Cardiologist and Congressman Larry Bucshon heard experts say something in Washington last month that he already knew: The heroin epidemic gripping the country and Indiana is the creation, at least in part, of doctors.
The rash of addiction — heroin deaths and arrests have tripled in Indiana since 2010 — was seeded by an explosive growth in prescriptions, Dr. Robert DuPont, a former White House drug chief, told members of the U.S. House Energy and Commerce Subcommittee on Oversight and Investigations.
Bucshon said in an interview that he agrees: “We have to shoulder some of the blame.”
In 2012 alone, 259 million painkiller prescriptions were written — enough for every American adult to have his or her own bottle of opioid pills, according to testimony before the committee. While Americans represent less than 5 percent of the world’s population, we consume 80 percent of its painkillers.
Not every user of narcotics gets hooked, but many do. Experts at the hearing said one-quarter of painkiller users are considered addicts. Four of five new heroin addicts say their addictions started with prescriptions.
That resonated with Bucshon, who started practicing medicine in 1995 and later moved to southwest Indiana, where he now represents a district that includes Evansville, Terre Haute and Washington.
He remembers reading as a young surgeon a report from the Joint Commission on Hospital Accreditation that chastised doctors for under-treating chronic pain and said thousands of patients suffered needlessly. The report, released in 2000, encouraged doctors to turn to a new wave of opioid-based drugs that were billed — erroneously, as they later found — as non-addicting.
“Physicians are in the business of taking care of people,” said Bucshon. “We saw prescribing these medications as the compassionate thing to do.”
But, he added, “Over time the recognition of how badly addicting these medications are caught up to us. That’s where we are today. We’ve got a lot of people who are fighting addictions.”
Slowly the medical profession has pulled back on routinely handing out scrips for narcotics. Regulators, including those Indiana, are tracking prescriptions to thwart abusers as well as over-prescribing doctors.
But addictions remain, Bucshon said, and that’s driving heroin use. Easy to get and cheap at about $6 a dose, it’s become the substitute opioid for many.
Bucshon has given his congressional colleagues a grim diagnosis. Opioid addiction as a hellish, lifetime disorder. Even after long periods of abstinence, the risk of relapse is substantial. Treatment is expensive and sparsely available, especially in rural areas where heroin use is rising.
As a policymaker, Bucshon is working to help states do a better job of tracking painkiller prescriptions. He’s pushing federally funded treatment programs toward a more patient-centered approach.
He strongly supported recent legislation to put about $7.5 billion toward community mental health centers that offer addiction treatment.
A Republican and fiscal conservative, Bucshon said there was a time when his constituents may have balked at the idea of spending that kind of money on addicts.
That’s changing as numbers spike.
Heroin cases sent to the Indiana State Police labs for analysis shot up almost 300 percent between 2008 and 2013 — from 354 cases to 1,396. They came from all over the state, from the wealthiest counties to the poorest.
“Addiction crosses socio-economic status,” said Bucshon. “It’s everywhere now.”
Maureen Hayden is statehouse bureau chef for CNHI newspapers. Send comments to firstname.lastname@example.org.