Side Effects: Heroin Uptick Follows Crackdown On Prescription Drug Abuse
New York State’s recent efforts to crack down on prescription drug abuse—especially dangerously addictive opioids like hydrocodone and oxycodone—have been enormously successful. The results of the so-called I-STOP program are so good, in fact, that some are linking the state’s rapid uptick in heroin use to the lack of availability of prescription opioids—commonly known as Vicodin and OxyContin.
This theory was put forth during testimony at a series of bipartisan hearings currently under way across the state, conducted by the New York State Senate Task Force on Heroin and Opioid Addiction.
“I-STOP has been extremely effective, with the unintended consequence of increasing our heroin and opioid use,” said state Sen. Phil Boyle, the chairman of the task force, which has heard from police officers, doctors, rehabilitation specialists, addicts and parents of addicts, among others.
I-STOP stands for the Internet System for Tracking Over-Prescribing Act. The legislation created an electronic prescription monitoring program that requires doctors and pharmacists to check a patient’s controlled substance history before issuing a new prescription. The registry, which was initiated in June 2013, has dramatically decreased instances of “doctor shopping,” where a patient illegally obtains prescriptions from multiple practitioners, according to the state. Doctor shopping was down 75 percent, for example, the Department of Health says comparing the fourth quarter of 2012 to that of 2013.
The link between the success of the prescription monitoring program and the increase in heroin abuse will remain a theory, however, until the state can provide statistics the Department of Health says are not currently available.
Several factors contribute to the rapid rise in heroin addiction, according to some experts, with the decrease in the street supply of prescription opioids being just one of them.
“I-STOP has often been pegged, but I don’t know that it was the driving force,” said Dr. Jeffrey Reynolds, the executive director of the Long Island Coalition on Alcohol and Drug Dependence.
Reynolds said the trend toward greater heroin usage started several years ago, in part owing to an increased awareness by pharmacists, by consumers who are now destroying pills they don’t use, and by the high profile arrest of several doctors who were overprescribing. But a huge factor is price, he said, as people progress in their addictions from, say, two to eight pills a day.
“Vicodin is $40 a pill,” Reynolds said. “Then someone taps you on the shoulder and says, ‘Heroin is exactly the same drug, but it’s much cheaper.’ ”
Boyle echoed that sentiment. “In Long Island the price of OxyContin is $30 each, and heroin can be purchased for six dollars a bag,” he said. “So you know where the addict will go.”
Whether or not I-STOP is a major contributing factor, many medical and treatment professionals agree that heroin abuse is increasing at a dangerous rate, and addicts who want to quit are finding it nearly impossible to get insurance companies to approve the intensive inpatient treatments heroin addicts generally need. Instead insurers are pushing care to cheaper outpatient counseling, with no doctor to monitor the difficult detox process. The consequences can be deadly.
Dr. Michael Dailey, an emergency room physician at Albany Medical Center, said insurance carriers will not deem inpatient treatment a “medical necessity” until the addict has failed outpatient therapy.
“These people want help, but there is nowhere for them to go,” Dailey said. “If you have to fail outpatient rehab first, then you go back to the drug again. What if the next time you touch the drug you’re dead?”
Amy Sucich is the assistant director of counseling at the ambulatory detox program at St. Christopher’s Inn, a Putnam county shelter that has 174 beds for men in crisis. Many insurance companies are only allowing 10 days of treatments for addicts, which is not nearly enough, Sucich said. “It’s extremely frustrating,” she said. “I don’t know if medical necessity means you have to be dead.”
As a bigger percentage of her program’s patients are heroin addicts, there are more deaths from relapses, Sucich said.
"Years ago, we would hear of a few deaths a year,” she said of those who had gone through St. Christopher’s treatment process. “Now we hear of a few deaths a month.”
Addicts and their families are often willing to accept the outpatient therapy option, Reynolds said, because they want to believe a serious opioid addiction can be treated with relative ease. But that’s not usually the case. “The likelihood of success with just sitting with a counselor is not all that great,” he said. “I know of a dozen young people where it didn’t work who are now either incarcerated or dead of overdoses.”
“It’s like showing up at the ER with a limb ripped off,” Reynolds added. “But let’s put on a Band-Aid.”
While Reynolds feels the I-STOP program—which was spearheaded by Attorney General Eric Schneiderman and passed by the state Legislature in 2012—is a good first step to controlling drug abuse, he believes if lawmakers want to really make a difference, they should require insurance companies to “treat addiction in a way that is comprehensive and based in science.”
Reynolds and Dailey both find the state’s lack of data on opioid drug addiction inexcusable.
“We’ve gotten leadership from our attorney general: Eric Schneiderman is a real hero,” said Reynolds. “But there ought to be an equal force in public health. This state has no five-year plan for dealing with an opioid crisis.”
“Our data sucks, quite frankly,” said Dailey. “We don’t know as much as we should about the heroin problem. We just know it’s getting worse.”