Map of life expectancy at birth from Global Education Project.

Thursday, June 30, 2005

Shit is happening

And by shit, I mean shit -- junk, smack, H, horse, manteca, heroin, the cure for morphine addiction.

Trends are similar in much of the country, but I'll just concentrate on Massachusetts which has exceptionally good data. Annual hospitalizations for opioid related conditions (for overdoses, detoxification, complications of drug injection) started to bump up in 1997 and really took off in 2000. From about 8,000 in 1996, to 12,000 in 2000, to 18,000 in 2003. Fatal opioid overdoses went from 94 back in 1990 to 449 in 2002. (There's always a lag in this sort of data, but there is no reason to think these trends haven't continued.) We see the same sorts of trends in ER admissions for substance abuse related causes, and the other available indicators. (Here is some info from the Mass. Dept. of Public Health if you're interested.)

The really bad news? State spending on substance abuse treatment is declining. The Bureau of Substance Abuse services budget was cut from $86.9 million in 2001 to $72.5 million in 2003. Medicaid spending on substance abuse treatment bumped up from 2001 to 2002, but then it fell back again, as eligibility was restricted to throw many addicts off the rolls. Meanwhile, the overwhelming majority of the people we incarcerate have substance abuse disorders.

But our legislators are, as usual, idiots. The cost of substance abuse treatment is recovered 7 times over -- in large part, the savings are state funds, for health care, law enforcement, and imprisonment. (Cost Effectiveness and Cost Benefit Analysis of Substance Abuse Treatment: A Literature Review. The Lewin Group, 2002.)

I don't need to tell you that injection drug use -- which in Massachusetts almost exclusively means heroin -- is a principal means of transmission of HIV and Hepatitis C. And I assume I also don't need to tell you that, while the current heroin epidemic began in the late 1990s, it has been greatly exacerbated in the past two years, as cheap heroin has flooded the world following the fall of the Taliban.

Okay, apart from the availability issue, why is this happening? I can't confidently explain the trend, but I can tell you that the people who are most at risk for heroin addiction are people who don't see a better future for themselves. Quite a few addicts have other psychological problems, of various kinds, from personality disorders to post-traumatic disorders to psychoses, but most don't have other severe mental illnesses. Many are poor, uneducated, lack job skills, and certainly that's part of the risk package but there are exceptions.

What I am saying is that the problem is not that there are evil substances out there. Cervantes himself spent the better part of a week on a morphine drip once and believe me, the one thing I wanted more than anything else was to get off of that shit. But my pain was purely physical, and transient. Heroin addiction is a social problem, not a moral failing. And it's one we can solve. But it appears the country has other priorities.


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