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Overdose Death Rates | National Institute on Drug Abuse (NIDA)

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Overdose Death Rates | National Institute on Drug Abuse (NIDA)

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Insane amount of charts and statistics on deaths due to opioids in the last years of the opioid crisis

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Overdose Death Rates | National Institute on Drug Abuse

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The U.S. government does not track death rates for every drug. However, the National Center for Health Statistics (NCHS) at the Centers for Disease Control and Prevention collects information on deaths involving many of the more commonly used drugs available through 2020 at a searchable database, ca…

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Heroin use is driven by its low cost and high availability | National Institute on Drug Abuse (NIDA)

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Heroin use is driven by its low cost and high availability | National Institute on Drug Abuse (NIDA)

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Official source for availability of drugs

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Heroin use is driven by its low cost and high availability

One main factor that contributes to the popularity of a drug is availability. One key to prevention is reducing exposure. While efforts to reduce the availability of prescription opioid analgesics have begun to show success, the supply of heroin has been increasing (see Increased drug availability is associated with increased use and overdose). Prescription opioids and heroin have similar chemical properties and physiological impacts; when administered by the same method (i.e., ingested or injected), there is no real difference for the user.

It is not clear whether the increased availability of heroin is causing the upsurge in use or if the increased accessibility of heroin has been caused by increased demand. A number of studies have suggested that people transitioning from abuse of prescription opioids to heroin cite that heroin is cheaper, more available, and provides a better high. Notably, the street price of heroin has been much lower in recent years than in past decades (Unick et al., 2014). In addition to these market forces, some have reported that the transition from opioid pills to heroin was eased by sniffing or smoking heroin before transitioning to injection (Mars et al., 2014). In a recent survey of people in treatment for opioid addiction, almost all-94 percent-said they chose to use heroin because prescription opioids were "far more expensive and harder to obtain" (Cicero et al., 2014).

References

Cicero TJ, Ellis MS, Surratt HL, Kurtz SP. The changing face of heroin use in the United States: a retrospective analysis of the past 50 years. JAMA Psychiatry. 2014;71(7):821-826.

Mars SG, Bourgois P, Karandinos G, Montero F, Ciccarone D. "Every 'never' I ever said came true": transitions from opioid pills to heroin injecting. Int J Drug Policy. 2014;25(2)257-266.

Unick G, Rosenblum D, Mars S, Ciccarone D. The relationship between US heroin market dynamics and heroin-related overdose, 1992-2008. Addiction. 2014;109(11):1889-1898.

Ordering Publications

Call 1-877-643-2644 or:

APA Style MLA Style AMA Style

NIDA. (2018, January 17). Prescription Opioids and Heroin. Retrieved from https://www.drugabuse.gov/publications/research-reports/prescription-opioids-heroin

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Heroin use is driven by its low cost and high availability

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One main factor that contributes to the popularity of a drug is availability. One key to prevention is reducing exposure. While efforts to reduce the availability of prescription opioid analgesics have begun to show success, the supply of heroin has been increasing (see Increased drug availability is associated with increased use and overdose).

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Cheaper, More Addictive, and Highly Profitable: How Crack Took Over NYC in the ’80s | Village Voice

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Cheaper, More Addictive, and Highly Profitable: How Crack Took Over NYC in the ’80s | Village Voice

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"Crack ran for $5 to $10"
Good baseline for the comparisons of accessibility between opiates today and crack in the 80's

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Crack popped up in Miami and Los Angeles in the 1970s. The Drug Enforcement Agency didn't pay it much mind then. It was nothing more than a different version of cocaine, the agency figured. Crack arrived in New York City in the early 1980s before most of the public had heard anything about it. And as we noted in last week's cover story, which explored how the crack era shaped policing strategies, the NYPD was ill-prepared for the crime wave the drug would bring.
See also last week's feature story: The Tragedy of Louis Scarcella

The department was understaffed. Budget cuts from the 1970s, when the city was almost bankrupt, had forced the NYPD to lay off nearly a third of its officers from 1975 to 1982.

Meanwhile, crack began its spread across New York. It was cheaper than cocaine. Anybody could afford it, and anybody could sell it - anybody could buy a gram of coke, chop it up, cook it, and flip it for double the money.

"So now, all of a sudden, you have got a product that is saleable to a mass new audience," Robert Strutman, a former New York city D.E.A. agent, told PBS Frontline in 2000. "And that is what the New York drug peddlers did. They mass-merchandized cocaine."

