Studies Show Heroin Crisis Not Caused by Medical Use of Rx Opioids

Heroin Crisis Not Caused by Medical use of Rx Opioids: Research Gives Context To Addressing Nation’s Drug Abuse Crisis, Review Finds | Kaiser Health News

Prescription painkiller abuse is drawing national attention as states battle increasing abuse cases, presidential candidates offer possible solutions and even President Barack Obama includes the issue in his State of the Union address Tuesday night.

The review of recent studies examines the often cited link between abuse of prescription painkillers and heroin use. That consequence, the researchers say, fuels the need for better treatment and prevention of prescription drug abuse.

They noted, however, that  although the majority of current heroin users report having used prescription opioids nonmedically before they initiated heroin use,

heroin use among people who use prescription opioids for nonmedical reasons is rare, and the transition to heroin use appears to occur at a low rate.”  

The correlation between painkillers and heroin, the authors suggest, could be in part because the drugs are chemically very similar. Heroin, meanwhile, has become much cheaper than it was 20 years ago, the review notes.

“Once someone has a significant habit or addiction to [prescription painkillers], heroin turned out to be cheaper and readily accessible,”

The top 10 percent of doctors prescribe about 57 percent of all painkillers, according to a study he co-authored that came out last December. That’s fairly concentrated but still consistent with other kinds of medications that aren’t abused — about 63 percent of all medications are prescribed by only 10 percent of physicians.

The NEJM article addresses another issue that’s been raised: whether efforts to curb inappropriate painkiller use will just drive more people to use heroin instead.

On the whole, the article said that studies in a variety of states, including North Carolina, Wisconsin, Florida and New York, did not find a clear link between those efforts and increases in heroin deaths.

“For an individual patient, when a doctor cuts them off [from painkillers], that may have been a strong motivation” to get heroin, Compton said. But on a larger basis, that isn’t generally the case, the review indicated.

To fully address painkiller abuse — and to curb heroin addiction — policymakers need to keep  people from getting started with drug abuse, but also to get treatment for those who need help, Compton said.  

I will post excerpts from the full NEJM article tomorrow.

 


I just saw another article about this, so this is apparently a significant find:

What is the Pathway to Heroin Use?

US researchers are challenging a leading theory about the nation’s heroin epidemic, saying it’s not a direct result of the crackdown on opioids. The commentary has been published in the the New England Journal of Medicine.

“The prevention efforts don’t seem to be pushing people to heroin. We think there are other factors,” commentary lead author Wilson Compton, MD, deputy director of the US National Institute on Drug Abuse, told HealthDay. The common link is that heroin and opioids are in the same class of drugs and have similar effects, he said. “It’s the initial exposure to opioids that’s pushing them to heroin.”

In the past, abusers might have begun with heroin and then turned to the prescription narcotics, Compton said, but now the pattern is reversed.   

3 thoughts on “Studies Show Heroin Crisis Not Caused by Medical Use of Rx Opioids

  1. teeks55

    Hi Zyp….good to be back on WordPress and reading all your wonderful posts. I have a lot to catch up on. Thank you for bringing all this crucial information to us. I appreciate all your tireless effort!! xoxo

    *****************************

    Well….I am just one of probably hundreds of thousands of chronic pain patients who are prescribed opioids for pain control in the USA. I have never abused them or taken more than I am supposed to. But then, my rheumatology NP understands my level of pain and has prescribed me an adequate dose.

    I just want to say that I have never, nor would I ever, “move on” to heroin for any reason. I am not looking to get high or to feed an addiction. I am looking for some sort of quality of life despite disabling chronic pain. That’s all.

    I have no interest in heroin. Thankfully I have a NP who gets me and knows me and trusts me enough to provide me with the opioid medication I need to control my pain (to a point…sometimes I have breakthrough pain but for the most part it is under control with the dose I am given).

    I know I am very blessed to have a relationship with this medical professional. I know from personal experience, after walking this chronic pain journey for nearly 35 years, that many doctors and NPs do NOT believe in giving patients opioid medication for any reason, no matter how bad the pain is. Which is not only sad, but unconscionable.

    I have seen countless doctors over the course of 35 years and some are heartless, cold, and dare I say, even cruel. They have no compassion for us and no concept of what it’s like to live a life in daily, severe pain. Some doctors did prescribe me opioids and some refused to. The ones that did not were not looking out for me or my needs but feeding their own agenda, in my opinion.

    I am lucky to have this NP in my life right now. But even though she is incredibly understanding and kind, she did have me sign a “Pain Contract” so that I would not get pain meds from any other doctor, that I would not take “illicit drugs” of any kind, etc. I did sign it and I honor my word. I have no reason to seek meds from other sources since she provides me what I need.

    I believe that we, as patients, deserve to have medical professionals as PARTNERS with us in our quest to have a quality of life despite our medical conditions. Chronic pain is a medical condition, no matter what disease is causing it. We do not need DICTATORS, who refuse to look at and consider each patient individually (lumping us all into one big pile and saying a loud “NO!” to us when we need pain medication)…. we need doctors who can partner with us to find the best way to treat us so that we can live our lives with the least amount of pain….and if that way is opioids, so be it.

    I am just one of many chronic pain patients who tow the line and walk with a clear conscience….taking my medicine as prescribed and trying to have a life in spite of my chronic pain condition.

    *********************************

    Keep up the good work, Zyp. I look forward to reading more of the articles you bring to us. Thanks again. xoxo

    Liked by 1 person

    Reply
    1. Zyp Czyk Post author

      Nice to hear from you again and thanks for the compliments!

      Even when I first started taking opioids in the 90’s, I always went to only one doctor and one pharmacy so that they could be tracked – by me! I liked going to the same pharmacy because they got to know me and my unusual prescriptions, and were thus able to answer detailed questions about interactions and substitutes.

      Perhaps they were so understanding because the pharmacy is located in a low crime (rich) neighborhood and the clientele is so well behaved. I’ve spoken with them about opioid issues and they way they talk to me makes it clear they believe in my pain.

      I know this is another blessing, in addition to having found a good prescribing doctor. My (and your) good experiences are very rare, and I feel sad and angry for all the folks that have to struggle to get their pain meds or are outright cut off.

      Liked by 1 person

      Reply
      1. teeks55

        Hopefully things will continue to go smoothly with this rheumy NP. She recommended a new general NP to see for the usual stuff (not chronic pain necessarily) because the one I was seeing treated me like a criminal because I was on opioids, even though she wasn’t prescribing them. I got sick of her smirks when I told her my fibro and my osteo were getting worse as I age….got tired of the attitude. She was a control freak and I’d had it. So the first visit with the new NP went very well, I like her a lot and I think she is quite smart. She took a look at my hubby’s abdomen while he was on the exam table and discovered a hernia that he didn’t know he had. Who knows how long he would have gone before getting a diagnosis. Anyway…off topic, but just to say that we’re starting a new chapter in the book of our lives and hopefully we will have a good rapport with this new NP and I’ll continue to have a good rapport with my rheumy NP. I don’t have anything against doctors, I just happened to land with these NP’s and so far all is well. There are doctors in the practice if they need any assistance but I think we are good to go. So! Wish me luck!! As I do you! I’m glad you’ve got a good doc and a good pharmacy. I, too, have used the same pharmacy for years, know most of the staff on a first name basis and it makes life a lot easier. :) Have a great weekend, Zyp!

        Liked by 1 person

        Reply

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