Why a promising heroin addiction treatment is unavailable in many states

More than 90 percent of heroin users who detox cold turkey will relapse, but there’s a dispute over prescribing drugs to help addicts get clean and keep them from deadly overdoses. Hari Sreenivasan talks to Ryan Grim of The Huffington Post about the recent rise of heroin and the debate over addiction treatment.

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    Here in the U.S., there's been growing concern in a number of states about a rise in the use of heroin and, in some places, a jump in overdoses.

    Hari Sreenivasan has a look at a new investigative report out that explores not just what's behind those numbers, but what could be done to help break addiction.


    Compared to other drug use, heroin is by no means among the most commonly used drugs. Exact statistics vary, but studies find anywhere from about 300,000 to a million-plus Americans regularly use heroin each month.

    But its toll is well known and increasingly worrisome. Its rise has been confirmed in published studies. And in a study of 28 states, the number of heroin deaths jumped by a substantial percentage since 2010.

    The Huffington Post is out with a major piece reported by Jason Cherkis. He is looking at its rise in Kentucky and specifically about a debate there and elsewhere over breaking addiction.

    One medication being viewed as an alternative to methadone is known as Suboxone, but there is not agreement. And some experts believe a substance-free approach is the only way to go.

    Ryan Grim is the Washington bureau chief for The Huffington Post and the editor of the article, joins me now.

    So, how significant of a problem are we looking at, when statistics are so hard to find, especially when there are so many other drugs and other drug problems in America that out — kind of outweigh heroin?

  • RYAN GRIM, The Huffington Post:

    Particularly in rural areas, this is — this is becoming a serious problem. The media does have a habit of exaggerating, you know, crises as they relate to drugs, but this is a serious one.

    You had some 400,000 people who went to emergency rooms the last year for heroin overdoses. More than 8,000 of those died. That's a 39 percent jump from the last year. And there's no reason to think that those numbers aren't going to continue to go up, as we're seeing more heroin coming into the country. We're seeing prices drop.

    And heroin addicts themselves are, paradoxically, the best salesmen for heroin, because they're broke. They need money. They go out and find other people that they can try to go in on a buy with, and that's how it spreads. This is a serious problem; 8,000 is a lot of people.


    OK, so I made a reference to this drug named Suboxone. What's the difference between — between Suboxone and methadone, which we are familiar with?



    Methadone, quite simply, gives you a lot more of a buzz. It's much — it's much easier to abuse methadone. And methadone might be the appropriate drug for somebody that has a more significant or serious addiction.

    Suboxone, though, is mixed with naloxone, which you have probably heard a little bit about. That's the one that they use to revive people from overdoses. So, in other words, they have put it into a film which can't be split up, so that if you take too much Suboxone, then naloxone kicks in. And it's just a miserable time for the person.

    So, the act of abusing it leads to a terrible time, and it's not something that somebody would want to do twice. And because there's naloxone in it, you can't die from simply a Suboxone overdose.


    In the report, you spoke to several different characters and several different experts and you also had a video version.

    I want to play out a couple of clips, if I can, for our audience. You talked to a couple of characters that really summed up the argument and the tension there. You spoke to a judge who says that she doesn't feel that there is any place for drugs in the treatment process, and then you also spoke to a doctor who wants to be able to prescribe this.

    Let's take a listen.

  • JUDGE KAREN THOMAS, Campbell County, Kentucky:

    I personally feel that when you're talking about Suboxone and methadone, you're talking about replacing one opioid for another.

    With heroin, you have to keep it a level just to feel decent. It's not even feeling high anymore. It's just to feel OK. And so when you detox somebody in a jail facility, you're not giving them any treatment, you're not giving them any course of conduct to overcome the cravings. You're just housing and detoxing, basically.

    And I have talked to more than one heroin addict that has told me the same thing, that the memory of how difficult detoxing was, was one of the things that actually got them through not using again. Now, to get to that point is pretty hard.

  • DAVID SUETHOLZ, Kenton County, Kentucky, Coroner:

    The problem that I see is this lack of being more open-minded to the medical treatment of the problem. We're not contributing to the addiction. What we're giving people is a light at the end of the tunnel.

    If I have urges once I leave a treatment program, these urges could potentially kill me. So, if I have a medication that can reduce those urges and allow a person to participate in life normally, what's wrong with that?


    There's a lot of people that feel probably the same way the judge does, that the idea that, whether it's methadone or Suboxone, we're essentially just displacing one addiction for another, and then we're going to be on the hook paying for a lifelong addiction in some cases for some people.

    So what's the — what's been the response from people like the doctor to that?


    Right. That's exactly right.

    And there is a lot of discomfort with the notion that you would do what's called maintenance. The drug war started about 100 years ago, and it's common now for people to say, look, the drug war has failed, we need to focus on treatment over incarceration.

    But the same kind of impulses that drove the drug war are actually now driving treatment, and that's looking at drug use through a prism of morality or politics. And that's kind of what the judge is doing there. She's saying, like, this — this seems wrong to me, or it seems wrong that we should be paying for somebody's addiction.

    But the doctor is saying, no, this is a medical issue. Step aside, allow the medical community to deal with it. And I said earlier that you simply can't die from Suboxone. You can — that's too much. You can die from aspirin. You can die from anything. You should obviously be careful with whatever.

    But the doctor and others are saying, this is a medical issue. Take politics and take morality out of it and deal with it based on the evidence.


    So, how — let's take an apples-to-apples comparison, if that's possible. How effective is Suboxone vs. the standard of care that we have today, which is kind of a 30-day 12-step program? What kind of relapse rates or dropout rates? How do we compare the two?


    So, the success rate for abstinence-based treatment — this is the 30 days and then you go home and attend meetings — you know, it's hard to find precise numbers, but the consensus is, it's less than — less than 10 percent.

    So that means more than 90 percent of these people are going to relapse, and they're in a very dangerous situation. Because they have gone, they have — because they have gone through detox, they have gone cold turkey, now, all of a sudden, when they use the exact same amount of heroin that they used to, their tolerance is way down, and that's why an overdose can be fatal.

    So just looking at keeping people alive, Suboxone's success rate is staggeringly higher because it has this naloxone within it. Dropout rates, Dr. Suetholz has said his dropout rate is around 8 percent. There stills need to be a lot more studies done of it, but it's much more effective than the status quo.


    All right, Ryan Grim, Washington bureau chief of The Huffington Post, who edited this article, thanks so much for joining us. e


    Thank you.