Heroin policy shifts toward treatment, but experts say not nearly enough

WASHINGTON — Amid a nationwide rise in heroin use and related overdoses, the White House announced an initiative on Monday to help combat the epidemic. However, advocates for drug treatment say it doesn’t go far enough.

Michael Botticelli, the director of the National Drug Control Policy, announced that Barack Obama’s administration would invest $2.5 million over a year in 15 states along the Northeast corridor and Washington, D.C., to track where heroin is coming from, where it is being distributed and where it is being mixed with a powerful additive believed to be contributing to the spike in overdose deaths.

Heroin overdose deaths in the United States quadrupled from 2000 to 2013, propelled by lower costs as well as the abuse of prescription opiates, according to a tally by the Centers for Disease Control and Prevention. Most of the growth came after 2010. Just last month, over 75 opiate overdoses were reported to the San Francisco Drug Overdose Prevention and Education Project, compared with 25 in July 2014.

The new federal program, focused on hard-hit New England, would pair drug intelligence officers with public health coordinators to emphasize public safety as well as treatment, issuing alerts about dangerous batches of heroin and training first responders on how to effectively treat overdoses.

“The new heroin response strategy demonstrates a strong commitment to address the heroin and prescription opioid epidemic as both a public health and a public safety issue,” Botticelli said in a statement. “This administration will continue to expand community-based efforts to prevent drug use, pursue smart-on-crime approaches to drug enforcement, increase access to treatment, work to reduce overdose deaths and support the millions of Americans in recovery.”

Community advocates and public health experts caution, however, that the program still appears to prioritize law enforcement over programs that get drug users the medical help they need. Harm-reduction workers say they would prefer that the government invest in two proven health strategies: distributing naloxone, a medication that reverses opiate overdoses, and where possible, setting up syringe access and exchange centers to curtail hepatitis and HIV transmission among intravenous drug users.

It's increasingly common for police and first responders to use naloxone on overdose victims, and activists have pushed hard for laws permitting lifesaving naloxone kits to be provided to drug users and their families and friends. In Cincinnati, 68 opiate overdoses were reversed with naloxone in the last year and a half. And the Atlanta Harm Reduction Coalition, which operates the city’s only syringe exchange, reports that 307 lives have been saved with the antidote since April 2014.

Still, activists say, naloxone’s high cost prohibits wider use.

“What are [federal officials] going to do about treatment?” said Mona Bennett, an associate director of the Atlanta group. “We’re doing all that we can do just to get needles, sterile syringes, to get the naloxone out.”

Jason Merrick, a social worker and recovering drug user in northern Kentucky, has distributed scores of naloxone kits, but because of the cost, “we made our last foreseeable purchase a few weeks ago,” he said. “We only have 150 kits left.” He has lobbied for maintenance therapies such as suboxone and methadone and in the last state legislative term lobbied for a bill legalizing syringe exchanges.

“There’s so much that needs to be done, and harm reduction is at the top of that list, but no one ever talks about that,” said Judith Feinberg, a professor of clinical medicine at the University of Cincinnati. “I’m glad the federal government is even thinking about it, period, but this is primarily a law-enforcement initiative, and only very indirectly is it going to help addicts."

Corey Davis, a staff attorney with the National Health Law Program, a health care advocacy group for low-income people, also questioned the program’s priorities.

“Where is the public health part of this initiative?” he said. “Botticelli has done a good job moving the [Office of National Drug Control Policy] towards a more evidence-based, public health approach to drug use. But the focus continues to be on traditional law enforcement approaches, which by and large don’t work and hurt rather than help people with the disease of addiction.”