mexico’s drug traffickingindustry

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Evaluating the economic impact of Mexico’s drug traffickingindustry

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Opioids Also Pose Overdose Risk for Intermittent, Low-Dose Users

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Opioids Also Pose Overdose Risk for Intermittent, Low-Dose Users

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Environmental Health News | Department of Environmental and Occupational Health Sciences

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"It may be beneficial to revise guidelines to also address opioid poisonings occurring at relatively low prescribed doses, and with acute and intermittent opioid use," said lead author Deborah Fulton-Kehoe, a research scientist in the Occupational Epidemiology and Health Outcomes Program in the Department of Environmental and Occupational Health Sciences.

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Opioid Epidemic has cost MA Economy Over $9.7 billion 

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Opioid Epidemic has cost MA Economy Over $9.7 billion 

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Location: Massachusetts, US

Problem: Thousands of people are abusing and overdosing on opioids, while It has cost the state almost $10 billion while the cost is continuing to increase.

Solution: "One way employers are dealing with crisis is by updating their benefits and policies to limit coverage of opioids, expand coverage of alternative pain treatment and increase payment for substance abuse and addiction programs"

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Dive Brief:

The opioid epidemic is taking a severe toll on the Massachusetts economy that will have consequences for years to come, according to a new report from the Massachusetts Taxpayers Foundation (MTF). Between diminished productivity due to peoples' inability to work, income lost due to fatalities and absenteeism and expenses built up in health care costs, the crisis has run up a bill of about $9.7 billion. A new anti-addiction nonprofit, Rize Massachusetts, funded the study, which its authors said is the first to assess the epidemic's economic toll on the state and the employers and healthcare providers within it.

The study estimates that opioids have kept about 32,700 people out of the Massachusetts labor force in the past seven years, making it harder for employers to fill open positions. Lost productivity from absenteeism and presenteeism (which the study defines as reduced job performance due to an illness, injury or anxiety) in the state is likely more than $2.5 billion a year.

Massachusetts is at the forefront of the epidemic, with the fourth highest rate of opioid-related deaths in the nation. The report shows that the opioid epidemic is having a major impact on Massachusetts businesses by making a tight labor market more challenging, and requests that business leaders get more actively involved to find solutions to the crisis. Key findings in the report show that: the crisis has transitioned from heroin to fentanyl and fentanyl-related substances, including carfentanil and other fentanyl-related drugs, which are 100 times as potent as fentanyl and 5,000 times more powerful than heroin.

Dive Insight:

Employers may not have grasped the extent to which opioid addiction has damaged their workforces and communities. The MTF lays out the costs in lost productivity in comprehensive details so that employers of Massachusetts can see the devastating effects the epidemic has on hiring, absenteeism and retention. Opioid addiction has forced an estimated 20% of men out of the workforce, according to a 2017 paper authored by a Princeton University economist. The Centers for Disease Control and Prevention reports that about 115 deaths due to overdoses occur daily, and, as the study stated, the epidemic shows no current signs of being over.

Shira Wilensky, national practice leader, health and well-being at OneDigital, told HR Dive recently in an email that one way employers are dealing with crisis is by updating their benefits and policies to limit coverage of opioids, expand coverage of alternative pain treatment and increase payment for substance abuse and addiction programs. Putting some controls on the accessibility of opioids can help stem the epidemic among employees in employer-sponsored plans.

The National Business Group on Health has encouraged employers to reach out to their pharmacy benefits managers and health plans to make sure they include strategies and rules that can better protect U.S. workplaces from the addiction crisis. Plans should require physicians to opt for the lowest effective doses when writing prescriptions and prescribe immediate-release opioids instead of extended-release or long-acting drugs when an employee starts therapy for chronic pain control.

Top image credit: Adobe Stock

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Study: Opioid epidemic has cost Massachusetts economy $9.7B

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The opioid epidemic is taking a severe toll on the Massachusetts economy that will have consequences for years to come, according to a new report from the Massachusetts Taxpayers Foundation (MTF). Between diminished productivity due to peoples' inability to work, income lost due to fatalities and absenteeism and expenses built up in health care costs, the crisis has run up a bill of about $9.7 billion.

