The chart above shows the total number of U.S. overdose deaths involving heroin from 2002 to 2015 with a 6.2-fold increase in the total number of deaths over the period. Automobiles killed around 32,000 people last year or a little over 2x that of heroin overdoses. When adding non-methadone opioids (illicit fentanyl) overdose that number surged to 20,000, a 33% YoY jump on 2014 and 5.9x 2002. Why is it happening? The problem is that for many prescription painkiller users is that once their bottle ends, the addiction doesn’t stop meaning many switch to heroin to get the same ‘opioid’ hit.
Looking at deaths caused by all illicit drugs, we are looking at 50,000, more than double the level of 2002. So illicit drugs killed almost as many as car accidents and gun murders combined in 2015.
Overdose deaths from taking pain relievers has also been shockingly high. Drugs such as OxyContin which contain opioids have also found their way to creating problems in the US armed forces.
The US Government has recorded stats on the use of illicit drugs by active duty military personnel. While still off the highs (no pun intended) of the 1980s, since the 1990s the trend has been climbing. The chart above shows the usage as a % of total active personnel. The USAF has the lowest incidence of drug abuse. Illicit drug use includes marijuana, cocaine, hallucinogens, heroin, methamphetamine, inhalants, GHB/GBL and prescription drug misuse.
Excessive use of pain relievers make up a large proportion of illicit drug use. Oxycodone is one of the more common type of opiate pain killer and it is highly addictive. In 2010, the US Food and Drug Administration (FDA) required the formulation of OxyContin be changed to make it harder to become addicted to.
A policy of zero tolerance for drug use among DoD personnel is likely one reason why illicit drug use has remained at a low level in the military for 2 decades. The policy was instituted in 1982 and is currently enforced by frequent random drug testing; service members face dishonorable discharge and even criminal prosecution for a positive drug test.
According to the National Institute on Drug Abuse (NIDA), “Suicide rates in the military were traditionally lower than among civilians in the same age range, but in 2004 the suicide rate in the U.S. Army began to climb, surpassing the civilian rate in 2008. Substance use is involved in many of these suicides. The 2010 report of the Army Suicide Prevention Task Force found that 29 percent of active duty Army suicides from fiscal year (FY) 2005 to FY 2009 involved alcohol or drug use; and in 2009, prescription drugs were involved in almost one third of them.”
As opioid overdoses rise, companies such as Adapt Pharma have seen sharp rises in the sales of products like Narcan (Naloxone) which basically revives victims from the dead. Narcan publicizes its price that is even insured meaning one can overdose and revive with a $10 co-payment.
“94% of insured lives in the US have coverage for NARCAN® Nasal Spray*. According to IMS Health, nearly three quarters (74%) of prescriptions for NARCAN® Nasal Spray have a co-pay of $10 or less**. For those paying cash, ADAPT Pharma has partnered with retail pharmacies to reduce out of pocket costs (Retail is $62.50/dose)…To expand community access, NARCAN® Nasal Spray is available to all qualified group purchasers for $37.50 per 4mg dose ($75 per carton of 2 doses). This pricing is available for all Qualified Group Purchasers, such as first responders (EMS, Fire Department, Police), community organizations and Departments of Health, regardless of size. This pricing represents a 40% discount off the Wholesale Acquisition Cost (WAC) of $125 per carton.”
Price hikes have been a feature of naloxene. As of January 2015, Amphastar’s version of naloxone was up to $41 a dose, according to Fierce Pharma, a pharmaceutical industry news website. That follows a price increase from $17 to $33 a dose back in October 2014, according to data provided by Truven Health Analytics. So not only is volume spiking, so is price. Walgreens has expanded the availability of prescription-free naloxone to 33 states.
West Virginia health officials are responding to opioid overdoses by distributing more than 8,000 kits with Naloxone that can get people breathing again if administered in time. Money for the kits comes from a $1 million federal grant to West Virginia, which has had the nation’s highest rate of overdose deaths at 41.5/100,000 people.
Local emergency medical services agencies in West Virginia administered 4,186 doses of Naloxone in 2016, up from 3,351 the year before and 2,165 two years ago and that data doesn’t include uses by hospital emergency departments, urgent care centers, first responders and family members.
So layered on top of poverty, food stamps and deteriorating employment we now seem to have an America that is increasingly becoming high on opioids. I am working closely with a company which is developing the antidote and progress is good. It will knock out the addiction even including ice in Australia. Tests are promising.