Quality & Science

Jeremiad: Heroin Deaths Go Unnoticed

by Mark Publicker, MD, FASAM | January 29, 2014

Philip Seymour Hoffman's tragic death puts a face on what has been ignored. A few weeks ago, there were 22 heroin overdose deaths in Pittsburgh that went unreported. When a story was finally published several days late, finding it required quite a bit of scrolling through the online paper, and the content focused on impersonal facts rather than the underlying issues that are making heroin deaths commonplace.

Ironically, the "brand" name for this lethal heroin in Pittsburgh is "Theraflu" - though I am very sure that the public eye does not approximate flu deaths with those caused by heroin. Surely, had the 22 Theraflu deaths been caused by the flu we would have seen a major news story. While searching for reports of overdose, I confirmed this theory by easily finding a flu-related death reported in Allegheny County.

The Pittsburgh Theraflu deaths and their lack of coverage are not unique; there were also over 20 deaths in Rhode Island in the first two weeks of January. Deaths from overdoses have quadrupled in Maine between 2012 and 2014 and doubled in Vermont. None of the parents of my patients have slept soundly in years, kept awake by fear of that midnight phone call.

These deaths are preventable. ASAM supports the increased availability of naloxone to anyone in the position of being a first responder (see our Public Policy Statement).

The nation is late awakening to the heroin epidemic, just as it was late to discover the prescription drug epidemic. Other than some hand-wringing, nothing has been done or likely will be done. In Maine, where I live, the response has been to criminalize addiction. The state has already severely limited access to care, both to behavioral as well as medication therapies. Coverage and payment for both outpatient and residential therapies has been cut. A two-year retroactive limitation for buprenorphine treatment is into its second year. And on January 1 ‘non-categoricals’ lost their Medicaid coverage (single, no dependent children). Our patients on buprenorphine and methadone have been abruptly thrown into withdrawal, risking relapse, illness and death.

ASAM’s Patient Advocacy Task Force (PATF) has taken the lead in establishing the effectiveness and cost-effectiveness of all FDA-approved medications for the treatment of opiate addiction. And yet, the nation continues to only treat the symptoms of this metastatic cultural cancer, not the disease.

Opiate addiction is a chronic brain disease. We have the proven-effective opiate addiction chemotherapy that is a necessary part of the holistic treatment of this disease. The ultimate prevention for overdose deaths is treatment. And treatment is contingent on insurance coverage. Because of stigma and fear our patients and their families are often silent in demanding access to treatment. The PATF has created the advocacy tools. Use them and speak out loudly for our patients.