As the Vietnam War ended and the U.S. sought to limit supply from the main source country for heroin at the time, Turkey, the drug’s use subsided and was confined to poor urban areas for the remainder of the 1970s, 80s and most of the 90s. This would all change in the early 2000s in the wake of high-dosage prescription opiates –ultimately leading heroin to spread beyond the poor black neighborhoods into rural and suburban white areas, including the poor, middle-class and wealthy.
At the outset, on a dose-per-dose basis, heroin and drugs like Oxycontin were similar in price. But as the U.S. government began to crack down on the loose standards of pharmaceutical companies and doctors, prescription opiates became expensive and difficult to obtain and convert into crushable powder for snorting or liquefied for injection. An opiate-addicted U.S. population turned to cheaper and readily available heroin, courtesy of the Mexican drug cartels. Large cartels like the Sinaloa would distribute to major cities like Chicago and New York while the discreet diaspora of the young Jalisco Boys from Nayarit, Mexico were largely responsible for flooding suburban and rural areas in Appalachia, the Midwest, South and Southwest.
Heroin use has now doubled in the past decade. More concerning are the accuracy of the figures that most rely upon. Those from the National Survey on Drug Use and Health (NSDUH) from 2010 cite only 60,000 daily and near-daily users, but a more comprehensive model used by RAND (based on the ADAM-based projection models) places the figure around 1 million daily users. Most users started their heroin addiction with prescription opiates with 75% of heroin addicts already using pills, compared to 1960 when 75% began by using heroin.
Recent data also shows that those addicted to painkillers are eight times as likely to have used heroin in the past year, while those who used heroin in the last year were five times as likely to have used prescription pills. Pill addicts are 40 times more likely to be addicted to heroin. Yet, for heroin users, the pure form remains their drug of choice: 98% prefer the high from heroin over prescription opiates and 94% say that heroin is actually cheaper and easier to obtain. Given such evidence, it is hard to see how any legal regulatory regime that would make a drug like heroin –or crystal meth or cocaine– purer, cheaper and more available, would not significantly drive up use as legalization advocates argue.
Heroin in the U.S. has led to a spike in deaths from overdoses. Since 2010, heroin overdoses have more than tripled, killing more Americans than firearms. In severely impacted states like New Hampshire, the drug kills 6 times as many of its citizens more than guns. While some states like Vermont, New Hampshire and Ohio have reacted by passing laws to grapple with the growing heroin crisis, the federal government has been slow to react. Finally, in 2016, it passed bi-partisan legislation through the Comprehensive Addiction and Recovery Act (CARA), which seeks to address addiction and demand for prescription opiates and heroin. Specifically, the bill promotes best prescribing practices as well as a national education campaign and grants to address local drug crises. Additionally, a major law enforcement component prioritizes treatment programs over incarceration as well as training police on how to use naloxone for those who overdose.