When an epidemic strikes it’s rarely our first thought to ask how the demographics shake out. Thoughts and prayers go out to victims and their families and whatever is left goes to the hope that our own folks will remain unaffected. With overdose rates rising every year, placing the focus on statistics can seem like a callous and unnecessary distraction.
“I focus on the issue at hand,” Says Robert Childs Executive Director of the North Carolina Harm Reduction Coalition, “people are dying in North Carolina and we are working on reducing mortality.”
Across the country, that work has been focused on providing medications like Naxalone, an overdose treatment which has reversed over 9,000 opioid overdoses in North Carolina from 2013 to 2017.
Numbers that staggering are difficult to ignore and it’s important to remember that they are not just numbers, they are individuals who have been robbed of their lives. A closer look at who these individuals are can give us an idea of who’s responsible and why; questions that need to be asked if we want to prevent overdoses rather than treat them.
Baby boomers are at the highest risk of abusing opioids.
Examining pharmacy and medical claims made from 2011 to 2015 (the year the epidemic reached record-breaking levels), Castlight, a health research group, provided HERB with compiled data on the cities hit hardest by the opioid crisis. Their study found that when we account for age groups, baby boomers are at the highest risk of abusing opioids—four times more likely than millennials. This indicates a serious shift away from the average seen in the previous heroin epidemic of the 1970s and a shift in the nature of the suppliers.
Beyond age, those who exhibit mental illnesses like depression are three times more likely to abuse opioids while an overwhelming number of overdose cases are reported in the south with lower income areas twice as likely to be affected by the crisis.
People with opioid prescriptions in states that prohibit medical marijuana are nearly twice as likely to abuse their prescription drugs.
In terms of treatment, Castlight found that states which prohibited medical cannabis saw an average rate of abuse of 5.4% among those with opioid prescriptions, while that number was 2.8% in states that had some sort of medical cannabis system.
What’s more, the current crisis exhibits a race-based pattern that has not been seen before. A 2014 study published in JAMA Psychiatry found that since the 1960s those who were most vulnerable to opioids were younger people of color. Yet that dynamic has taken a drastic turn in which, “nearly 90% of respondents who began use [since the early 2000s] were white.”
Nearly 90% of respondents who began using opioids in the last decade are white.
That shift appears to be associated with the wide accessibility of prescription drugs which became more widely abused than heroin in the 90s. Centers for Disease Control data shows that opioid prescriptions increased fourfold in just over ten years from 1999 to 2010. Today, prescription pills make up 63 percent of overdose cases.
In fact, nearly half of the 2,797 respondents in the 2014 study indicated that prescriptions were preferable to heroin. “It is legal with a prescription and [I] wouldn’t have to worry about the consequences of getting caught and the legal troubles that getting caught would cause.” One of the participants told researchers.
Today, prescription pills make up 63 percent of overdose cases.
Notably, the response to this opioid crisis has been much different and some have suggested that the reason lawmakers are now taking action is racism. Where the solution to the first opioid crisis was stiffer penalties and prison time, the current solution is treatment based, some argue. Experts have even claimed that people of color were under-prescribed in the current crisis because doctors wrongly believed they were more likely to abuse or sell drugs.
“The answer is that racial stereotypes are protecting these patients from the addiction epidemic,” Dr. Andrew Kolodny a senior scientist at Brandeis University told the New York Times in 2016.
But racism may not be the answer so much as reckless behavior on the part of doctors, pharma companies, and government officials. Studies have shown that white Americans are not only more likely to be diagnosed with depression, they are also more likely to receive treatment making them uniquely vulnerable to a healthcare system which was oversaturated with pills. In fact, a map of Gallup’s Well-Being Index measuring mental health by state looks a lot like a map of those hardest hit by the opioid crisis.
At the bottom of that list is West Virginia, which currently has the highest rate of overdose deaths in the country (over 800 just this year). As a 2016 Pulitzer Prize-winning report from the Charleston Gazette-Mail found, drug companies oversaturated the state with 780M opioids in a matter of six years.
Last week, one of those suppliers, Cardinal Health, announced their own solution: an Opioid Action Program which will ship 80,000 doses of Naxalone to West Virginia, Kentucky, Tennessee, and Ohio. It’s something that pharmaceutical distributors like Cardinal will certainly be good at—and that’s the problem. They’ve recently agreed to pay a $44 Million settlement for being so good at shipping drugs they managed to violate the Controlled Substances Act with a legal substance.
According to an investigation by 60 Minutes and the Washington Post, this abuse was the result of government obstruction of regulations. Under the masterfully deceptive name of Ensuring Patient Access and Effective Drug Enforcement Act, the DEA was blocked from investigating massive shipments of drugs to local pharmacies.
Veterans are twice as likely to die of an opioid overdose.
Among those most heavily affected, veterans are twice as likely to die of an overdose and a closer look at VA practices at the time shows exactly why.
As of 2016, the number of overdose deaths across the country topped the casualties for the entire Vietnam War. Veterans who returned from combat with battlefield injuries and PTSD are now fighting a new enemy at home.
“Twenty-three different types of pills,” were prescribed to a Marine Lance Corporal Jeremy Brooking, “easily over 100 different pills a day,” He told CBS in 2014 after a federal investigation found that the VA had been severely over prescribing its vets.
A small town in Indiana received 832,310 hydrocodone pills for a city of about 28,500.
In Terre Haute, Indiana, local reporters discovered that the small town of Marion received 832,310 hydrocodone pills for a city of about 28,500.
It’s a picture that’s eerily similar to small-town Appalachia. Contracts for pharmaceutical supplies to the Department of Veterans Affairs are usually held by a single vendor, and in recent years those vendors have been Cardinal and two other major distributors, who are now paying fines to the federal government for their shipments to West Virginia.
Since these alarming reports the VA has reduced its prescriptions by at least 20 percent, doctors have been arrested and pharmaceutical companies are facing lawsuits across the country. But the fact remains that the drugs and the practices which allowed us to fall into this trap were perfectly legal and professionally peddled to the most vulnerable parts of the country.