As you can see, the right half of the graph looks nothing like the left. Heroin had been around since the 1960s, during the time of Jimi Hendrix and the Vietnam War. After the 1970s, heroin was essentially only found in small urban pockets. However, heroin went through a major resurgence in 2010, rapidly becoming the most lethal opioid on the street. Fentanyl appeared on the scene barely 3 years later. Fentanyl is 50-times stronger than heroin and took no time to make heroin all but obsolete. 

I cannot stress this point enough: it isn’t the same opioid epidemic anymore. There are many other deadly changes that aren’t even shown on the graph. These include the introduction of chemicals like fentanyl analogues, designer benzodiazepines, xylazine (a horse tranquilizer known as “Tranq” on the street) and medetomidine, not to mention fake pills. There are even opioids called nitazenes that may be 40-50 times stronger again than fentanyl, which is already 50 times more potent than heroin. This ain’t your parent’s heroin epidemic anymore!

The point is that if you’re still thinking about the opioid crisis like it was 2010, you’re hopelessly out of date and it might cost someone’s life!

Before 2010, an opioid addict who quits using drugs was unlikely to die if they relapsed because the drugs on the street were much less deadly. In today’s drug scene, the drugs are so potent that anyone who totally quits using drugs will lose all tolerance. They are likely to overdose and possibly die the very first time they relapse. That’s why there is a high rate of fatal overdoses for those recently released from jails or prisons, from people who go through drug-free detox or rehab, and for people who discontinue medications for opioid addiction. All these people had become abstinent and lost their tolerance to opioids making them highly vulnerable to fatal overdoses.

A colleague once asked me, “How could you support Harm Reduction instead of Abstinence? Abstinence means zero drugs. Zero drugs equals zero harm.” Unfortunately, abstinence also often means no life-saving medical treatment as well.

Addiction treatment is overdue for a rethink and a major update.