THE RISE OF THE OPIOID EPIDEMIC AND LAW ENFORCEMENT/FEDERAL RESPONSES
BY TODD ROSSBACK | FBINA #271
The opioid epidemic sweeping our nation did not happen overnight. Its origins reach back three decades to efforts to manage and relieve pain through pharmaceutical solutions. A large factor attributed as a root of today’s crisis is the rise of prescription drug addiction and abuse. Most notably, Purdue Pharma’s OxyContin was overprescribed to patients by doctors targeted by the company’s extensive marketing campaign. Since 1996, when the drug was brought to market, Purdue Pharma downplayed the addictive nature of this ‘wonder drug’ with marketing statements such as, “less than 1% of patients become addictive” (Frontline, 2016). In 2007, the company admitted to charges of fraudulent marketing following a four-year federal investigation, paying $600 million in fines and settlements (Frontline, 2016).
According to the Centers for Disease Control (2018), fifty-three thousand Americans died from opioid overdoses in 2016, exceeding car crash and gun violence deaths. In 2017, opioids killed roughly 142 Americans each day (Office of National Drug Control Policy [ONDCP], 2017). Research suggests a variety of factors have contributed to the rise of opioid abuse, including: the philosophy of pain management and associated attempts to alleviate suffering through pharmaceutical drugs, the over-prescription of pain medications like OxyContin, shame felt by predominantly suburban whites whose addiction falls outside traditional middle class social norms, and passing of addiction from parents to children, called neonatal abstinence syndrome (ONDCP, 2017; Frontline, 2016; House of Representatives, 2015).
In 2012, the problem of prescription drug abuse had reached epidemic proportions, as evidenced by growing federal government attention and strategies devoted to address prescription drug abuse. On March 7, 2012, the House of Representative subcommittee on crime, terrorism, and homeland security held hearings to review the prescription drug epidemic in America. These hearings reveal the extent to which this crisis had grown, with testimony and written statements asserting that:
- 254 million prescriptions for opioids were filled in the U.S. in 2010, which is “enough painkillers to medicate every single American adult around the clock for a month” (House of Representatives, 2012).
- The original purpose for OxyContin was to only be prescribed to help patients in the last stages of cancer or other severe illnesses, but OxyContin and other generic oxycodone drugs are being prescribed for less severe reasons, which has expanded the availability of the drugs and potential for their abuse (House of Representatives, 2012).
Simultaneously, while prescription drug abuse was reaching epidemic proportions, the last two decades have also witnessed an expansion of the epidemic from prescription drugs to street opiates like heroin.
The evolution of prescription drug and heroin epidemics has occurred for a multitude of reasons, including both push and pull factors. Among the pull factors is the demand for opioids from people who have become addicted to prescription drugs to manage pain. Efforts to address prescription drug abuse have focused on educating prescribers on the risks of prescribing opioids and expansion of programs for monitoring prescription drugs (ONDCP, 2015). While these efforts have been successful in slowing prescription opioid overdoses, the success in reducing prescription opioid overdoses has largely been offset by easy access to cheaper, more potent, and less controlled opioid sources, such as heroin and synthetic opiates like fentanyl.
Among the many push factors, the influx of heroin from Mexican drug cartels in the last two decades has produced an illicit market flooded with cheap and available heroin. As Sam Quinones, author of Dreamland, stated on Frontline (2016), “the cartels were the first to realize that the pill market was essentially priming the heroin market.” This is supported by a statement from the National Institute on Drug Abuse that:
Mexican heroin production increased from an estimated 8 metric tons in 2005 to 50 metric tons in 2009—more than a six-fold increase in just four years. Domination of the U.S. market by Mexican and Colombian heroin sources, along with technology transfer between these suppliers, has increased the availability of easily injectable, white powder heroin. In a recent survey of patients receiving treatment for opioid abuse, accessibility was one of the main factors identified in the decision to start using heroin (House of Representatives, 2012).
As a result of persistent demand for opioids, combined with the inability to obtain these drugs through other means, the number of deaths from illicitly manufactured and supplied heroin and synthetic opiates has skyrocketed. The National Center for Health Statistics reported that overdose deaths involving opioids rose from 28,647 in 2014 to 33,091 in 2015, with overdose deaths attributed to heroin increasing 23 percent and overdose deaths due to synthetic opioids increasing 73 percent (ONDCP, 2015).
In 2015, the House of Representatives (2015) held another hearing to address America’s growing heroin epidemic. This hearing revealed that:
- Increased demand for, and use of heroin is being driven by both increasing availability of heroin in the U.S. market and by individuals with opioid use disorders using heroin (House of Representatives, 2015).
- The majority of new users come to heroin with experience as nonmedical prescription drug users, while previously, heroin had largely been confined to urban centers with large heroin using populations (House of Representatives, 2015).
- Individuals with opioid use disorders who have recently switched to heroin are at high risk for accidental overdose because unlike with prescription drugs, heroin purity and dosage amounts vary, and heroin is often cut with other substances like fentanyl (House of Representatives, 2015).
The magnitude of the opioid epidemic has driven this problem to the forefront of many law enforcement agency’s concerns. As part of the House of Representatives (2015) hearings, the DEA reported the percentage of law enforcement respondents who reported heroin as the greatest drug threat in their area had grown from 8 percent in 2007 to 38 percent in 2014.
