Pot Matters: Heroin Drives the Harm Reduction Learning Curve

Heroin has been back in the news lately, actually throughout much of 2015.

It’s return to prominence follows heroin’s return to the market—there’s more of it available than in the past, and it’s cheaper than ever. Use is increasing, and with increased use, there has been increased problems with addiction and, sadly, increases in deaths from overdose. 

Something else, though, has been increasing as a result—an understanding and appreciation of the failure of the drug war approach and the need to replace it with public health policies based on the principle of harm reduction.

One of the flash points in the reappraisal of the heroin problem was a viral video of remarks by presidential candidate Chris Christie on the subject of addiction. Christie was widely praised for suggesting, as described by Jonathan Capehart in the Washington Post, “that drug addiction is a disease and we should treat it as such” and “that those suffering from addiction deserved compassion and help, not stigma and shame.”  Christie was speaking about addiction to tobacco and prescription painkillers, but his remarks apply across the board to all drug addiction.

In the last several years, Americans have been increasing their use of prescription painkillers, and many have subsequently developed serious dependency problems. Many have migrated from prescription painkillers to heroin, which is now more widely available than ever and less expensive than prescription drugs. 

According to an April 2015 Heroin Threat Assessment by the DEA, while once primarily used by urban populations, “heroin use in the 1990s and 2000s spread to users in suburban and rural areas, more affluent users, younger users, and users of a wider range of races.” 

The growing diversity in the population of heroin users has increased attention and concern over recent increases in use and overdose deaths. Now that heroin is affecting more demographic groups, both it—and addiction—are being re-examined by politicians, community leaders and voters. This re-examination has opened up many minds to the failure of drug war policies and created a new receptiveness to the use of treatment, rehabilitation and other public health approaches with respect to public policy.

There are other lessons to be learned beyond the need to look at drug addiction as a disease and not a crime. Consider these reports from the DEA’s Threat Assessment:

• In 2013, there were three times as many overdose deaths from heroin (8,620) as in 2010.
• Heroin seizures have increased 81 percent from 2010 (2,763 kilograms) to 2014 (5,014 kilograms).
• The average seizure of heroin has increased from 0.86 kg in 2010 to 1.74 kg in 2014.
• The average retail-level purity of heroin has increased from 10 percent in 1981 to between 30 and 40 percent since the 1990s.
• The average price of a pure gram of heroin has decreased from $3,260 in 1981 to $622 in 1999 and has remained near $500 in recent years.
• The user population for heroin is “growing aggressively.” The number of people using heroin nearly doubled between 2007 (161,000) and 2013 (289,000), according the annual National Survey on Drug Use and Health.

It’s commendable that Christie and others are beginning to understand that drug addiction is a disease rather than a crime. But there is more to this learning curve. What do the facts above tell us about prohibition?

Look at the arguments being made for why marijuana should not be legalized. Opponents of legalization frequently agree that cannabis users should not be sent to jail and often advance the idea that users should be referred to drug treatment. Indeed, this is often a requirement of probation as a sanction for a marijuana possession arrest.  

But what come’s next? The illegality of marijuana is necessary to keep the price of cannabis high, to reduce supply and to keep the user population from increasing.

Advocates of prohibition argue that it keeps drugs expensive and keeps drug using populations from increasing. The facts about heroin’s resurgence contradict these claims.  Despite harsh criminal laws, heroin is cheaper, more available and used by more people than in recent history. Furthermore, validating Richard Cowan’s Iron Law of Prohibition, heroin is now considerably more potent.

Politicians in both political parties are reassessing their drug war positions regarding heroin use and treatment. They’re on the learning curve, and that’s a good thing for patients and a good thing for the country. But there is more to this than acknowledging that drug addiction is a disease not a crime. 

The next step involves understanding that prohibition not only fails to protect the public, it also contributes to drug-related public health problems that communities across the nation so urgently desire to resolve.

The DEA’s Heroin Threat Assessment not only presents important facts about the modern heroin problem, it also presents important facts that threaten prohibition and the continuation of the War on Drugs. This matters when it comes to addressing the heroin problem, but also when it comes to addressing opposition to marijuana’s legalization.

Criminal penalties do not restrict or reduce the availability, potency or use of drugs. The facts about heroin prove that drug control, by way of prohibition, is not only a myth but also a sad and tragic folly.

(Photo Courtesy of EMCDDA)