Painkiller Addicts Shifting to Heroin

Man Injecting Heroin

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An increase in emergency department visits for a heroin overdose and a rise in the amount of heroin being seized by law enforcement over the past several years has signaled an increase in the use of the drug across the United States.

News media outlets throughout the nation have reported a trend toward increased use of heroin observed by healthcare and law enforcement officials.

Officials speculated in the media that the reason for the increase was due in part to a nationwide crackdown on prescription drug abuse. The implementation of prescription-tracking programs and the shutting down of known "pill mills" especially in Florida caused a shortage of prescription painkillers on the street and a corresponding increase in price.

With pain pills harder to obtain and more expensive, people who had developed an addiction to the prescription drugs slowly began to turn to heroin, the officials speculated, simply because it was suddenly cheaper and more available.

Shift to Heroin No Longer a Theory

Now that theory is no longer speculation but backed up by scientific research, namely a survey of more than 15,000 patients in 49 states who sought treatment for their opioid addiction over a period of almost seven years.

Researchers at Washington University School of Medicine in St. Louis surveyed 15,227 patients from Jan. 1, 2008 through September 31, 2014. These patients were asked to complete anonymous surveys as they entered non-methadone-maintenance treatment programs throughout the U.S.

They were asked about their drugs of choice and patterns of use and abuse.

Heroin Use Increased Significantly

The participants were also given an opportunity to complete more detailed online interviews about their drug use if they were willing to give up their anonymity. Of the 15,227, only 267 agreed to the online interviews.

By 2014, almost 42% of drug users seeking treatment reported that they had taken both heroin and prescription painkillers within a month of entering treatment. In 2008, only 23.6% had reported using both drugs a month prior to treatment.

New Transition Toward an Old Drug

Over the almost seven years of the study, the survey found that nationwide:

  • Those who abused only prescription opioids declined by 6.1%.
  • Those who abused both prescription drugs and heroin increased by 10.3%.
  • Those who abused only heroin increased by 14.1%

Regional Trends Differ in Heroin Use

When broken down further by regions of the country, researchers found some variations from the national trend, the researchers reported.

"On the East and West coasts, combined heroin and prescription drug use have surpassed the exclusive use of prescription opioids," said senior investigator Theodore J. Cicero, Ph.D. "This trend is less apparent in the Midwest, and in the Deep South, we saw a persistent use of prescription drugs — but not much heroin."

Heroin a Supplement to Pain Pills

The study found that few who abuse prescription painkillers completely give them up to take up heroin. Instead, most use heroin to supplement their pain pill use.

"We see very few people transition completely from prescription opioids to heroin; rather, they use both drugs," Cicero said. "There's not a total transition to heroin, I think, because of concerns about becoming a stereotypical drug addict."

That may be due to the fact that there is still a significant stigma attached to heroin use, Cicero said.

Availability, Cost a Factor in Transition

"People used to tell us quite often, 'At least I'm not using heroin,' when we asked about their drug abuse," Cicero said. "But in recent years, many have come to ignore that aversion, both because heroin is cheaper and accessible and because they've seen friends and neighbors use heroin."

But, addiction is addiction. If people who have become addicted to prescription painkillers find them harder to get, they are going to turn somewhere.

"If users can't get a prescription drug, they might take whatever else is there, and if that's heroin, they use heroin," Cicero said.

Those who completed the more detailed online interview, who previously used prescription drugs before using heroin, said they made the transition to heroin for practical reasons — accessibility and cost.

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