Prescription drugs kill more people in the U.S. than any other drug, but heroin overdose deaths have exploded, leading the Drug Enforcement Administration to declare both as the most threatening drugs.
Drug overdoses continued to be the leading cause of injury death for Americans, killing more people than guns or car crashes each year since 2008. There were 46,471 fatal overdoses in 2013, with about half coming from prescription medicines and about 8,000 from heroin, according to the annual Drug Threat Assessment report, which was released on Wednesday.
"Sadly this report confirms what we’ve known for some time: drug abuse is ending too many lives too soon and destroying families and communities,” said Chuck Rosenberg, acting administrator for the DEA.
Among fatal overdoses, prescription medications are by far the leading cause of death. Pills, especially opioids like oxycodone and hydrocodone, killed 16,235 people in 2013, while cocaine and heroin claimed 4,944 and 8,257 lives respectively. Opioid deaths peaked in 2011 at 16,917. Cocaine deaths are down from 6,512 in 2007.
The particularly bad news is about heroin use, which is skyrocketing. Nearly 40 percent more people died of heroin overdoses in 2013 than 2012, and deaths have increased by 243 percent since 2007. From 2013 to 2014, there was a 51 percent jump in current heroin users -- defined as people who've used the drug in the past month -- according to the Substance Abuse and Mental Health Services Administration.
There are other signs of increased heroin availability, according to the report. More than 5,000 kilos of the drug were seized in 2014, compared to 2,763 in 2010.
"Heroin is available in larger quantities, used by a larger number of people, and is causing an increasing number of overdose deaths," the report says. Later, it warns that "heroin use and overdose deaths are likely to continue to increase in the near term."
Marijuana is by far the most widely used drug, according to the report. But prescription medicines come in second and are used by more people than cocaine, methamphetamine, heroin and MDMA (also known as "molly" or "ecstasy") combined.
The DEA reports that pills are still widely available in most areas of the country. They cited data that more than half of users said they acquired pills for free from family and friends.
The National Safety Council recently called on the DEA to require new training for opioid prescribers to curb the number of overdoses.
"The most fatally abused drug today is legal and sitting in our medicine cabinets," Deborah A.P. Hersman, president and CEO of the National Safety Council, said in an Oct. 20 statement.
They're also a potential gateway for heroin users. For many people, heroin addiction begins with prescription opioids -- a shift that the DEA calls "a progression of an untreated substance use disorder."
In a report on the heroin epidemic published by The Huffington Post earlier this year, Dr. Tom Frieden, director of the Centers for Disease Control and Prevention, said he predicted three-quarters of heroin users started with pills.
When authorities began clamping down on pill mills and other illegal prescription drug operations over the past few years, users turned to heroin, which is cheaper and relatively easy to obtain on the street.
Sean Dunagan, a former DEA agent, said his former employer should have anticipated that the relentless crackdown on doctors and pharmacists pushing opioids would push addicts to look for a high elsewhere.
"We're wasting a tremendous amount of money and we're not doing enough to help people with this disease," said Dunagan, now a research specialist at Law Enforcement Against Prohibition. "The report shows that the problem with drug abuse is not getting any better."
Drug policy officials also told HuffPost earlier this year that they were aware of the potential consequences of their crackdown.
“We always were concerned about heroin,” said Kevin Sabet, a former senior drug policy official in the Obama administration. “We were always cognizant of the push-down, pop-up problem. But we weren’t about to let these pill mills flourish in the name of worrying about something that hadn’t happened yet. … When crooks are putting on white coats and handing out pills like candy, how could we expect a responsible administration not to act?”
Last year, the DEA called methamphetamine the most threatening drug. Meth use "may be increasing," and it's likely to remain widely available, this year's report warns.