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Assignment: Incorporating Global Perspectives into Your Project

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Assignment: Incorporating Global Perspectives into Your Project

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10 pts. Due Mon. Dec 3, 2018

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Incorporating Global Perspectives into Your Project

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Both lawful and illicit drug manufacturing and disposal can have a negative impact on the environment, a consequence that is often overshadowed by society's emphasis on how drugs destroy people. The damage drugs pose to the environment widens the scope of the drug problem in America. An accurate assessment of the consequences drugs have on Americans must take into account the impact of drugs on land, wildlife, plants and microorganisms.

Pathways of Entry

There are numerous ways that medications, at varying levels of concentration, can enter the environment. A consideration of these pathways illustrates the complexity and pervasiveness of the contamination problem. The following are some main ways the environment becomes tainted by medications:

Drug residue can enter surface waters in the manufacturing process.

Humans metabolize drugs and then excrete trace amounts of them into the sewer system. This waste ends up traveling through treatment systems and into the water supply.

Veterinary pharmaceuticals used on pasture animals are excreted into soils and surface waters.

Using manure as a fertilizer can spread the medications used in livestock.

Unused medications are often disposed of into the water supply through sinks, toilets and landfills.

Direct emissions are released into the air during manufacturing.[1]

The only way to redress current practices is to pinpoint the ways in which the environment is vulnerable to pharmaceutical exposure. A multipronged effort is necessary at every level of society, including consumer education on how to properly dispose of medications, safer production practices at pharmaceutical companies, and national legislation to govern the drug manufacturing and disposal process.

Green Pharmacy

According to Yale Environment 360, a publication of the Yale School of Forestry and Environmental Studies, concerns about the impact of drug manufacturing on the environment led to federal regulation in this area as early as 1938.[2] Today, the movement to protect the environment and waterways from pharmaceutical manufacturing practices is known as "green pharmacy."

The concept of green pharmacy embodies a commitment to designing the drug manufacturing process to make the lightest footprint on the environment. Such measures are not only desirable, but also necessary over the long term. The following are facts about how drugs are damaging nature:

Contaminants travel far

Researchers have found trace amounts of more than 150 different human and veterinary medications in landscapes as far away as the Arctic.

The water supply is vulnerable

A United States Geological Survey found that 80 percent of American's streams and almost 25 percent of US groundwater was contaminated by numerous medications.

Manufacturing is on the rise

In 2008, the US pharmaceutical industry sold over $773 billion in drugs worldwide, which was more than double than the amount sold in 2000, and the pharmaceutical industry only continues to grow.

Impact of human waste on animals

Medications can pass through the human body and into waste facilities that end up tainting the land. For instance, vultures in South Asia have been poisoned by the anti-arthritis painkillers that humans consume.

Top 10 Prescribed Pharmaceuticals

Trace amounts of these drugs have a good chance of ending up in the environment. The top 10 most prescribed drugs per month, with monthly counts included, are:

Synthroid: 22.6 million

Diovan: 11.4 million

Crestor: 22.5 million

Lantus Solostar: 10.1 million

Nexium: 18.6 million

Cymbalta: 10 million

Ventolin HFA: 17.5 million

Vyvanse: 10 million

Advair Diskus: 15 million

Lyrica: 9.6 million

Source: WebMD

Green pharmacy concerns clearly illustrate that the earth is a great recycling machine, one that unfortunately fuels the problem of drug contamination. Not only do the chemical byproducts of the manufacturing process end up in our water supply and soil, but the drugs we consume and subsequently excrete also share that fate. Compounding this problem, these drugs are re-consumed by humans, other animals and plant life.

Further, drug residues can impact microorganisms and potentially pose a public health threat. The emergence of antibiotic resistant pathogens (microorganisms that cause diseases) demonstrates this point well. Scientific researchers have found that bacteria resistant to medications are most common in places where antibiotics are heavily used. This is an undesirable and health-defeating consequence of the proliferation of antibiotics.

