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This deserves more attention than it gets over here, but parts of America are in the grip of a heroin epidemic. According to Graeme Wood in the New Republic, “the total number of monthly heroin abusers has [since 2002] doubled to 335,000 nationwide.”

This is in contrast to the situation in Britain, where the misuse of heroin and other class A drugs appears to be coming down, especially among young people. It’s also at variance with recent US trends on other illegal drugs like cocaine and methamphetamine.

Graeme Wood is very clear as to who’s to blame for America’s growing smack habit – the medical profession:

“Heroin epidemics don’t come and go randomly… They have clearly identifiable causes—and in this case, by far the largest cause is doctor-prescribed pills. Every year since 2007, doctors have written more than 200 million prescriptions for opioid painkillers. (Consider that there are 240 million adults in the country.) And about four in five new heroin addicts report that they got addicted to prescription pills before they ever took heroin.”

America has a highly commercialised healthcare system – which could be pushing some doctors to cater to the non-medical demand for opiates and opioids. According to Wood, there are even cases of doctors having advertised a “No Pill, No Pay” policy.

He goes on to describe the over-prescription of pills as a “supply shock” which has transformed the geographical pattern of addiction, pushing “heroin use out of cities and into rural and suburban and middle-class areas”:

“Massachusetts reported a staggering 185 heroin deaths outside its major cities since November, and Peter Shumlin, the governor of Vermont, spent his entire ‘state-of-the-state’ address talking about the nearly eightfold increase in people seeking opiate treatment there since 2000.”

One can choose to put a positive spin on these developments:

“…we can take slight comfort in knowing that the origins of this epidemic at least aren’t directly tied up in gang violence… If you can choose which addict to have in your life, the one who starts by furtively gobbling pills, or the one who is surrounded by violence and one day decides to drive a spike into his vein and inject a substance sold to him by a street-corner pusher, you definitely want the former.”

Then again, it’s not that prescription pills are displacing the illegal opiates – rather the legal and illegal trades appear to be functioning side-by-side, hence the increase in heroin abuse:

“Some of the addicts get the pills through a well-meaning doctor or dentist, and many others swipe leftover pills from their friends or family members. The result for an addict is the same: Once the pills or money run out, heroin is still available—and cheap. At about $10 per hit, it can be half the street cost of pills.”

None of this should be especially surprising. If you make a product easier to buy and consume, then more of it is likely to be bought and consumed. Furthermore if an illegal version of the product can, in certain circumstances, be sold more cheaply and/or conveniently than the regulated version, then it too will find a market. Both the official and underground markets will also find willing suppliers. The doctors we’ve heard about, but put yourself in the position of a drug dealer: given the choice, who would you rather sell to – potentially violent customers in the most dangerous part of town or middle class addicts out in the suburbs?

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