Pubdate: Fri, 25 Mar 2016
Source: Washington Post (DC)
Copyright: 2016 The Washington Post Company
Contact:  http://www.washingtonpost.com/
Details: http://www.mapinc.org/media/491
Author: Joe Davidson

THE COLOR OF ADDICTION: WAR THEN, BUT TREATMENT NOW

The nation's heroin epidemic found its way from the shadows of 
America to Capitol Hill this week as lawmakers and experts struggled 
with a raging disease that is leaving an increasing number of bodies behind.

Heroin deaths have almost tripled since 2010, Louis J. Milione, a 
Drug Enforcement Administration deputy assistant administrator, told 
a House Oversight and Government Reform Committee hearing Tuesday. 
"Today's heroin at the retail level costs less and is more potent 
than the heroin that DEA encountered two decades ago," he said.

The surge in overdose deaths is one reason Congress now is examining 
heroin addiction. Another reason is the complexion of the addicted.

Rep. Elijah E. Cummings (DMd.), who has seen the effects of drug 
abuse in his Madison Park neighborhood in West Baltimore, pointed to 
the difference in the way heroin addiction is dealt with now compared 
with years ago.

The difference between a war on drugs and drug treatment is like the 
difference between black and white.

"In Baltimore, where many of the victims were poor and black . . . 
our nation treated this issue like a war rather than a public health 
emergency," said Cummings, the ranking Democrat on the panel. "We 
incarcerated a generation rather than giving them the treatment they needed."

"Now, things are changing," he noted. "Between 2006 and 2013, the 
number of first-time heroin users nearly doubled, and about 90 
percent of these first-time users were white."

While the hearing heard from knowledgeable medical, law enforcement 
and policy experts, it lacked the testimony of those who reek of the 
poison in their arms, those who have tried to kick only to relapse, 
those who have stolen from their families to feed a deadly habit.

Leana Wen, Baltimore's health commissioner, made heroin addiction 
real with a story from her emergency room experiences.

"I remember well my patient, a 24-year-old mother of two who came to 
the ER nearly every week requesting addiction treatment," Wen 
recalled. "She would be told there was nowhere for her to go that day 
or the next and would be offered an appointment in three weeks' time. 
Because she lacked housing and other supportive services, she would 
relapse. One day, her family found her unresponsive and not 
breathing. By the time she arrived in the ER, it was too late for us 
to save her and she died."

Stories like that repeat, increasingly in places not like Baltimore, 
whose many troubles are well chronicled.

Take Orange County, Fla., which includes Orlando. It's becoming known 
for more than Walt Disney World.

The county's mayor, Teresa Jacobs, told the panel that heroin-related 
deaths in the county jumped almost six-fold from 2011 to 2015.

"Despite Central Florida's strengthening economy, extraordinary 
quality of life and soaring reputation," she said, "heroin use has exploded."

Cummings called on Congress to take action.

"Congress should not leave town until we take emergency action to 
increase funding to help states combat this epidemic," he said.

For Republicans, however, one item on their list of "takeaways" from 
the hearing indicates their hesitation on spending more. "In 2015, 
$400 million was appropriated to address the opioid epidemic - an 
increase of $100 million," it said. "To date, none of the money has 
been spent."

With an almost unanimous vote, the Senate approved legislation 
earlier this month designed to fight the abuse of opioids, including 
heroin. The bill, which still must be considered by the House, would 
encourage the use of naloxone, a drug that can reverse heroin overdoses.

Cummings directed some of his fire toward Amphastar Pharmaceuticals, 
which makes naloxone.

The drug was praised at the hearing for its effectiveness. But it's 
getting very expensive.

Cummings accused Amphastar of "corporate greed," saying it raised the 
price as more first responders turned to naloxone. The price of the 
10-dose pack used by the Baltimore City Health Department jumped from 
$190 in May 2014 to more than $400 today, according to Cummings.

Bill Peters, Amphastar senior vice president and chief financial 
officer, said by email "this is definitely NOT" (his emphasis) what 
the company charges and could reflect a middleman markup.

"We have negotiated rebates with various entities for lower pricing," 
he said. "For example, we entered into a rebate agreement with the 
following states: New York, Ohio, Delaware, Wisconsin, Vermont, Rhode 
Island and New Jersey. We have offered rebates to Maryland, but as of 
today, they have not accepted our offer."
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MAP posted-by: Jay Bergstrom