Where the opiate epidemic is spreading and why

The market for black tar and powdered heroin

 Opioids are cutting through the country, claiming an increasing number of deaths and, in some cities, taking more lives than traffic fatalities and murders combined.1 But the rapid increase in overdose deaths over the past ten years didn’t extend to all parts of the country. In some states in the western half of the U.S., data suggests deaths may have leveled off or even declined.2

Map of overdose deaths across America, age adjusted per 100,000. (Data 2015. See Citation 6) 

Looking at heroin smuggling in the U.S., we historically saw four different global regions involved. Heroin from Southeast Asia, once smuggled throughout the world, is now limited to Australia and Canada; and heroin originating from poppies grown in Afghanistan and refined in Southwest Asia is sold predominantly in Europe. Today, heroin in America is exclusively from Mexico and Colombia.3 The latest data from the US Drug Enforcement Agency finds that within the U.S., 58% of heroin is Colombian-sourced, 40% Mexican-sourced with Southeast and Southwest Asia heroin combined falling to a 2% share.4

However due to the physical qualities of heroin shipped from Mexico and Colombia, Mexican supply chains and cartels control the western half of the United States, and Colombia the eastern half. The “black tar” heroin of Mexico is heavier per gram than the lightweight and low volume powdered heroin of Colombia.3 This difference in weight and volume makes it harder and more expensive to ship black tar heroin abroad. The weight of Mexican heroin makes it too expensive to be air shipped. Instead, black tar heroin finds itself distributed directly across Mexico’s nearest border: the United States.

Why is this important?

As overdose deaths mainly rise in the eastern half of the United States but not the west, it can be attributed to the availability of the stronger and often more synthetic forms of heroin in the Colombian distribution. While there is little difference in heroin addiction or use in one half of the country over the other, there is a strong difference in the availability of different types of these opiates. High density powdered Colombian heroin brings with it lower prices per gram (along with access to synthetic forms such as fentanyl.) It is with the decrease in price per gram that the strongest correlation with overdose deaths is found. The number of overdose deaths is found to correlate to the decrease in price rather than an increase in purity.5 As prices for the powdered and synthetic forms of heroin continue to fall, overdose deaths are expected to continue to rise, unless further action is taken to end the epidemic.

1. Baker, Al. “When Opioid Addicts Find an Ally in Blue.” The New York Times. The New York Times, 12 June 2017. Web. 19 July 2017.
2. Katz, Josh. “Drug Deaths in America Are Rising Faster Than Ever.” The New York Times. The New York Times, 05 June 2017. Web. 19 July 2017.
3. Ciccarone, Daniel. “Heroin in Brown, Black and White: Structural Factors and Medical Consequences in the US Heroin Market.” International Journal of Drug Policy 3 (2009): 277-82. Web.
4. US Drug Enforcement Administration. News Release, For Immediate Release, June 21, 1995. Colombian Heroin a Major Threat. Almost One Third of Heroin Seized in the United States Originates in South America. 1995 [Retrieved July 31, 2007].
5. Unick, George, Daniel Rosenblum, Sarah Mars, and Daniel Ciccarone. “The Relationship between US Heroin Market Dynamics and Heroin-related Overdose, 1992-2008.”Addiction 109.11 (2014): 1889-898. Web.
6. Kaiser Family Foundation analysis of Centers for Disease Control and Prevention (CDC), National Center for Health Statistics. Multiple Cause of Death 1999-2015 on CDC WONDER Online Database, released 2016. Data are from the Multiple Cause of Death Files, 1999-2015, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at https://wonder.cdc.gov/mcd-icd10.htmlon March 2, 2017.