Yale Environment 360 believes that drug manufacturers should focus on making drugs that are easily biodegradable and have a more benign impact on the environment. They reported that the U.S. Food and Drug Administration (FDA) only legally requires drug manufacturers to do an environmental impact assessment when the company plans to make more than 40 tons of any given drug. In 2008, this rule resulted in only 20 drug manufacturers being required to conduct an environmental assessment. Green drug manufacturing is not impossible, but this area needs further development and the help of federal and state laws that are pro-environment, and in turn, pro-public health.

Our Drinking Water

The National Resources Defense Council (NDRC), a non-profit environmental advocacy group, has collected helpful data on water contamination. According to NDRC, in 2008, the Associated Press reported that researchers surveyed the drinking water of 24 major urban cities, serving 41 million people, and found several pharmaceutical contaminants, including antibiotics, anticonvulsants and mood stabilizers.[3] NRDC urges that further research should be conducted to evaluate the threat of pharmaceuticals in our drinking water supply.

Pfizer is one of the largest pharmaceutical companies in the world and has become a household name synonymous with prescription and over-the-counter drugs. In 1849, Pfizer got its start with one production complex in Brooklyn, New York. Today, Pfizer has a presence in 180 countries, employs over 110,600 people internationally, and, in 2011 alone, had amassed over $65 billion in revenue.[4] Pfizer is also one of the obvious targets of any debate on the potential hazardous impact of drug manufacturing on the environment. For this reason, it is no surprise that Pfizer funds its own research on the effects of manufacturing on the supply of drinking water, among other things.

According to Pfizer, the number one cause of pharmaceutical contaminants in water stems from consumer use (which accounts for 90 percent of all trace concentrations found). As discussed, the body excretes small concentrations of pharmaceuticals that, down the road, end up in the water supply. Even then, the level of medication in the drinking water is at least a thousand-fold less than minimum treatment doses. Pfizer notes that there are no reports that trace amounts of manufactured drugs (prescription and over-the-counter) in the water supply adversely affect the population.

To put trace concentrations of drugs found in drinking water in context, Pfizer uses ibuprofen as an example. Ibuprofen is one of the most common drugs (in trace amounts) found in drinking water across the world. Pfizer advises that a person would have to drink two liters of water per day for over 100,000 years to consume the equivalent of one 200 mg tablet of ibuprofen.[5] Although there may not be current evidence to support that drugs in our water supply are damaging our health, it would be going too far to say there is zero threat. It is most advisable to keep interest in this research area alive and well-funded. To the extent stricter and greener laws are enacted, the better it is for the water supply.

Our Wildlife

Ecosystems are delicate. The introduction of a drug, even trace concentrations, can deleteriously impact the habitat and reproduction success of a species. For instance, a research study on the topic of the "feminization of male fish" found that drugs are threatening the survival odds of fish.[6] Women all over the world use oral contraception as a birth control practice. Trace amounts of these drugs find their way into the water supply (again, most often through the sewage system) and end up being consumed by fish. In the case of male fish, studies show that the consumption of hormones in birth control cause them to breed at lower rates.[7] The threat, of course, is that over time species of fish that are chronically exposed to these hormones may become extinct.

Another study, from the University of York in the UK found that low levels of the antidepressant fluoxetine in the environment caused starlings (song birds) to feed less often during the key times of sunrise and sunset. While there are reports of starlings consuming antidepressants in their natural habitat (by eating worms that feed on sewage and consume trace amounts of antidepressants), the research was conducted in a controlled environment in which the starlings were fed fluoxetine. According to the researchers, other antidepressants and drugs were found in the birds' natural environment. One concern is that combinations of different drugs could prove to be more detrimental to wildlife than one medication alone.[8]

Another study found that otters that had been exposed to two common non-steroidal anti-inflammatory drugs developed severe liver damage.[9] This finding is only the tip of the iceberg in terms of how sea animals are likely being negatively impacted by human drugs altering their environment. Otter livers have not evolved to metabolize drugs to which they are now exposed, which may be a reason for the acute liver problems reported.

