Essay from America: With 47,000 deaths last year drugs are an election issue

Donald Trump’s plan to drug-proof America with his wall along the Mexican border seems a little remote way up in the north-eastern state of Pennsylvania, writes Caroline O’Doherty.

Heroin use has reached crisis levels here, say law enforcement agencies which counted more than 3,500 drug overdose deaths here last year — more than the annual death toll from road crashes in the state.

The number was up almost a third on the 2014 figure and to put it into a familiar context, it’s a death rate that runs four times higher than Ireland’s.

All but four of Pennsylvania’s 67 counties recorded deaths, an alarming new trend in a largely rural state where previously only the city areas had notable fatalities.

Even with deaths nationally on the rise, 47,000 last year, Pennsylvania’s death rate is about 50% above the norm. In an attempt to save lives, police and other emergency personnel are being issued packs of Naxalone, a medication that, if administered fast, can block the effects of heroin and other opioids on the brain and respiratory system and restore breathing.

Even family members and friends of people with heroin and opioid addiction can get Naxalone from their doctor and keep it handy in case they have to administer it in an emergency.

A good samaritan law has also been introduced in some parts to grant immunity from prosecution to a drug user who raises the alarm for a fellow drug user who has collapsed in their company as it was feared some people fled or delayed getting help for fear of arrest. Patrick Trainor, one of Pennsylvania’s 140 Drug Enforcement Administration agents, says heroin reaches the US through Mexico, where previously Afghanistan was the main source.

“You can always do with more security, but to be honest, it’s only part of the solution,” he says. The rise of heroin use in Pennsylvania, as in other parts of the US, is traced not to drug cartels in Mexico, but to corporate America’s big pharmaceutical industry and a discredited health profession.

“What’s really unique here is that the feeder system for the heroin epidemic now is prescription opioids,” says Trainor.

“People are receiving very strong prescriptions for drugs like Percoset and Oxycontin for very simple surgical procedures. These are very effective drugs to treat pain but unfortunately they’re very addictive and very often when the addiction kicks in and the legitimate script runs out, people start buying these pills illegally.

“Sometimes they can pay up to $40 for a pill. Some people might have to take eight pills a day so if you do the math, you’re talking about an addiction that costs $300 to $400 (€270 to €360) a day at which point it’s a simple transition from Oxycontin to a drug like heroin which you can buy as cheap as seven bucks for a bag,” he says. The big problem over the last year or two is that increasingly, the heroin is mixed with Fentanyl, a powerful opioid used as part anaesthesia that is 50-100 times more powerful than morphine.

Little more than a pinch of pure Fentanyl can kill, and that’s exactly what it’s doing in Pennsylvania. Even worse is what’s coming down the line.

“Bad as things are now, they’re probably going to get a lost worse when Carfentanil hits the area. It’s an elephant tranquiliser that’s 10,000 times stronger than heroin and we’ve already seen a few cases of it,” says Trainor.

Perversely, he says it’s good for a drug dealer’s business when a customer dies. “There is no greater endorsement for a drug dealer than if his product kills somebody. It’s counter-intuitive, it makes no sense, but it puts the word out that his product is potent.

“Unfortunately the attitude among heroin users is, if I’m an experienced heroin user I have the tolerance that it won’t kill me so there’s a lot of bravado associated with it,” he says.

Fentanyl and Carfentanil are sourced mainly from China, so no wall with Mexico is going to break that supply chain. However, equally important, says Trainor, is clamping down on the doctors who over- prescribe in the first place and those who keep the addictions going by charging handsomely for pills and writing unnecessary prescriptions.

“This epidemic that’s killed ballpark 47,000 people here in the States last year came from our healthcare system. That’s what’s so appalling to us.

“We have a lot of bad doctors. We call them white coat drug dealers. They’re different from the guy standing on the corner selling heroin with a gun stuck in his waistband. These guys have a licence to prescribe so they have the badge of respectability,” he says.

Oxycontin is only prescribed in Ireland as a last resort, in cases of severe unresolved pain or where a patient has intolerance to other alternatives, but in the US it is common that it earned the nickname hillbilly heroin.

However, with 76,000 doctors and other medics licenced to prescribe in Pennsylvania alone, policing them is a massive undertaking. Trainor says medical schools and teaching hospitals are taking on board the need to educate doctors better about responsible prescribing.

The Drug Enforcement Administration, which has authority over pharmaceutical companies, is going to impose restrictions on production of certain drugs to keep volumes at what is needed only for legitimate medical reasons, and to dampen some of the aggressive marketing the firms put behind their products.

Trainor is speaking after a ‘town hall’ meeting — a public forum — taking place in the auditorium of the main hospital in Centre County, a mainly rural county which has seen 16 drug overdose deaths so far this year.

It’s a measure of how seriously the issue is taken that it’s the fourth such town hall on the subject here since the summer and the organisers, the Centre County Heroin/ Opiate Prevention and Education Initiative, has managed to gather representatives of the FBI, the Drug Enforcement Administration, the US Attorney, the state attorney general, the state and local police, the probation and parole office and the coroner to address the attendance.

Even the local judge, Pamela Ruest, comes along to describe how the epidemic is swamping her court. A quarter of all crimes are now drug related and that doesn’t include robberies, assaults, child endangerment and other incidents prompted by drugs.

“This crisis is affecting all areas of public life. We’re dealing with more cases in family involving domestic violence, violation of protection orders, homelessness, eviction, children being taken into care, babies being born addicted. It’s heart-breaking and it’s happening more and more,” he says.

Drugs are an issue in next week’s election as the federal government government is spending one billion dollars a year on the heroin/ opioid problem alone. Hillary Clinton has laid out a plan that ticks most of the boxes raised at the town hall but she’s only promising to maintain current levels of funding when critics say more treatment and rehab services are needed.

At local level too the issue is contentious. In Pennsylvania, the position of attorney general is up for grabs and both of the candidates, Democrat Josh Shapiro and Republican John Rafferty have made the heroin epidemic a key feature of their campaigns.

Neither make any mention of building walls.