Why is Heroin So Cheap?

On Monday the White House announced its newest strategy to combat a growing heroin epidemic in the U.S. Their plan is to enhance coordination between law enforcement and public health officials in fifteen Northeastern and Mid-Atlantic states where rates of fatal heroin overdoses have exploded. The goal is to more swiftly disrupt distributors, while creating better health resources for users.

This latest initiative comes on the heels of the CDC’s announcement last month that fatal heroin overdoses have quadrupled since 2002, and that half a million Americans were using the drug by 2013. As heroin use expands beyond urban centers and into suburbs and rural areas, government officials are scrambling to find funding for treatment services. Many communities, inexperienced and ill-equipped in dealing with the drug, are being forced to reexamine traditional stereotypes of heroin addicts, as use now extends across all income, race, and age groups.


The Real History of Drugs Episode 6: Heroin

The dark history of how we've mishandled heroin addiction.(ATTN: is excited to launch Episode 6 of our new series about the history of illegal drugs).

Posted by ATTN: on Sunday, July 26, 2015



But where did this unexpected demand for heroin come from? And how’s the drug more widely available than ever before? Answering these questions requires looking at both the tangled web of state and federal drug policy and the dynamic black market economy that it attempts to control.

1. Demand: National Crackdown on Prescription Opiates

Unfortunately, the demand for heroin correlates with well-meaning changes in prescription drug policy intended to contain the large public health hazard of pharmaceutical opioids. Opiate-based prescription drugs like OxyContin, Percocet, and Vicodin are widely prescribed in the United States as painkillers. While prescription opioids may help many patients cope with the pain of a surgery or a chronic injury, users can quickly become tolerant to the drug’s effects and require subsequently higher dosages to achieve the same level of relief, increasing the likelihood of both physical dependence and accidental overdosing. This dynamic has led use of controlled prescription drugs to become the deadliest drug problem in the nation, as deaths from regulated pharmaceuticals (an estimated 16,000 per year) outnumber those involving heroin and cocaine combined.

Realizing that these drugs had been prescribed without adequate education of their inherent risks, state and federal policymakers adopted a range of strategies to limit further harm, including centralized prescription monitoring, prosecution of “pill mill” practices, and reassignment of prescription opiates within the federal drug schedule to limit access. All of these actions, as planned, shrunk the available supply of prescription opioids, and in turn they became a lucrative commodity for drug dealers. As policy controls on these drugs continue to tighten, their street value only rises, compelling many addicted users to start using a cheaper opiate: heroin. In its report of the rapidly escalating rate of heroin overdoses, the CDC emphasized a new study which found that 45% of heroin users were first addicted to prescription drugs. Earlier studies even found that a 2010 spike in heroin use coincided with the launch of an abuse-resistant version of OxyContin. Apparently, in attempting to prevent further harms from prescription opioids, authorities have inadvertently fanned the flames of heroin addiction.

2. Supply: Mexican Cartels Move Out of Cannabis, Into Opium Poppy

As the demand for heroin has grown in concert with a dwindling supply of prescription opioids, the supply has expanded partially in response to another shift in U.S. drug policy: liberalizing attitudes towards marijuana. As additional U.S. states continue to legalize either medical or recreational cannabis, demand for Mexican marijuana has steeply declined, with pot consumers increasingly choosing higher quality domestic bud over much maligned Mexican “brick weed.” Cartel farmers south of the border, subject to market dynamics like any other producer, have responded by replacing their cannabis plants with opium poppies. There poppies are processed into heroin, smuggled across the southern border and ferried throughout the United States along the cartels’ long-established distribution channels.

While this shift in product may not surprise many, what’s new about the cartels’ behavior is where they’re selling. Traditionally, Mexican heroin was only distributed west of the Mississippi, with Columbian and Dominican groups controlling the trade in the East. But now, as their profits from marijuana plummet, Mexican cartels have repurposed their illicit trade routes to muscle into the East Coast heroin market, where New York City serves as a major hub for relaying product across the region (where the social harms of heroin are now most visible). This increased competition between dealing factions, combined with more supply than ever, further serves to push down the average price of heroin relative to pills on the street. Where contractions in prescription opioid supply left vacuums of demand, cartels have regrettably filled the void with cheaper heroin.

Alternative: Treatment, but It’s More Expensive and Less Accessible than Heroin

While the “sticker price” of heroin may be lower than ever for users, the myriad costs to communities—including homelessness, rashes of property crime to fuel addiction, families torn apart by the plight of afflicted relatives, and escalating expenses of medical treatment and law enforcement for users—are enormous, and frequently funded by taxpayers. Public health officials are now urgently calling for elected officials and legislators to heavily invest in treatment resources for addicts, with the argument that treating this dilemma as health crisis rather than as police problem will ultimately be less expensive for communities themselves.

For an addict seeking to safely break their addiction with proper assistance, the current options are unpalatable. Private rehabilitation typically costs tens of thousands of dollars for only several months of treatment, far beyond the financial capacity of most addicts who’ve hit rock bottom. For public treatment programs, waiting lists are months or years-long, leaving many desperate addicts hanging out to dry. Given the severe physical withdrawal symptoms of opiates, going cold turkey from heroin without medical or psychological guidance is extremely unlikely at best, and deadly at worst.

While some optimistic addiction specialists believe that the current heroin dilemma will cyclically recede over time, policy around prescription opioids is still being tweaked and retooled as the drugs continue to be prescribed. Just last week, the FDA approved OxyContin for use by children ages 11 to 16. As long as medical providers continue to rely on this class of narcotics for pain management, communities will have to decide whether it’s in their interest to allow prescription opiate and heroin addicts alike to continue to suffer without timely, affordable treatment. To be successful, communities must compete against the low price of heroin by making the act of getting help far less expensive.