US Opioid Crisis – Part 4: The Pathway to Addiction and the Updating of the Law
What started as a noticeable rise in overdose deaths between 2012 and 2015 turned into a full-blown epidemic in 2016. As a result of the alarming statistics, media coverage rapidly increased awareness, while law enforcement acknowledged the severity of the new opioid overdose threat to the public.
Unfortunately, what the news showed as the typical opioid addict, a heavy heroin user, did not represent the reality of the affected demographic. The average profile of an overdose victim more closely resembled people that would not normally seem like they were at risk as many victims were without any previous drug abuse history.
What are Opioids?
Opioids are a class of drug that includes legal and illegal drugs. The illegal drug category includes heroin, synthetic opioids such as fentanyl and its derivatives. The legal drug category includes pain relievers available by prescription such as oxycodone (OxyContin), hydrocodone, Vicodin, codeine, morphine, and many others.
What are the effects of Opioids?
Opioids don’t actually block pain receptors in the brain, what they do is they force the brain to release endorphins that give a good feeling like a “runners high”. This essentially distracts the user’s attention away from their pain.
When the opioid effect wears off, as the body processes it and gains tolerance, the first milestone of addiction is encountered as the body begins to desire the return of the feel-good state. As the opioids are taken repeatedly over time, the body can slow and sometimes even stop the production of endorphins altogether.
One of the reasons why opioid addiction is so common is that users who develop a high tolerance feel driven to increase their dosage in order to sustain the good feeling consistently throughout their day to day lives.
Opioids come in all forms
The most common delivery method of opioids is in pill form, but desperate addicts who have taken to the streets often require faster methods to gain the desired effect. Faster effects are delivered when the opioid is used in powder form, either snorted or in most cases injected.
Opioid deaths outnumbered murders in 27 of 49 states in 2006. In 2014, the number reached 45, and in 2018 reached 47. Currently, more people die per day/week/month of an opioid overdose, in the US, than homicide.
5 Quick Opioid Stats from the National Institute on Drug Abuse
- 21 to 29% of patients prescribed opioids for chronic pain misuse them.
- 8 to 12% of patients develop an opioid use disorder.
- 4 to 6% of patients who misuse prescription opioids transition to heroin.
- 80% of people who use heroin first misused prescription opioids.
- In 2017, opioid overdoses in large cities increased by 54% in 16 states.
The Typical Pathway to Addiction
The typical scenario of the escalation of a patient’s usage of pain killers to stronger opioid synthetics is as follows:
A physician prescribes legal opioids to a patient for the relief of a medical condition, usually pain-related. The patient then increases the amount taken, as well as the frequency of ingestion, which they justify for their pain relief. After the legal prescription schedule ends, the patient (without a drug abuse history) may approach family members, friends, or even opt to forge prescriptions to access more opioid medication.
When these channels become exhausted the patient will often move on to other opioid sources like the street, to secure dealers of opioids. Pill dealers typically also provide heroin or heroin laced with synthetic opioids for the patients to experiment with. This leads to 3 possibilities:
- Extended opioid use
- Death by overdose
- Exercising will power to stop
In the event an opioid-addicted patient tries to quit, the transition drug prescribed is methadone. Unfortunately, the methadone-assisted transition phase intended to reduce the patient’s addiction in many cases does the opposite as opioid users will try to both receive their prescription and access street-level opioids as well.
The Case of Florida
In Florida, an opioid overdose death occurs every 2.5 hours. Nearly 12% of opioid overdose deaths in the US took place in Florida in the last year and in Orange County alone, opioid deaths increased by more than 70% over a 3 year period.
During the first half of 2017, it was the leading cause of overdose deaths in Florida, causing 704 deaths, according to the latest data available from the Florida Medical Examiners Comission.
New Crisis Creates New Laws
When the opioid crisis started making the news and becoming a national crisis many states, Florida included, began updating their murder statutes to be able to charge opioid dealers with homicide. Addicts were not targeted, as sending them to jail was not the answer when they went straight back to searching for dealers upon their release.
Since 2013, the Florida Metropolitan Bureau of Investigation has tried to continuously crack down on doctors that are known as “Pill mills”. According to the anti-”Pill Mill” law in Florida, prescribed opioid transactions must be tracked.
Furthermore, only a certain amount of dosage is allowed to be prescribed over a 3-day period and is monitored with E-Forcse, a computer system installed in all pharmacies in the state. Doctors found violating these laws have been convicted and as a result, most of the “pill mills” have closed up shop.
Most states that have a grand jury process are the ones that seem to have the most opioid-related homicide cases dropped. In similar cases, the grand jury has refused to indict, or prosecutors have dropped the case due to a lack of evidence. There is a heavy reliance on physical evidence to confirm that the defendant dealt the opioids to the victim which resulted in their death.
So, What Can be Done?
With a typical lack of incriminating physical evidence found in these types of cases, law enforcement needs to be able to turn to new channels to find irrefutable evidence that links dealers to their overdose victims. As smartphones are often the communication medium of choice between addicts and dealers, digital forensics performed on seized smartphones can retrieve critical data to close cases faster.
Moreover, digital social channels can often contain incriminating messages and photos that are accessible using tokens stored on a mobile device. Digital evidence retrieved from these sources can establish connections between overdose victims and their dealers, identify locations of drug transactions and visualize routes of activities leading up to, and after, the crime.
We have produced the webinar, “Opioid Crisis in America: From Digital Clues to a Murder Conviction,” co-sponsored by the FBINAA. You will benefit from getting an overview of the impact that the opioid epidemic is having in the United States and how law enforcement is using digital evidence to combat drug dealers and other criminals.
For more in-depth coverage of the crisis, read the whitepaper – Battling the Narcotics Crisis with Cellebrite Pathfinder