These findings on the impact of drugs on wildlife call into question whether drug contaminants in the environment are contributing more to the extinction of various species than is known. Research is required wherever there is life, including the ocean, though the challenges of covering so much land and oceanic mass are readily apparent.

Our Plant Life

A research study on the impact of commonly used drugs on lettuce and radish plants found damage to the growth of these plants even at low levels of concentration in the environment.[10] These drug contaminants, such as trace amounts of ibuprofen, find their way into the soil through various channels, including the use of waste water for irrigation and sewage sludge for fertilizer. The study considered specific changes in plants exposed to trace amounts of drugs, including the plants' water content, length of root and shoot, size overall, and the impact on the photosynthesis process. Each drug had a specific impact on each type of plant. For instance, ibuprofen had a significant impact on the early development of the root of lettuce plants. The study did not consider the impact of these foods on humans who consume them.

Interestingly, the Pfizer study discussed earlier found that trace amounts of ibuprofen in drinking water does not adversely affect humans, but that outcome changes when plants are considered. The differential impact of ibuprofen traces on different species, such as animal versus plant, is a testament to how difficult it can be to determine the true impact of drugs on the environment. The lettuce and radish research study directors specifically noted that more efforts must be made to determine the impact of drugs on flora and fauna.

The Impact of Illicit Drug Manufacturing

Thus far, the discussion has centered on the impact of lawfully manufactured drugs on the landscape; however, illegally manufactured drugs are also a threat, and possibly more so because they escape regulation. For instance, the chemicals used to convert the coca leaf to saleable cocaine and opium latex to heroin are hazardous materials. Annually, millions of liters and tons of chemicals are cast off into the environment after these illegal drugs are produced, or when law enforcement confiscates and destroys these drugs.[11]

Despite the ripeness for research in this area, studies lag. One study, conducted in 1992 in the Chapare area of Bolivia found that chemical waste involved in the manufacture of illegal drugs was diluted during high rainfall and only caused some loss of soil and microorganisms, but no perceivable damage to the fauna or flora was noted.[12] Regarding further research, one concern, however, is that the illegal manufacturer of drugs happens in many third-world countries that do not have adequate research funding to conduct an in-depth study. Of course, in addition, the underground nature of illicit drug manufacturing makes it difficult to study.

Reports of the impact of unlawful drug manufacturing are global. In Colombia, for instance, approximately more than one million hectares of forest have been destroyed in the production of unlawful crops. It is estimated that for every hectare of coca, four hectares of forest are damaged, most often through a crude slash-and-burn farming technique. This deforestation causes soil erosion, among other environmental problems.[13]The production of unlawful crops not only potentially devastates the environment, but so do the various efforts made to eradicate such vegetation. One method to eradicate crops is to use airplanes to dispense chemicals that terminate plant life; however, these chemicals have a high potential to pollute the air. Concerns about this particular practice have resulted in countries, including Peru, Ecuador, Bolivia, and Thailand, banning the use of chemicals to eradicate illegal drug crops.[14]

Illicit crop eradication involves international policy and calls into question how to balance the need to stem drug production while at the same time not having a detrimental environmental impact. Further, when it comes to the environment, each nation needs to think globally. For example, the US has researched the use of mycoherbicides to eradicate coca and opium poppy plants but has not developed the technology because of concerns over the impact on the environment and public health.[15] The key lesson here is that while certain methodologies may be useful to control the manufacture of drugs, such practices do not occur in a vacuum; the US and all countries have the need to protect both the public and the environment.

Strategic Recommendations

Although there may seem to be a dearth of research in the critical area of the environmental impact of drugs, there is a growing and firm concern about how to design more benign drugs. The consensus may be that since we do not have sufficient information about how the environment is impacted, we're going to err on the side of caution.One strategy is to make drugs more environmentally friendly. It is clear that human excretion of drugs is a source of water contamination, and that fact can be the starting point of savvier and healthier drug design. However, one problem is that tinkering with a drug to make it more ecofriendly can undercut its treatment efficacy. One possibility is to develop a formula that improves biodegradability once a medication is excreted.[16]

Drug companies that are not forced by law to make more ecofriendly versions of their drugs have little incentive to do so unless there is a profit associated with the change. At present, a lack of compelling research that the afterlife of pharmaceuticals is dangerous insulates these companies against having to change. Although drug companies may not be the ones to drive major change, the government and consumers may be able to do so.

