Pain Medications, Heroin, and You

The journey from prescription opiate medications to heroin

Posted Mar 04, 2015

Many people are prescribed opiate medications for short- or long-term treatment of pain. When used appropriately, these medications can be very helpful. Unfortunately, there have been dramatic societal consequences because of increased access to opiate prescriptions.

Nora Volkow, director of the National Institute on Drug Abuse, has noted a fourfold increase in the number of deaths resulting from overdose of prescription opiates between 1999 and 2010. Most of these deaths were unintentional, i.e., they were not suicides. Opiate medications are very addictive.  At higher doses, they also suppress respiration, i.e., people may have diminished brain signals telling them to breathe. Because deaths are increasing dramatically, there has been a recent push to allow emergency first responders to administer naloxone, a medication that rapidly blocks the effects of opiates and reverses respiratory suppression.

Another concern linked to use of prescription opiates involves use of the non-prescription opiate heroin. In the past, heroin addiction may not have been on many people’s radars because many of us have not crossed paths with heroin addicts. This is rapidly changing.

In an article in JAMA-Psychiatry, Ted Cicero and colleagues reported dramatic changes in the demographic profile of persons who become heroin addicts. Analyzing data from an ongoing national survey of people seeking treatment from over 150 drug treatment centers across the country, they found that people who began abusing opiates in the 1960s and 1970s were predominantly men who lived in inner cities and whose first use of any opiate involved heroin. Those who became addicted to heroin more recently were predominantly men and women who live in less urban areas and whose first contact with opiates involved a prescription opiate medication.  Over this time, the age of first use of an opiate increased from about 16.5 to about 23 years of age. Young middle class people living in suburbia are increasingly becoming addicts.

Prescription opiates are expensive. However, heroin is now cheap and of sufficient purity that it can be smoked or ingested by means other than intravenous injection. Drug dealers blend in with middle class suburban young people. Almost everyone in a subsample of study participants interviewed by the Cicero group indicated that they preferred heroin to prescription opiates because it was less expensive and easier to obtain. These factors make it easy for a young person to sample the drug initially. The high from heroin can lead to further use, and it doesn’t take long for the vicious cycle leading to addiction to begin.

The marked rise in opiate addiction and accidental deaths by overdose is often discussed in national and local news reports. If we don’t yet know someone with opiate-related issues, we likely will in the future. Various approaches will be implemented by state and local governments in an attempt to solve this rapidly increasing problem. How this will play out remains to be determined.

This column was written by Eugene Rubin MD, PhD and Charles Zorumski MD.