Measuring America's opioid problem

by @alexandranewman @serfer6 February 3, 2016 5:00AM ET

A look at the numbers behind America's heroin crisis and changing drug policy


The numbers are hard to ignore: Today more Americans die from drug overdose deaths than car crashes; 44 people die each day from overdoses of prescription painkillers; deadly heroin-related overdoses quadrupled between 2002 and 2013, with more than 8,200 heroin overdose deaths in 2013.

As deaths soar, there is a growing recognition among legislators that throwing money at law enforcement alone will not stem the epidemic — that the criminalization of drug policy has not succeeded by any metric. Coaxed perhaps by a heroin epidemic that has gripped Republican-led states, the GOP has begun to rethink a decades-long drug policy centered on criminalization.

There is growing admission, among Republicans and Democrats, that drug use should be approached as a public health crisis. States, for example, are increasingly promoting syringe exchange programs, which have been proven to slow HIV rates without increasing drug use, and which are endorsed by groups like the American Medical Association, the National Academy of Sciences and UNICEF. Naloxone, the overdose reversal drug, is now available in two-dozen states, a rate that has doubled in the last two years. And dozens of states observe Good Samaritan laws, which protect people who alert authorities to overdoses.

The response is encouraging. But there is also consensus among drug policy experts that both political parties do not yet recognize the scale of the problem. The war on drugs that Richard Nixon launched 45 years ago will not disappear overnight, with one piece of federal legislation. Lasting change, they say, will require a broad assessment of drug policy, from policing tactics to prosecutorial discretion to sentencing precedures.

Here's a look at CDC data tracking drug-poisoning deaths from 2002 to 2014.

Deaths from drug poisoning, 2002-2014
The map below show deaths per 100,000 by U.S. county for all drug overdose deaths.
increase in drug poisoning deaths, 2002-2014
Source: CDC Drug poisoning mortality statistics. Graphic by Alex Newman.

Naloxone access is improving

Another way to measure changing response to the heroin epidemic is to look at how states have changed access to the anti-overdose drug naloxone. 

New Mexico lead the country in 2001, passing the first statewide legislation to increase access. In 2015, 20 states passed similar legislation.

Drug Policy Alliance

Only eight states have yet to pass any kind of naloxone law: Alaska, Arizona, Hawaii, Iowa, Kansas, Missouri, Montana and Wyoming. 

2001: New Mexico

2010: Illinois

2012: Massachusetts

2013: District of Columbia, North Carolina, New Jersey, Oregon, Vermont, Oklahoma

2014: California, Delaware, Georgia, Maine, Michigan, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, Tennessee, Utah, Wisconsin

2015: Alabama, Arkansas, Colorado, Connecticut, Florida, Idaho, Indiana, Kentucky, Louisiana, Maryland, Mississippi, Nebraska, Nevada, New Hampshire, North Dakota, South Carolina, Texas, Virginia, Washington, West Virginia



Good Samaritan laws

As with naloxone access, New Mexico was the first state to pass a 911 Good Samaritan law in 2011. Eighteen other states and the District of Columbia have followed suit. These laws provide limited immunity from arrest or prosection for minor drug law violations to those who summon authorities for someone who has overdosed. 

Drug Policy Alliance

Syringe exchange laws vary

 State laws on syringe exchange are complicated. Some 17 states (including Washington, D.C.) have explicitly authorized syringe exchange. Others have taken steps to reduce barriers to syringe access, which usually includes deregulating syringes entirely or removing references to syringes from prescription and drug paraphernalia laws.

"What we've been staying for 20 years is that states should just deregulate syringes," says Scott Burris, a professor at Temple Law School in Philadelphia who researches syringe access laws. "There's no reason why we need to have criminal laws governing needles. There should be syringe exchange everywhere its needed, not just in big cities.”

Source: LawAtlas syringe distribution laws map

The most recent state to change needle laws is Indiana, which allows counties to establish needle exchanges under certain circumstances. A total of 29 states have authorized or taken steps to allow syringe exchange programs. 

Source: LawAtlas syringe distribution laws map
LawAtlas syringe distribution laws map

An earlier version of the map showing naloxone laws showed South Dakota had passed a law in 2015. South Dakota does not have a law improving naloxone access.