Smack Madness


“A heroin epidemic of gigantic proportions exists in the United States, and is increasing at a runaway rate.”

That shrill warning was delivered in 1975 in a United Press International dispatch published in The New York Times, among other places. Citing a federal drug-use survey, the story said the number of heroin users in America had doubled over the previous six years, from 315,000 to 724,000.

The “demon drug” epidemic is back once more on the front pages. Following the overdose death of actor Philip Seymour Hoffman in New York on February 2, news outlets large and small, foreign and domestic, traditional and alternative, have declared a new “heroin epidemic” in the U.S.

A sampling:

  • “Scourge of Heroin Abuse in Vermont Mirrors National Epidemic,” ABC News, January 9
  • “Philip Seymour Hoffman Death Spotlights Heroin Epidemic,” Agence France Presse, February 3
  • “Heroin Ravages Rural America,” US News, February 7
  • “'We're All Paying': Heroin Spreads Misery Across America,' Associated Press, April 6

As proof, many of the stories cited an updated federal drug-use survey, which said heroin users had increased from 373,000 in 2007 to 669,000 in 2012—numbers that are about the same as those from the 1975 news story.

So is America in the midst of a real heroin epidemic? Or is this an example of periodic smack madness by the media?

“There's nothing new under the sun about heroin,” says Ernest Drucker, an epidemiologist associated with both Columbia University and John Jay College of Criminal Justice who has studied heroin use for four decades.

“It is what it is and what it has always has been: a drug used by about 1 million Americans each year.”

The smaller numbers from the federal government come from statistical extrapolations based on voluntary answers given in a broad national sampling. Drucker and other experts believe those numbers are low because people are reticent to admit heroin use, even in an anonymous survey.

While there is some ebb and flow in the figures over short terms, the long-term trend in heroin use has been fairly stable, Drucker maintains.

Oxy Is a Bigger Story

“It's a bloody merry-go-round,” adds Doug McVay, an activist who edits Drug War Facts. “This has all happened before.

“There is heroin all over the country, and there has been for decades. But America has this problem of generational forgetting.”

The truth, Drucker, McVay and other experts say, is more nuanced than most stories suggest.

They say any uptick in heroin abuse should be treated as a sidebar story to the much broader problem of abuse of prescription opioids, including the painkillers Oxycontin, Vicodin and Percocet.

Heroin and the opioids have become kindred drugs. They are fungible: If you are addicted to one, the other gratifies your biological jones.

“So here's what happens,” says George J Unick, a heroin researcher affiliated with the University of Maryland School of Social Work.

“Kids in the suburbs who have access to grandma's Oxycontin get addicted by crushing and snorting it. But when it's gone, they find it's expensive to buy and difficult to find. And they drive to the big city and buy heroin instead, which is cheap…

“So there's a direct causal link between the increase in opioid addiction and any increase in heroin addiction.”

Unick says he believes there has been a “bubble” increase in heroin addiction, though “epidemic is too strong a word.”

He says he is frustrated by the lack of up-to-date statistics that would prove or disprove the trend, an increasingly common criticism of the torpid pace of state and federal data collection and dissemination.

In one example, the latest data in the New York State Office of Alcoholism and Substance Abuse Services' primer on “Heroin Trends in NYS” comes from 2008.

“It doesn't do us any good to know what happened three years ago,” Unick says. “We just do a terrible job of collecting real-time data. We need to know what's happening now so hospitals can prepare to deal with it.”

To their credit, a number of news organizations have tried to quantify the presumed heroin epidemic, including the Associated Press in this April 5 story. But in most states, the freshest data is from 2012.

Scope of Heroin Problem

On March 23, The Christian Science Monitor reported that suburbs across the country—”from Los Angeles to Long Island, Chicago to New Orleans”—were struggling with heroin abuse by young adults.

That is a stretch. Experts agree that there have been surges of heroin use in places, though a lack of data makes it difficult to chart the breadth of the problem.

The scope of the heroin problem from a police perspective was addressed Wednesday at a Police Executive Research Forum “national summit” on drugs in Washington, D.C.

PERF said heroin was identified as the most “problematic” drug by 36 percent of respondents to a survey of 628 police departments. The figure was higher than any other drug, although respondents said there were more arrests for marijuana and meth. Three-quarters of respondents said they believe they've seen an increase in heroin overdoses.

Vermont became heroin ground zero on January 8 when Gov. Peter Shumlin dedicated his State of the State address to “a full-blown heroin crisis” there. Many hundreds of news stories about Vermont and heroin have been published.

But statistics from the state's health department call into question the media's focus there. Vermont counted 21 heroin overdoses in 2013, up from nine in each of the two previous years.

That's a 133 percent increase from one year to the next. But the numbers were a small fraction of the heroin overdose toll in other places. Connecticut had 257 heroin overdoses last year, and Virginia had 197. Cuyahoga County in Ohio, which includes Cleveland, had 195.

A disproportionate number of heroin users featured in recent news stories are white and live in the suburbs, even though the problem has festered for generations in inner cities.

