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History of an epidemic

Until the 1980s, the U.S. medical establishment reserved powerful opioid-based medicines — derived from the poppy plant and used since ancient times to treat pain — for grave, often terminal illnesses.

But when drug trials in the 1990s showed no significant problems, physicians also began prescribing OxyContin and Vicodin to patients afflicted with lumbar trauma, arthritis and sports injuries. “Opioids had been used since the ’50s or ’60s for cancer pain. … [If opioids helped cancer patients,] why wouldn’t it be true that people who were suffering from chronic, non cancer pain could benefit?” said Dr. Lynn Webster, former president of the American Academy of Pain Medicine.


By the early 2000s, easy access to these pills bred widespread addiction and a profitable, legal trade in painkillers. In 2012, some 2 million people tried prescription-strength opiates recreationally for the first time. “They would take [OxyContin] and crush it or take the whole amount at once,” Webster said. Patients replenished their supplies through “doctor shopping” and opportunistic physicians went through stacks of prescriptions at fraudulent pain clinics. Most of the consumers were Caucasian.

Opiates are “a white drug,” according to Sandra L. Kuehn, president of the Center for Chemical Addictions Treatment in Cincinnati. One explanation, she said, is “the proliferation of narcotics with sports injuries, which traces back to pills.” Whites may also benefit from higher rates of health insurance, butMedicare and Medicaid patients have also seen high rates of addiction.
 
As overdose deaths skyrocketed across the country, law enforcement cracked down on predatory pain clinics, or “pill mills,” squeezing one end of the opiate supply. The void was filled by a chemically identical drug, available for a fraction of the price: heroin. By making home deliveries and selling it for $10 or $20 per bag, compared with $40 for one prescription tablet, depending on the variety, dealers enticed suburban and rural users to go from swallowing and snorting pills to shooting heroin directly into their veins.

Overdose prevention has become a major health concern.Naloxone
is all over the national news and endorsed by such high-profile officials as

Prior to 2012, however, only a handful of cities and states had passed laws broadening access to naloxone or granting medical amnesty to 911 callers, and strategies outside the drug-treatment paradigm were harshly stigmatized, too fringe and controversial to inform public policy.


“It was thought that this harm-reduction thing is radical,” said Eliza Wheeler, of the San Francisco-based Harm Reduction Coalition. “The real shift in the mainstreaming of this has happened since prescription-drug use has fueled a rise in heroin use throughout the country, in communities that maybe weren’t as affected in the past.”


“Before, you had to go to a dark, scary place to get these drugs. Now you just go to your school bathroom,” said Robin Elliott, a real-estate agent in suburban Atlanta whose son Zack, a promising student-athlete, died of a heroin overdose in 2011.

The first advocates for naloxone distribution were health workers and grassroots activists who ran syringe-exchange programs and worked closely with active drug users. Long before there was a medical-amnesty bill, organizations such as the Atlanta Harm Reduction Coalition (AHRC) were preventing overdose deaths and needle-borne illnesses as best they could.

For nearly two decades, AHRC has given away clean needles, condoms, food and clothing and offered free HIV tests, showers and Internet access to local residents in the notorious, low-income neighborhood known as the "Bluff," home to seasoned users and the center of Atlanta’s opium trade. Kareem’s naloxone kit came from AHRC whose efforts, even now, remain exceptional: It operates the only syringe exchange in the entire state.


“The only economic development happening in this neighborhood in the last 30 years is the heroin trade,” said Marshall Rancifer, a former AHRC staff member. “This community has had no infrastructure upgrades or economic development. When someone black over here overdoses, you never hear about it and see it on the news, but someone white, they deserve to be recognized.”

AHRC Director Mona Bennett, who has long advocated for the widespread distribution of naloxone, agreed. Although opiate abuse seems to have re-emerged in just the past few years, “heroin never really went away.”
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