Drug Disposal Tips for Consumers

The FDA is helping to educate consumers on how to safely remove unwanted drugs from medicine cabinets. Here are some helpful tips:

Participate in any drug take-back programs available. Local pharmacies or police departments may be able to provide details.

Do not pour medications into the trash. The best practice is to mix medications (do not crush or alter them) with substances such as coffee grounds or cat litter, put it all in a sealable bag, and then dispose of it in the trash.

It is ok to flush certain medications; the FDA lists the approved medications.

Learn about any local rules that prohibit disposal into household trash. Inquire with a local pharmacist for more information.

According to the Natural Resources Defense Council (NRDC), there are numerous steps that can be taken to lighten the footprint of drugs on the environment. NRDC recommendations include:

Tighten up the FDA approval process.

Before drugs are approved for distribution, the FDA can change its guidelines to require environmental assessments in more cases, as necessary.

Improve production techniques.

Implementing technologies and practices to reduce waste would result in less drug residue leaking out into the environment.

Reduce the number of prescriptions.

America is arguably the most overmedicated society. One way to control contamination is for Americans to learn to rely less on prescription pills and over-the-counter medications, and instead utilize more holistic methods to manage conditions.

Dispose of drugs more safely.

As an alternative to flushing pills or throwing medications in the trash, some communities have drug take-back programs and this model, along with education, can be used on a national scale.[17]

These measures can help to better protect the environment and those we share our environment with against drug contaminants. Current research on the impact of drugs on the environment cannot control for the effect of future medications. It is possible that certain drugs may be developed in the future that may slip through the assessment process and detrimentally impact the environment. For this reason, preventative efforts and a tightening of FDA regulations are necessary.

Citations

[1] Boxall, A. (Dec. 2004). " The Environmental Side Effects of Medications." EMBO Reports. Accessed Feb. 27, 2015.

[2] Shah, S. (Apr. 15, 2010). " As Pharmaceutical Use Soars, Drugs Taint Water and Wildlife." Yale Environment 360. Accessed Feb. 27, 2015.

[3] Natural Resources Defense Council (Jan. 2010). " Dosed Without Prescription: Preventing Pharmaceutical Contamination of Our Nation's Drinking Water." National Resources Defense Council. Accessed Feb. 27, 2015.

[4] " Pfizer." (May 14, 2014). Drug Watch. Accessed Feb. 27, 2015.

[6] Kight, C. (Aug. 11, 2013). " Impact of Pharmaceuticals on Wildlife." Science 2.0. Accessed Feb. 27, 2015.

[8] Carrington, D. (Oct. 12, 2014). " Drugs Flushed into the Environment Could be Cause of Wildlife Decline." The Guardian. Accessed Feb. 27, 2015.

[9] Naish, J. (Oct. 26, 2014). " Are Happy Pills Destroying Our Wildlife? " Daily Mail. Accessed Feb. 27, 2015.

[10] University of Exeter (Dec. 5, 2014). " Drugs in the Environment Affect Plant Growth." Science Daily. Accessed Feb. 27, 2015.

[11] " Environment." (n.d.). Drug War Facts. Accessed Feb. 27, 2015.

[16] Tuhus-Dubrow, R. (Jan. 3, 2011). " The Little Green Pill." The Slate. Accessed Feb. 27, 2015.

[17] "Dosed Without Prescription: Preventing Pharmaceutical Contamination of Our Nation's Drinking Water."

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The Environmental Impact of Growing Drugs | Dual Diagnosis

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Both lawful and illicit drug manufacturing and disposal can have a negative impact on the environment, a consequence that is often overshadowed by society's emphasis on how drugs destroy people. The damage drugs pose to the environment widens the scope of the drug problem in America.