“It's really tragic that it takes the deaths of celebrities and white people in the suburbs to get this kind of attention,” says Unick.

The five New England states turn up frequently in heroin stories. So does northern Kentucky and the Cincinnati metro area, as well as Chicago and nearby cities in Wisconsin and Indiana.

A number of random places on the East Coast have also been identified in stories as emerging hotbeds of heroin: the Jersey Shore, Staten Island, Frederick County, VA, and a collection of upstate New York venues, including the small cities of Binghamton and Kingston as well as rural Delaware County in the Catskill Mountains.

Heroin outbreaks have also been widely cited by the media in a dozen different Ohio cities, including Cleveland, Columbus and nearby Lancaster; Cincinnati and nearby Hamilton; Sandusky and Erie County; Toledo, Dayton, Lima and Steubenville.

In 2012, Ohio state health officials issued a report that said heroin seemed to be “falling out of the sky.”

How Crime Waves Happen

Heroin may or may not be falling like Biblical manna on the Buckeye State.

But specious crime trends have a storied news history, dating to muckraking journalist Lincoln Steffens' canny “I Make a Crime Wave” essay, published in his 1931 autobiography.

It begins:

“Every now and then there occurs the phenomenon called a crime wave. New York has such waves periodically; others cities have them; and they sweep over the public and nearly drown the lawyers, judges, preachers, and other leading citizens who feel that they must explain and cure these extraordinary outbreaks of lawlessness. Their diagnoses and their remedies are always the same: the disease is lawlessness; the cure is more law, more arrests, swifter trials, and harsher penalties. The sociologists and other scientists go deeper into the wave; the trouble with them is they do not come up.”

Questionable crime trends still crest in much the same way. An alarming news event (Hoffman's overdose, for example) prompts journalists to “localize” the story: Is the same thing happening here?

Lacking data, they often present a cluster of anecdotes as evidence. Police and health officials, aware that journalists are seeking such anecdotes, begin highlighting those cases for the media, and they are presented as further proof of a trend.

Politicians often jump in, passing laws to increase penalties on the crime at issue.

A few years later, when the data catches up with the anecdotes, researchers have often discovered that the trends were bogus—the latest moral panic springing from a perceived societal menace.

So far, only Louisiana seems to be moving toward tougher new laws for those who sell heroin. Most states, including Wisconsin, are focused on expansion of treatment.

Fearing the Needle

Evidence also calls into question the portrayal of heroin as a coast-to-coast problem.

The University of Maryland's Unick says his new preliminary research suggests that the Mississippi River roughly divides the nation's heroin supply in half. White-powder heroin, which can be snorted, smoked or injected, is prevalent east of the Mississippi. Black-tar heroin, typically injected by needle, prevails in the west.

The need for needles may be moderating the number of heroin-users in the west, he says.

“Sticking a needle in your arm is a very transgressive act, a very shocking act,” Unick says. “It's not something most people are willing to do.”

The nature of a heroin high also diminishes the potential pool of users, the experts say.

“It's a boring drug,” says McVay. “You end up dozing on the couch.”

“Heroin is not a club drug experience,” adds Unick. “Your first experience with a drug is often the most important. And for many first-time users, heroin will make you vomit and put you to sleep. It's not like Ecstasy.”

Antidote Is Positive Trend

Drucker, of Columbia and John Jay, says the alarmist tone about the heroin problem is part of a ceaseless trend as America lurches from one narcotics crisis to another: heroin to marijuana to cocaine to crack to meth to club drugs to prescription painkillers and back again to smack.

“One of the ideas you see in the sociology of this field is that there's always a need for a demon drug,” says Drucker, who has tracked narcotics trends since the 1970s, when he ran a methadone clinic in the Bronx. “Fill in the blank. The name changes over time, but we always fear one drug over all others. Right now, it's heroin again.”

But even those who disparage the inevitable cycles of drug demonization acknowledge that the latest appearance of heroin in sensational headlines has had one surprisingly positive outcome.

For years, advocates who view narcotics as an urgent health issue have called for expanded availability of emergency doses of Naloxone, an overdose antidote that essentially sucks opiates out of one's nervous system.

Doctors have long taken a proprietary position regarding the administration of Naloxone, available only by prescription and typically injected by needle. But most overdose victims are long gone by the time a doctor is in proximity.

On April 3, the U.S. Food and Drug Administration gave fast-track approval to a new auto-injector version of Naloxone and recommended that states loosen controls on the drug's availability.

About half of all states now have Naloxone access laws, and many others are considering legislation. As a result, police officers and other first-responders, as well as relatives of addicts, will have easier access to the drug.

“This is a great step forward, and it will save lives,” says Drucker.

Adds McVay, “The spread of Naloxone and the idea of treating this problem with a harm-reduction mindset is a good thing—maybe the one good thing coming from all the heroin silliness.”

David J. Krajicek is a contributing editor of The Crime Report and a veteran criminal justice journalist. A true crime author, he writes “The Justice Story” for the New York Daily News and is a 2014 fellow with the Fund for Investigative Journalism. He welcomes comments from readers.

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