America’s heroin epidemic is a phenomenon that we’ve covered before on the Deep End. One might imagine that something similar is happening in most comparable countries, but it isn’t. For instance, in Britain, the prevalence of Class A drug use over the last decade has been pretty flat – and it’s in outright decline among the young.

The very different situation in the US is described by Lenny Bernstein in the Washington Post:

“…heroin addiction and the rate of fatal overdoses have increased rapidly over the past decade, touching parts of society that previously were relatively unscathed, the Centers for Disease Control and Prevention reported…

“The death rate from overdoses nearly quadrupled to 2.7 per 100,000 people between 2002 and 2013, CDC Director Tom Frieden said…”

If the trend of the last decade continues, it won’t be that long before America has a million active heroin users:

“The annual rate of heroin use rose from 1.6 per 1,000 people between 2002 and 2004 to 2.6 per 1,000 between 2011 and 2013, according to the report. That includes a doubling among women, a 114 percent increase for whites and a 109 percent rise among people ages 18 to 25, the report shows. Between 2011 and 2013, about 663,000 people said they had used heroin in the past year, up from 379,000 between 2002 and 2004…”

‘Gateway drugs’ are often blamed for leading people into heroin use – and, true enough, almost everyone who uses heroin uses at least one other drug (and most use several). Unsurprisingly, official surveys show that people abusing various other substances are more likely to be heroin addicts – twice as likely in the case of alcohol, three times as likely in the case of marijuana and fifteen times as likely in the case of cocaine.

However, all of those are overshadowed by a class of drugs commonly prescribed by doctors – opioid painkillers, abusers of which are forty times more likely to use heroin:

“About 12 million people have used prescription opioids, Jones said, and an estimated 16,000 people die of overdoses from them each year…

“Frieden called for more judicious use of the pain-killers by physicians who, he said, should seek other ways to manage some forms of chronic pain…”

It’s good to see the US authorities make the link between the country’s pill-pushing doctors and its heroin problem. If they want to bring the epidemic under control then they need crackdown on the legal trade in opiates as well as its criminal counterpart.

What are the wider lessons here?

I’ve argued before that a legal trade in a particular drug won’t necessarily displace the criminal trade in the same or similar substances. As demonstrated in America, the former can feed demand for the latter:

“With heroin an estimated five times less expensive than prescription drugs and widely available on the street, people with opioid addictions are turning to the drug in large numbers…” 

A second point is that regulation can’t always be relied on. American doctors are some of the most expensively trained professionals in the world, they are subject to elaborate regulatory safeguards, and harried by a legal profession that has the medical malpractice lawsuit down to a fine and well-rewarded art. And yet all of that has not prevented the massive over-prescription of opioids.

Thirdly, I think we need to recognise that the legal status of addictive substances is a less important issue that their availability. It should be obvious really, but the more available a substance, the easier it is to use and abuse it.