It's no secret that the over-prescription of opioid painkillers has led to the scourge of heroin inflicting its horrors once again on communities across the United States.

The less-than-discriminate distribution of painkillers by some doctors has resulted in a black market for the pills. But with the costs for such pills rising significantly and the formulation of the pills having been changed to make them harder to abuse, those who are hooked on the painkillers have been turning to heroin for their fix. This has created a boom market for heroin, especially in small-town America and locales such as Brattleboro, Bellows Falls and Springfield have been struggling with overdoses and crime related to heroin addiction. The street price for heroin is about five times less than the price of opioid painkillers.

According to the Centers for Disease Control and Prevention, there are about half-a-million heroin addicts in the United States. In 2013, there were 8,257 heroin overdose deaths, nearly four times the rate in 2006. Overdose deaths nearly doubled between 2011 and 2013. According to the Drug Enforcement Agency, about 120 people die every day of a drug overdose.

"Heroin use is increasing at an alarming rate in many parts of society, driven by both the prescription opioid epidemic and cheaper, more available heroin," said CDC Director Tom Frieden.

The U.S. Attorney's Office for the District of Vermont has brought together the state's law enforcement agencies in a unified effort to crack down on the distribution of heroin in the Green Mountain State. So far, building relationships and increasing communication between agencies has led to several high profile busts in southern Vermont and around the state.


And two days ago, Eric S. Miller, the U.S. Attorney for Vermont, launched a new campaign raising awareness about sex and drug trafficking activities in the state.

Heroin traffickers in Vermont do not work alone, noted Miller. They rely on local networks of people to support their illegal and destructive business model. These networks assist drug dealers by providing housing, contacts, and vehicles, and by transporting drugs. In some cases, Vermonters are also used by drug dealers for sex trafficking that profits their illicit drug organizations.

But, as Frieden noted, a legal approach isn't the solution to combating the scourge of heroin.

"To reverse this trend we need an all-of-society response — to improve opioid prescribing practices to prevent addiction, expand access to effective treatment for those who are addicted, increase use of naloxone to reverse overdoses, and work with law enforcement partners like DEA to reduce the supply of heroin."

States play a central role in addressing and helping to reverse the heroin epidemic, but their budgets are stretched thin and allocating resources for a stigmatised demographic is met by resistance by many sectors of our society. Nonetheless, states are taking concrete steps to address the epidemic, including making overdose intervention drugs such as naloxone more widely available.

But expanding access to and training for administering naloxone to reduce opioid overdose deaths costs money. Ensuring people have access to integrated prevention services, including access to sterile needles from reliable sources, also costs money and is often fought tooth and nail by the abstinence only crowd. Making sure recovering addicts have the mental health support they need is also expensive.

And addressing the strongest risk factor for heroin abuse or dependence — abuse or dependence on prescription opioid painkillers— also requires a financial investment and a willingness to confront the profit-driven pharmaceutical industry and doctors who over-prescribe opioid painkillers.

But, as the Reformer has noted in the past, perhaps the best first step to addressing the abuse of illicit drugs in our communities is to legalize them and eliminate the criminal element from the enterprise. If drugs such as heroin, cocaine and marijuana were properly regulated and monitored, not only could the profits from the sales go toward the aforementioned preventative measures, but users would also be able to come out from the darkness and get the help they need when they are ready for it. Of course, legalization has been and will continue to be fought by the Carrie Nations who refuse to admit it's natural for many people to turn to mind-altering drugs for whatever ails their existence. Admitting we are all imperfect human beings who sometimes make bad decisions is a good first step in addressing the issue. Legalization is a good second step.