GateHouse: Overdose the leading cause of injury death

Matthew T. Mangino
GateHouse News Service
July 11, 2014
Vermont Gov. Peter Shumlin delivered his annual State of the State address in January, and according to Rolling Stone Magazine, Shumlin devoted his entire speech to what he perceived as the state’s biggest threat — heroin addiction.

“In every corner of our state, heroin and opiate-drug addiction threatens us,” he said. “What started as an OxyContin and prescription-drug-addiction problem in Vermont has now grown into a full-blown heroin crisis.”

Less than a month later, Oscar winning actor Philip Seymour Hoffman died of a heroin overdose in New York City.

Deaths from drug overdose have been rising steadily over the past two decades and have become the leading cause of injury death in the United States, according to the Centers for Disease Control and Prevention. Every day in the United States, 113 people die as a result of a drug overdose.

To add some perspective, the CDC documented 38,329 fatal drug overdoses in the United States in 2010. That same year, 15,529 people with an AIDs diagnosis died and 11,078 people were murdered with a firearm.

These deaths are not occurring in filthy “drug houses” where junkies share dirty needles to get high. Fatal overdoses from opiate prescription medications such as oxycodone, hydrocodone, and methadone have quadrupled since 1999, accounting for an estimated 16,651 deaths in 2010.

“It is pretty amazing. Many people are focusing on the return of heroin and saying, ‘It’s all the fault of criminals.’ You’ve got to remember, 4 in 5 of people today who start using heroin began their opioid addiction on prescription opioids. The responsibility doesn’t start today with the stereotypical criminal street dealer,” Keith Humphreys, one of the nation’s leading addiction researchers from Stanford University told the Washington Post.

Why so many overdoses?

Humphreys says “overdose occurs because [addicts] had a loss of tolerance.” Tolerance is lost by the “consumption of other substances. This is particularly true of alcohol, which seems to lower the body’s ability to tolerate opiates.” Humphreys goes on to say, “Most of what we call “opiate overdoses” are really polydrug overdoses: alcohol and heroin, alcohol and oxycontin, benzodiazepine, alcohol and Vicodin, combinations like that.”

Robert S. Hoffman an emergency physician at NYU Langone Medical Center and Bellevue Hospital wrote in a New York Times op-ed earlier this year, “[T]hat up to 85 percent of users overdose in the presence of others.” As a result, an opportunity exists “for friends, family and other non-health care providers to intervene.”

Naloxone is an antidote to heroin overdose. The antidote has been in clinical use for more than 30 years. According to Hoffman, it can be administered via needle or as a nasal spray, and it works by displacing heroin from its receptors in the brain and rapidly restoring the overdose victim to consciousness and normal breathing.

Hoffman writes, “Some people might argue that the widespread distribution of a safe, effective and inexpensive antidote might actually encourage drug use. But that’s like suggesting that air bags and seatbelts encourage unsafe driving.”

Seventeen states and the District of Columbia have amended their laws to increase access to naloxone, resulting in over 10,000 overdose reversals since 2001, reported the U.S. Department of Justice.

This spring, U.S. Attorney General Eric Holder called the rise in overdose deaths from heroin and other prescription pain-killers an “urgent public health crisis.”
“When confronting the problem of substance abuse, it makes sense to focus attention on the most dangerous types of drugs. And right now, few substances are more lethal than prescription opiates and heroin.” Holder said.

One remedial measure recommended by Holder — encourage first responders to carry naloxone.

Matthew T. Mangino is of counsel with Luxenberg, Garbett, Kelly & George P.C. His book “The Executioner’s Toll, 2010” was recently released by McFarland Publishing. You can reach him at www.mattmangino.com and follow him on Twitter at @MatthewTMangino.
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