In our recent discussion at Washington Post’s Wonkblog, Harold Pollack and I talked about the astonishing scale of prescription opioid consumption in the US, which has no parallel anywhere else in the world. Americans consume 99% of world’s supply of hydrocodone, with the rest of the human race accounting for only 1%. Each year, U.S. health care professionals write more prescriptions for opioids than there are adults in the country.
Some of this prescribing has unquestionably been a blessing to people in pain. Some of it has however been highly destructive. Sally Satel highlights one of the adverse consequences of flooding the country with prescription opioids:
According to the 2012 National Survey on Drug Abuse and Health, four out of five new heroin users had previously abused painkillers.
The recent surge in heroin use is thus fundamentally different from its 1970s precursor. Its seeds were planted not in Southeast Asia but in doctor’s offices, emergency rooms and pill mills all across the country.
As policy makers focus attention on the resurrection of heroin in American life, they should remember that it remains a small problem compared to the painkiller addiction epidemic that fomented it and is still doing so: Deaths from legal prescription opioids exceed those from heroin by a factor of five. If we want a lower prevalence of heroin addiction five years from now, we should be looking upstream at policies that will combat the mis-marketing, mis-prescribing, diversion and abuse of prescription opioids.