Several approaches have been attempted across the U.S. to deal with this vexing social issue. The default option for handling opioid use and associated crimes like theft, trespassing, and vagrancy is arrest and incarceration. This approach, however, has been insufficient alone in solving the problem. Arrest, incarceration, and release results in a vicious cycle of offender recidivism without solving the underlying problem. Lieutenant Leslie Mills of Washington Department of Corrections captures the essence of the problem, stating:
We could not incarcerate these people or arrest our way out of the problem. You want to arrest a person, they’d be in jail for 20-30 days. They would get sober. They would start using again, we’d continue to arrest them (Frontline, 2015).
As a result, local law enforcement agencies have approached opioid addictions with many different non-traditional responses, including:
- Routing drug cases through state drug courts rather than traditional criminal courts (ONDCP, 2017).
- Equipping law enforcement officers with naloxone to provide immediate life-saving means to those arriving to the scene of drug overdoses (ONDCP, 2017).
- Law Enforcement Assisted Diversion (LEAD) and other diversion programs focused on treatment over incarceration (Frontline, 2016).
- Alternate prescription drug treatment programs, such as methadone clinics or prescribing suboxone (Frontline, 2016).
Beyond the local level, the federal government has also been actively involved in developing strategy and policy to counter the opioid epidemic.
Starting in 2010, and updated in 2016, the Obama Administration published a National Drug Strategy that described the administration’s efforts to address the opioid epidemic by reducing illicit drug use and its consequences in the U.S. (ONDCP, 2016). Of the many goals of this strategy, the most pertinent to law enforcement were:
- Preventing drug use in our communities.
- Breaking the cycle of drug use, crime, and incarceration.
- Disrupting domestic drug trafficking and production.
Upon entering office, President Trump has taken immediate steps as well to address the opioid crisis. In 2017, the president appointed Governor Chris Christie to lead a commission to review the history of how the opioid epidemic came about and provide recommendations. Among the commission’s recommendations (ONDCP, 2017), those pertaining to law enforcement include:
- Reduce the number of illicit opioids available on the streets.
- Expand access and administration of naloxone.
- Disrupt the illicit fentanyl supply.
- Protect first responders from harmful effects resulting from exposure to fentanyl and other synthetic opioids.
- Encourage drug courts and diversion programs, including establishing federal district drug courts.
- Enhance drug enforcement efforts aimed at reducing the flow of illicit drugs into the country and increasing investigations of transnational criminal organizations, violent gangs, and drug traffickers.
Because this epidemic did not reach its current proportions overnight, it will not be resolved by any single measure or level of response. The resolution of the opioid crisis will only result from the collaborative effort of local and state law enforcement, working in partnership with local communities and treatment resources, and acting in concert with the overall strategy and policies developed by the federal government.
Center for Disease Control. Retrieved 16 February 2018, from https://www.cdc.gov/drugoverdose/index.html.
Gaviria, M. (2016). Chasing heroin [Video]. Frontline. Retrieved 16 February 2018, from https://www.pbs.org/wgbh/frontline/film/chasing-heroin/
Hearing before the Subcommittee on Crime, Terrorism, and Homeland Security of the Committee on the Judiciary, House of Representatives. One Hundred Twelfth Congress, Second Session. Serial No. 112-95. March 7, 2012. Washington, DC: U.S. Government Printing Office.
Hearing before the Subcommittee on Crime, Terrorism, and Homeland Security of the Committee on the Judiciary, House of Representatives. One Hundred Fourteenth Congress, First Session. Serial No. 142-45. July 28, 2015. Washington, DC: U.S. Government Printing Office.
National Institute on Drug Abuse. (2018). Retrieved on 16 February 2018, from https://www.drugabuse.gov/publications/drugfacts/heroin.
National Institute on Drug Abuse. (2018). Retrieved on 16 February 2018, from https://www.drugabuse.gov/publications/research-reports/relationship-between-prescription-drug-abuse-heroin-use/introduction.
National Institute on Drug Abuse. (2018). Increased drug availability is associated with increased use and overdose. Retrieved 16 February 2018, from https://www.drugabuse.gov/publications/research-reports/relationship-between-prescription-drug-abuse-heroin-use/increased-drug-availability-associated-increased-use-overdose
Nolan, D. & Amico, C. (2016). How Bad is the Opioid Epidemic? Frontline. Retrieved 16 February 2018, from https://www.pbs.org/wgbh/frontline/article/how-bad-is-the-opioid-epidemic/
Office of National Drug Control Policy, White House. (2016). Prescription Opioid Misuse and Heroin. Retrieved on 16 February 2018, from https://obamawhitehouse.archives.gov/ondcp/policy-and-research/ndcs/key-issues/opioids.
Office of National Drug Control Policy, White House. (2016). National Drug Control Strategy. Retrieved on 16 February 2018, from https://obamawhitehouse.archives.gov/ondcp/policy-and-research/ndcs.
Office of National Drug Control Policy, White House. (2017). President’s Commission on Combating Drug Addiction and the Opioid Crisis. Retrieved 16 February 2018, from https://www.whitehouse.gov/ondcp/presidents-commission/.
Quinones, S. (2015). Dreamland: The true tale of America’s opiate epidemic. New York, NY: Bloomsbury Press.
U.S. Department of Health and Human Services. (2018). About the U.S. opioid epidemic. Retrieved 16 February 2018, from https://www.hhs.gov/opioids/about-the-epidemic/index.html
About The Author:
Captain Todd Rossbach was commissioned into the Regular Army in 2008 where he continues to serve as a Military Police Officer. He is currently serving as a Small Group Leader for the Military Police Captains’ Career Course at Fort Leonard Wood, Missouri. His education includes: a Bachelor of Arts in History and Political Science from the University of Minnesota; a Master’s degree from Webster University in Business and Organizational Security Management; and graduation from the FBI National Academy, Session #271.
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