Another undesirable landmark: Heroin fatalities passed gun homicides in the CDC’s rankings.

The Washington Post’s coverage is here.

This most recent surge in deaths is mainly attributed to fentanyl, often in combination with heroin. Sometimes the user is aware of the presence of fentanyl, and decides to use it anyway. Other times, it’s a hidden danger.

Just to recap: once the market for opiates began to include rural areas– largely through expanded use for chronic pain, and the appearance of pill mills– heroin smugglers recognized that it was safer and therefore more profitable to sell their product in small towns, rather than gang-controlled urban areas. They used a “pizza delivery” model. The local customer phoned in an order and arranged a meet to complete the transaction– often in the parking lot of a fast food joint. The locals then turned around and resold the product to their own network of friends and associates.

By the time law enforcement was cracking down on the pill mills and pain clinics, heroin was an easy switch for the user to make– first through smoking, then by injection. That’s how people who wouldn’t dream of frequenting a drug corner in the big city were nonetheless able to access affordable, quality smack, not far from their own neighborhood. It was probably inevitable that somewhere along the line, fentanyl would be introduced into the supply. It simply made economic sense.

I’ve oversimplified this, but not by much. That’s the thing about addictive drugs: They reinforce their own use. Epidemics are not unusual. Once there’s a source and a customer base, things tend to take off.

After they have, it’s a real challenge to interrupt. The public is divided on remedies. Some are crude in the extreme. For instance, this comment following the article: “The government puts hot shots in the drug supply. Thus, potential druggies do not become addicts. Existing addicts either get treatment or die. Any other fixes you would like me to solve?” Or what about this, from another reader? “Medical treatment doesn’t help addiction. We’re just about to waste another billion dollars. Only the addict can stop being an addict.”

Sadly, the notion of treating addiction as a disease remains counter-intuitive for many Americans, who view it as the user’s own fault, the result of some horrendously unwise decision-making process. Once  you accept that people don’t set out to become addicted– that in reality, it happens despite efforts they may make to prevent it— you’re on the way to real understanding.

Until then, it’ll be a mystery.