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:
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.