Why more Americans are getting high — and overdosing — on heroin

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    The sudden, shocking death of Oscar wing actor Philip Seymour Hoffman has brought fresh attention to the source of the addiction that apparently killed him, heroin. The use of the drug has been on the rise in states like Maryland, where 37 deaths have been reported since September, and in Vermont, where the governor devoted his state of the state address to the topic.

    But its use is spreading across the nation.

    Jeffrey Brown has that.


    Heroin may not be the most commonly used illegal drug, but a national survey shows its use has doubled since 2007. We look at the changing faces and places of addiction, as well as the reasons for it, with Gil Kerlikowske, director of the White House Office of National Drug Control Policy, the nation's so-called drug czar, and Sam Quinones, an author and reporter at The Los Angeles Times. He is currently writing a book on the recent heroin surge in the U.S.

    And let me start with you, Gil Kerlikowske.

    Are we seeing — to what extent are we seeing a new surge and how serious a problem is it?

  • GIL KERLIKOWSKE, U.S. Drug Policy Director:

    It is a serious problem.

    We are seeing an increase. I think the concern is always that data usually lacks one or two or sometimes three years, depending on what the survey or what the measure is. But I can tell you, in my travels across the country, and I spoke to the national narcotics officers today at lunch, there is no question we are seeing a resurgence of heroin.


    And seeing it where and in what kind of populations?


    Well, it's very different.

    And two issues come up. One is, of course, if prescription drugs are more tightly regulated or less accessible or more expensive, people can turn to heroin because they are already addicted. They suffer the disease of addiction to these opioids. Heroin in less expensive.

    But there is a second part, and that is that we see a group of young people who are very naive and believe that heroin, and used in certain ways, they won't become addicted. It's edgy. And what of course happens is, it is incredibly dangerous.


    Sam Quinones, what — what — you have been looking at this all around the country. Where do you see it, what kind of populations, and how perhaps has it changed over time?

  • SAM QUINONES, The Los Angeles Times:

    I have been all over the country.

    And I would say, largely, this is a white problem. I don't find opiate addiction too much in black or Latino populations. This is very different from the way heroin spread 40 years ago in the 1970s, where a lot of black or Latino communities were really badly hit.

    Heroin today and prescription pill addiction today is almost entirely a white phenomenon. And it's in rural America. It's in largely in suburban America, places that have done fairly well, middle-class, upper-middle-class areas. And it's in towns that really never had a problem with heroin before this, Charlotte, Salt Lake, Columbus, Cincinnati, Albuquerque, places like that where you just didn't really see it so much.

    Now it has become a very, very big problem. And, as Gil Kerlikowske said, it's mostly related to the use of — the gateway drug in all this is — are these prescription pills.


    Well, explain that a little bit more.

    Sam, you start, the tie between these prescription drugs and heroin.


    Well, many of these prescription painkillers are virtually identical molecularly to heroin.

    Oxycodone is very, very similar. Almost identical to heroin. The problem is that there is a black market in these pills now, because they have been so widely prescribed. There was a revolution in medicine in the United States back in the '80s and '90s that said these pills are nonaddictive ones prescribed to pain patients, chronic pain patients.

    So we had this kind of rising sea level of pills all across — all across the country. A very deep black market developed in which these pills now cost a dollar a milligram. Most of these pills come in 30, 40, 80 milligram doses. That means you are having to pay 30, 40, 80 bucks a pill, and a lot of people getting addicted. Their tolerance rises.

    They cannot — they end up using three, four, five of these pills. I have met people who had $300-, $400-a-day addictions. Heroin comes in and it is a fifth to a 10th cheaper than that. And if you are already, a lot of these folks, getting addicted to the pills, have already begun injecting.

    And when they start injecting, it's kind of like you crossed the Rubicon in a sense. And so heroin, injecting heroin isn't much different from injecting these pills. It just happens to be far cheaper.


    And where — Gil Kerlikowske, where does the heroin come from? And how has that changed?


    Sure. Almost — and it really hadn't changed. Almost all of the heroin that enters the United States enters at the southwest border.

    And it is a significant increase in seizures that Customs and Border Protection has been making. So we do know the cartels can market and they can market to younger people. So we are seeing that increase. And we are seeing this concern that young people don't recognize that this is incredibly dangerous and powerful. And they think using it in other ways, they won't become addicted. Unfortunately, they do.


    Philip Seymour Hoffman is said to have a heroin with the logo of ace of spades, a brand name, so to speak. What do you make of that? Are there different strains, different power? What is that?


    It's very common for these folks to label or put some type of tag. But you never really know what you're getting.

    Just because it has that heart or that ace of spades on it doesn't mean that that is what you are getting the next week or the week after. And if you look right now in Western Pennsylvania, I think we're up to something like 22 deaths with heroin that is laced with another pharmaceutical painkiller, Fentanyl.


    Sam Quinones, the other thing we know about the Hoffman story is that he had gone into rehab many years ago. He was essentially said to be clean for several decades, in fact. That tells us something clearly about the nature of this kind of addiction.


    It tells us that this is an enormously difficult addiction to kick.

    People have to relapse six to eight, nine, 10 times before they're actually able to kick the heroin habit. Once you get down, once you start down that slope, it is very difficult. It also has this horribly mangling effect on the families surrounding the people who use it.

    I have been talking with lots of families, people around the country who have lost loved ones to this. And the death sometimes is even almost like a relief, because for so many years, it's just been this horrible, horrible problem dealing with this one kid who cheats, who lies, who steals. And that is a big part of the addiction.

    Can I say also that in my view heroin is like — it's a commodity. Whatever they stamp on these things, or however they sell it, the only way it differs from — heroin differs from each other is literally by the way it's cut. And so it's like aspirin. You know, it's like, everywhere, you can find it. It is just measured differently.

    And I think that this is a key to all this, because heroin traffickers have learned to market — they're expert marketers. They have to market because that's the only way they can differentiate between their drug and others.


    All right.


    And so, to me, that's really a big part of this. These guys have learned to market expertly all across the country.


    Is there one — just in our last 30 seconds here, Gil Kerlikowske…




    … is there one policy prescription that you are most focused on to stem this?


    You know, for heroin, it is going to have to be the education.

    At one time, the Office of National Drug Control Policy had $190 million to do prevention programs. That has been zeroed out for the last couple of years by Congress, even though the president has asked for about $20 million. Kids get plenty of pro-drug messages. We need to give them anti-drug messages, particularly around heroin, that work.


    Gil Kerlikowske and Sam Quinones, thank you both very much.


    Thank you.

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