Stemming the spike in heroin deaths

Health officials still aren't certain what is causing the alarming uptick in heroin overdoses that has occurred across Maryland recently. But it would be especially disturbing if the trend turns out to be an unintended consequence of state efforts to crack down on prescription drug abuse and fraud. The concern is that people addicted to prescription drugs are now finding them harder to get, and as a result may be turning to illegal narcotics like heroin, which are cheap and relatively easy to obtain on the street but which pose even greater public health and safety risks.

It's too soon to say whether the two developments are related, and if so what can be done to remedy the situation. Obviously, the solution isn't to simply allow people to continue abusing prescription drugs so they won't become heroin addicts. But authorities will need more precise data before they can develop a plan that balances the dangers of both heroin and prescription drugs in a way that reduces overall addiction. In the meantime, they must carefully monitor the communities most threatened by overdose deaths, with an eye toward identifying as many prescription drug addicts at risk of heroin abuse as possible and steering them toward treatment.

Last week, police in Ocean City, Maryland's largest beach resort, reported an "overwhelming" increase of nearly 550 percent in drug cases compared to last year — largely, they suspect, as a result of tougher enforcement of laws against prescription drug fraud and abuse. Officers there recently launched a weeks-long undercover investigation into the local drug trade that led to the indictments of more than 20 people on felony drug charges and the seizure of more than 100 bags of heroin.

Moreover, in recent months state health department officials have detected an alarming change in the pattern of reported drug overdoses that result in hospitalization or death. For years, overdoses among prescription drug abusers had been steadily trending upward, while deaths from heroin overdoses fell. The surge in prescription drug abuse was what initially prompted public health and law enforcement agencies to put more resources into clamping down on people suspected of fraudulently obtaining drugs from hospitals and clinics, and the effort appeared to be succeeding.

But starting this summer, the trends may have reversed themselves. According to a health department report released Friday, fatal heroin overdoses are up statewide by 41 percent this year — including an astounding 80 percent increase on the Eastern Shore — while cases involving prescription drugs fell by 15 percent. Disturbingly, there was evidence that more younger people may be turning to illegal narcotics like heroin as a substitute for prescription drugs that were no longer obtainable. That's what suggests the spike in heroin deaths may be, at least in part, a side-effect of the crackdown on prescription drug abuse. Nor is the problem confined to Maryland; other states have reported similar increases in heroin overdoses as well.

In 2011, the Maryland General Assembly passed legislation setting up a computerized system that allows hospital emergency room doctors and pharmacies to instantly check whether patients asking for pain medication have made similar requests elsewhere, how often they did so and what drugs they received. While the system still isn't fully up and running, it has led to many more physicians declining to write pain prescriptions for people they suspect are likely to abuse them. That's a good thing, but it needs to be taken further.

Joshua M. Sharfstein, secretary of the Maryland Department of Health and Mental Hygiene, says his department is already working to develop overdose-prevention plans tailored to the needs of the local communities most affected by the problem. The aim is to encourage health care providers to look for signs of potential prescription drug abuse and remind people that treatment is available rather than simply turning them away. Stressing alternatives to addiction may be the most effective approach hospitals and clinics can take in communities where heroin overdoses are on the rise.

Maryland has made significant progress toward reducing drug use, and an effective anti-drug strategy doesn't require picking between the twin evils of addiction to illegal narcotics and prescription drug abuse. Both are problems that must be managed if we are to minimize the terrible toll they exact on those victimized by addiction and society as a whole.

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