THE HEROIN EPIDEMIC & NIMBY – Op-ed submitted to the Boston Globe

I felt proud to be a Massachusetts resident as I listened to Governor Patrick’s state of the state address a couple of weeks ago.  However, unlike the Governors of Vermont and Maine in their state addresses, Governor Patrick never mentioned the words “drug epidemic”; “addiction”; “heroin” or “prescription drugs”.  As a physician with years of experience in both Emergency Medicine and Addiction Medicine and as a resident of the South End in Boston, I was disappointed by Governor Patrick’s omission although I do not doubt that our governor cares deeply about this scourge to our society.  But how can we talk about the fiscal health of the Commonwealth without drawing attention to the tremendous societal costs of the disease of addiction; and even if one does not want to acknowledge that this is an illness with biological/genetic; psychological and sociological components, one cannot deny its horrific cost in terms of tax payer dollars, and public health and safety.

NIMBY – Not In My Back Yard – is the rallying cry heard from many politicians and citizens when asked if there is a drug problem in their neighborhood or if they would welcome a drug treatment facility.  “Sure, maybe we have a problem, but it’s not that bad” or “it’s really worse in the next neighborhood over”, or “the next town over” or “the next state over.”  Baloney – it’s in all of our yards and is as prevalent as the ragweed that grows in all of our lawns!  It does not matter if we live in the city, suburbia, the Northeast Kingdom of Vermont or Downeast Maine – it is truly everywhere and New England has an especially high incidence of heroin and opiate drug addiction.

To truly understand the magnitude of this problem we need to examine the economic impact of addiction to society.  There have been reports that when one considers the cost of drug use related to law enforcement, crime, judicial costs, incarceration, emergency room visits, hospitalizations, lost job productivity, and workers compensation; not to mention the deterioration of societal priorities or the overall risk to the public in terms of spread of disease (Hepatitis C & HIV) or secondary health and safety consequences such as domestic abuse or childhood asthma … the overall national annual cost exceeds $180 Billion.  Moreover, as an example, to treat one heroin addict in an outpatient medication based treatment center with admission and yearly annual exams, laboratory screening for HIV and Hepatitis C, group and/or individual counseling on a regular basis, and frequent random drug testing, the cost for this patient in Massachusetts is approximately $5,000 per year.  Halfway houses can cost $20,000 or more per year and incarceration of this patient costs upwards of $50,000 per year.  And even if one wants to ignore the scientific evidence that treating a heroin or “Oxy” opiate addict with a replacement medication such as methadone or buprenorphine is not simply trading one addiction for another, one cannot deny the documented fact that patients who enter into this type of treatment have an approximate tenfold decrease in criminal activity.

I hope that our current state legislators and all our local politicians and citizens will look critically at the facts and not adopt a NIMBY approach to drug addiction that is ruining lives and stealing our tax dollars by inadequately treating and preventing this epidemic from expanding.  Just look at some recent regional and national statistics:

  • The Boston metropolitan area had the highest rate of ER visits for “illicit drugs” of any of the 11 major cities in the entire country;
  • Greater Boston region ranked first in ER treatment for heroin overdoses, with a rate of 251 per 100,000 - nearly 4 times the national rate;
  • MA Emergency Rooms see 4 times the number of cases featuring heroin compared to the rest of the country
  • Opiate abuse-related MA hospital visits > 35,000/year;
  • 950% increase in abuse of oxycontin and other opioids in MA in the last 10 years;
  • MA had > 102,789 people admitted to hospitals for substance abuse in fiscal year 2011;
  • Heroin use in past 3 years has doubled since reformulation of Oxycontin;
  • An estimated 20 million people nationally need treatment for substance abuse but only 15% - 20% receive it;
  • 2% of US citizens are opioid dependent;
  • Heroin supply & purity is up and costs are down (as little as $4/bag);
  • In Massachusetts, in one year, 916 persons died as a direct consequence of drug use. This far exceeds those who died from motor vehicle accidents (397) and firearms (207); and
  • Massachusetts drug-induced deaths exceeded the national rate

But how should we attack this problem?  There is no easy answer but we need to look at both the supply and demand.  We have tried to cut back on the supply side for decades, yet we are again facing a heroin/opiate epidemic, most notably in New England.  Yes, we can arrest and incarcerate all the current drug pushers, big and small, and we can continue to burn the fields of the countries that produce opium; but the profits of this organized occupation of drug production and distribution is so great that others rapidly fill the void.  Just ask the Taliban how much money they make now that Afghani opium production has markedly increased since the beginning of the war.  So, I ask that the citizens of the Commonwealth of Massachusetts and elsewhere take a fresh look at this issue and make some of the hard decisions; decisions that can only be made by fully understanding, whether or not we believe addiction is a disease or a weakness of moral character, that expanded access and funding for treatment makes fiscal sense.  We must cut back on the demand to stand a chance of limiting the financial damage.  And to our politicians, I know this is a politically hot issue, but lives and dollars are at stake and it is time to lead the charge to educate through scientific fact and not out of fear.  I commend Governor Shumlin of Vermont for spending his entire state of the state address on this essential economic issue and his call to attack the epidemic on the demand side (treatment); recognizing that putting more people in jail may make us feel good on the short term, but does not solve the problem.  Governor LePage of Maine addressed the issue of drug addiction as an economic issue as well, but he unfortunately spoke not of increased funding for treatment and access to care, but only of expanded law enforcement and judicial response.

As the death of Philip Seymour Hoffman’s has again  reinforced, drug addiction, including heroin abuse, is an equal opportunity disease affecting all socioeconomic strata; and knows no boundaries.  This is not a problem of the welfare state or the poor or less fortunate.  It is NOT NIMBY!!  The disease is present in our impoverished neighborhoods as well as our wealthy suburban communities and in our resort towns and backwoods of New England.  Establishing treatment centers for addiction in one’s own locale should be worn as a badge of honor, no different than establishing a cancer treatment center or cardiac center; both of which are illnesses that may be related to the disease of addiction.  NIMBY no longer works!

Steven Kassels, MD has been Board Certified in Addiction Medicine and Emergency Medicine.  He currently serves as Medical Director of Community Substance Abuse Centers (with treatment facilities throughout New England) and has authored the book, “Addiction on Trial: Tragedy in Downeast Maine”. 

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