The media world first noticed crack in 1984, when the Los Angeles Times reported that "cocaine sales explode with $25 rocks." According to a 1999 paper in Columbia University's Souls journal, reporters began using the word "crack" in 1985. The earliest instance was a November 1985 story in the New York Times: "new form of cocaine, known as crack, was for sale in New York City."

By 1986, crack was available in 28 states. Newsweek called the drug's impact a "national crisis."

It was around this time that authorities realized that crack hit communities with a savage force unlike any previous drug.

"Crack literally changed the entire face of the city," Strutman told Frontline. "I know of no other drug that caused the social change that crack caused. You can't name another drug that came close."

It was more potent than cocaine. The high was short, just a few minutes. And for just $5 to $10, you could get it again and again. Parents became junkies. Addicts robbed and looted. Now there was more money at stake on the streets, and the dealers became protective of their territories. The barriers for entry into the business were low. There were always more dealers entering the game, trying to get in on the cash flow.

"Crack brought on a new kind of organization," said Strutman. "With the crack organization, it started street-up...We started seeing it move downtown, and you could literally follow it block to block, going from 125th Street all the way down to Alphabet City, which is the other side of New York, the southern tip of Manhattan. From 1985 to 1987, maybe 1988, there were no real major organizations. We used to joke that we had 25,000 crack cottage industries in New York."

More organizations meant more violence.

"Drugs have changed the complexion of crime in America," Lee Brown, the city's police commissioner in the early '90s, told the Harvard Business Review in 1991. "The crack epidemic has precipitated an explosion of violent crime, unlike anything we've ever experienced."

In 1986, Ronald and Nancy Reagan addressed the crack epidemic and the violence it triggered. They gave America their their "Just say no" speech. Nancy Reagan declared that the country must be "unyielding and inflexible" in its fight against crack. And the War on Drugs was underway.

Congress passed the Anti-Drug Abuse Acts of 1986 and 1988. The new laws made the penalties for crack possession much harsher than the penalties for powder cocaine possession. For instance, five grams of crack would get you a five year prison sentence, while it would take 500 grams of cocaine to do so. Not until the Obama Administration would congress pass a bill reducing the disparity.

In 1985, there were fewer than 600,000 incarcerated people in America. By 1995, there were more than one million. The total correctional population - including those in jail, on parole, and on probation - increased from around three million in 1985 to seven million in 2005.
Send story tips to the author, Albert Samaha

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Cheaper, More Addictive, and Highly Profitable: How Crack Took Over NYC in the '80s

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Crack popped up in Miami and Los Angeles in the 1970s. The Drug Enforcement Agency didn't pay it much mind then. It was nothing more than a different version of cocaine, the agency figured. Crack arrived in New York City in the early 1980s before most of the public had heard anything about it.

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Useful map and information on current* OD's in NH

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Why New Hampshire Has One of the Highest Rates of Opioid-Related Deaths | Best States | US News

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Why New Hampshire Has One of the Highest Rates of Opioid-Related Deaths | Best States | US News

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Highlights severity of NH opioid crisis. First hand accounts from fire-chief

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Page: 51
"Crazily accessible, insanely potent - and addictive."
61% jump in murder rate due to gang modernization and profitability of cocaine. Murder demographic, young black men.
NYC 2008, 417 murders. NYC 1990, 2,605 murders

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Opioid crisis weighs on New Hampshire’s chief medical examiner - The Boston Globe

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Opioid crisis weighs on New Hampshire’s chief medical examiner - The Boston Globe

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Eric Bedard's mom
Why is there so little in the way of assistance? Highlighting the unprepared nature of NH at the moment.

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CONCORD, N.H. - On some days, Dr. Jennie Duval calls as many as six families after fatal overdoses - some of the families stunned and heartbroken, some of them resigned to a death they saw coming.

This, Duval said, is the most difficult part of her job as the only full-time medical examiner in New Hampshire, which leads the nation in per-capita deaths caused by fentanyl and other synthetic opioids.

"It's not like I can rush the call," said Duval, the state's chief medical examiner, as she described a heart-wrenching notification. "It takes a lot of time. But sometimes I feel like a broken record."

The crush of fatal overdoses has forced the office to abandon its practice of conducting an autopsy on each suspected overdose victim. Still, Duval has no alternative but to work a grueling schedule of 10- to 12-hour days that drains her physically and emotionally.

"If this epidemic is cresting, I'm not feeling it," Duval said in a conference room at Concord Hospital, the strain of another long day visible on her face. "There are many more autopsies that I'm not doing."

A Chelsea physician writes of the importance - and rewards - of treating opioid addiction in primary care.

