Blog | Thursday, September 10, 2015

Stopping the spread of disease, overdose deaths from opioid use


Heroin use is soaring in the U.S., and with it deaths due to overdose. Many users begin with prescription pain killers but move on to heroin when the cost of getting high on pills becomes prohibitive.

Paralleling this trend is the increase in HIV and hepatitis C infections spreading through injection drug use.

But heroin and other opiate abuse is hardly new, and preventing death and disease from its use isn't rocket science. We Americans have insisted on treating substance use disorders as a criminal problem first and a medical problem—well, almost never. And we can't claim we don't know how to do better.

We've known for many years that needle exchanges prevent infections. We know that methadone treatment (a legal, oral replacement for heroin) reduces HIV infections. In southern Indiana and adjacent Kentucky, HIV and hepatitis cases have soared due to injection drug use. Needle exchange programs are getting off the ground slowly, and are actively opposed by lawmakers who think these programs encourage drug use.

This shows a profound ignorance of addiction. Addicts don't choose to inject based on the availability of clean needles; they inject using any damn thing they can because if they don't they get sick. There is no viable “moral hazard” argument here.

In addition to the spread of infection, IV drug use is leading to increasing number of overdoses, an approximate 200% increase in the last 10 years. Drug treatment programs can help reduce overdoses, but so can “overdose kits.” In some areas, law enforcement officers are carrying these kits, which are used to administer naloxone (Narcan), a medication that reverses the effect of heroin and other opioids. An auto-injector, similar to an Epi-pen, is now available by prescription. Evzio (Kaléo) won expedited FDA approval for this product, which is priced at about $60.

Given that naloxone has no abuse potential and is very safe, this should be made available without a prescription.

We've known for decades how to fight opioid overdoses and how to slow the spread of disease from IV drug use. What's taking us so long?

Peter A. Lipson, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. After graduating from Rush Medical College in Chicago, he completed his internal medicine residency at Northwestern Memorial Hospital. This post first appeared at his blog at Forbes. His blog, which has been around in various forms since 2007, offers "musings on the intersection of science, medicine, and culture." His writing focuses on the difference between science-based medicine and "everything else," but also speaks to the day-to-day practice of medicine, fatherhood, and whatever else migrates from his head to his keyboard.