Duval's only assistance comes from two contractors who each work five days a month. Among them, they conducted 548 autopsies last year - about one-third for overdoses in a state where 476 people are confirmed or suspected to have died from drugs in 2017. Duval conducted nearly 300 autopsies, far above the profession's suggested limit of 250.

The state Legislature has approved funding for two physicians to join the office. But in the ultra-competitive field of forensic pathology - a limited pool of doctors to fill many openings in the country, coupled with the challenge of recruiting in a rural state with long winters - Duval is crossing her fingers that help arrives soon.

"It takes a certain kind of person to do this job," she said. "It's not pleasant. You're dealing with death every day."

The state's former chief medical examiner, Dr. Thomas Andrew, said the opioid epidemic was part of the reason he retired last year to pursue a calling for the ministry.

The office's overall caseload has more than doubled since 1997, the year Andrew became chief medical examiner, and reached 1,820 in 2017. Twenty years ago, opioids were linked to less than 10 percent of deaths referred to the office, Andrew estimated.

"It was simply a slowly unfolding catastrophe that, even in seeing it coming, we didn't have the surge capacity to account for it," Andrew said. "The casework was getting done, don't get me wrong, but the numbers became so overwhelming."

The medical examiner's office investigates fewer than 20 percent of the approximately 12,000 people who die in New Hampshire each year. They include victims of suicide, accidents, and sudden, unexpected deaths of people under 60.

The number of cases that include an autopsy makes up about one-third of all referrals, although they are mandatory for some cases, such as homicides.

Choosing which overdose victims to autopsy "is a gamble," Duval said.

Some cases seem obvious - a syringe in the arm, opioids near the body, and a documented history of drug abuse, she said. But even cases that appear straightforward can involve factors that are discovered only through an autopsy, Duval said. Perhaps a pulmonary embolism will be found. Perhaps other damage might have caused or contributed to the death.

And as the opioid crisis continues, autopsies can yield valuable information about the effects of synthetic drugs such as fentanyl.

"It's the right thing to do," Duval said. "You want to have every piece of the puzzle."

New Hampshire is not alone in its staffing struggles.

Dr. Kim Collins, a South Carolina physician who is president of the National Association of Medical Examiners, said the profession is finding it hard to fill vacancies as fewer students choose the field and more forensic pathologists are retiring.

Each year, only about 30 to 40 young doctors in the United States become certified in forensic pathology, Collins said. Medical schools are devoting less attention to the subject - "some medical students will never even see an autopsy,'' Collins said - and the field pays far less than many other specialities.

Massachusetts, for example, is working to add three or four more doctors to a staff that already has hired two others since the beginning of the fiscal year, said Daniel Bennett, the state secretary of public safety, who oversees the medical examiner's office.

The state's nine full-time medical examiners average more than 300 autopsies a year, Bennett said. Massachusetts also has three part-time forensic pathologists, nine contracted examiners, and three young physicians who work for the office on a fellowship program.

Still, Massachusetts must improve to be fully accredited by the national association that Collins leads. Bennett said the opioid epidemic, mirroring its impact elsewhere, has created a backlog in completed autopsy reports that the office hopes to shrink to industry guidelines this year.

The national association requires that 90 percent of autopsy reports be completed in 90 days. In Massachusetts, 58.3 percent of autopsy reports met that standard between October 2015 and September 2017.

To help address the lag, Governor Charlie Baker wants to boost funding for the office by $1.7 million in fiscal 2019, to a total of $11.9 million.

In Maine, two full-time forensic pathologists handle nearly all the autopsies. Two others work on a per-diem basis and handle about 10 percent of the cases.

"We did have trouble with turnover in this office, and it was difficult. Once you get an employee trained, they leave, usually for more money," said Mark Belserene, administrator of the state's medical examiner's office.

"We were successful in reclassifying positions to better reflect the actual tasks and also to bring the salaries up to a more competitive level," Belserene said.

Despite the physical and mental stress, Duval plans to stay put as New Hampshire's chief medical examiner.

"I'm not going anywhere," she said with a small smile.

Although the caseload continues to climb, the addition of two doctors should make the work more manageable. Still, Duval said she does not expect the yearly number of autopsies to fall below 250 for any examiner.

The opioid crisis should ensure that.

Brian MacQuarrie can be reached at brian.macquarrie@globe.com.

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Opioid crisis weighs on New Hampshire's chief medical examiner - The Boston Globe

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CONCORD, N.H. - On some days, Dr. Jennie Duval calls as many as six families after fatal overdoses - some of the families stunned and heartbroken, some of them resigned to a death they saw coming.