Is Pain Medication the Gateway to Heroin?

Is Pain Medication the Gateway to Heroin? – By Zachary Siegel 04/10/16

With detail, clarity, and rigorous sourcing, Mr. Siegel has written a thorough debunking of the myth that opioids prescribed for pain lead to heroin use and overdose. He shows how destructive this myth is and how contradictory data has been overlooked by policy makers.

To say, as the CDC did, that both pain patients and doctors are the culprits in rising mortality is misguided for several reasons.

As the death toll from opioids and heroin rises, people are looking for answers, and also, someone to blame.

This may be another aspect of current anti-opioid policy development: all parties want to make sure the blame for so many overdoses does not fall on them.  

The director of the Centers for Disease Control and Prevention [CDC}, Dr. Tom Frieden, thinks he’s found both, in light of recently calling the epidemic of overdoses “doctor-driven,” where it’s urged that prescribers reign in the number of patients—particularly those with chronic pain—prescribed to opioid pain relievers.

He believes that the epidemic “can be reversed in part by doctors’ actions.”

It may sound like a sensible thing to do. The less prescription painkillers out there, in theory, the less chances there are of people becoming addicted to them.

But there is a catch: the the 8 million chronic pain patients currently prescribed to opioid pain relievers, the overwhelming majority of whom are not addicted, will see their supply cut off.

So why should this group be bearing the brunt of restrictive policies and regulations when they’re not the ones contributing to the extreme death toll in the first place?

The panic over pain pills has reached far and wide. One New Jersey hospital, … became the first in the country to abandon the use of opioid pain relievers all together. If you had a broken wrist would you want to be rushed to this ER?

To say, as the CDC did, that both pain patients and doctors are the culprits in rising mortality is misguided for a few reasons:

1) patients who suffer from chronic pain rarely misuse their medications or wind up addicted;

2) over 75 percent of people who misuse prescription painkillers score them the old fashioned way—from friends and dealers or other illicit sources, rarely physicians; and finally

3) the CDC itself found “those at highest risk of overdose are about four times more likely than the average user to buy the drugs from a dealer or other stranger,” not through a doctor’s prescription

So the hard truth behind opioid prescribing, which the CDC neglects in its guidelines, is that the vast majority of people on them simply do not develop a dependency.

But there is another story fueling the prescription painkiller panic, one that must be quashed. It’s an uncritical trajectory being peddled, that prescription painkillers are the “gateway to heroin.”

People attribute this false trajectory as another primary cause of the current opiate crisis. And as a result, people who actually need opioids are being undertreated because of the new heroin hysteria. 

This is exactly what pain patients are suffering: rapid, sometimes instantaneous, decreases or even stoppages of their opioid pain relievers – the medication that gives them a decent chance at a full life.

The reality is that people are not moving toward heroin in the way it’s being portrayed. A 2013 study by SAMHSA found that even among the non-medical use of prescription pain relievers—i.e., people who took them without a prescription—the “vast majority” did not progress to heroin use.

Only 3.6 percent of this group began using heroin within five years after their first non-medical use.

While there is a great need to keep doctors in check, to prevent future pill mills and such, restricting the supply of opioids for people who need them will not make a dent in rising mortality.

It’s simply the wrong target. 

This is truly a simple truth – and a glaring error in the CDC guidelines.

Instead of cutting the supply of painkillers—which, as history tells us, only drives more people to black markets—why not put more resources into adequate, science-based treatment, so those who do get addicted get the help they need?

Sadly, this is generating a torrential flow of money into the recovery business.

The recovery industry is taking advantage of the current hysteria about opioids. With vast profit potential and no regulation, new recovery businesses are springing up, gladly financed by big business and even smart hedge-fund money.

Cutting the supply without a safety net to catch them sounds like another disaster waiting to happen.

Lastly, no one really understands why people, especially young people today—among whom heroin use has more than doubled in the past decade—are dulling themselves with a powerful, dangerous drug.

It’s this pain that must be understood and alleviated.

With his closing sentence, Mr. Siegel dives down into the deeper source of the problem: increasing numbers of people becoming addicted without a clear cause to blame.

Though many would deny it, the increasing economic pain and societal misery in our country could very well be driving the high rates of addiction/overdoses and a host of other societal ills. (I saw a graph that showed how addiction and economic disparity have been rising in parallel)

These are just my comments and selected annotations, but in the full article, Mr. Siegel gives the colorful example of his own story, of how he discovered his intense love of opioids through a prescription after spraining an ankle and eventually moved on to heroin because it was so much cheaper.

Is Pain Medication the Gateway to Heroin? –  Zachary Siege  has been a regular contributor to The Fix since 2013.


3 thoughts on “Is Pain Medication the Gateway to Heroin?

  1. Kathy C

    This false narrative benefits a lot more than just the “Addiction Industry.” Big Pharma, th Medical Industry, and the Insurance Industry are all benefiting too. Pharma is Marketing more expensive under Patent drugs that are not even “better” that Placebo. The Insurance Industry can deny certain types of care, because they are pain related, this includes everything from back surgery to cancer treatments. They are now doing people a favor by keeping them away from “Care”. Workman’s Comp has found another way to avoid paying injured workers, because pain is no longer an indicator, and postponing treatment or coverage is now up to them,and their Doctors. If they can avoid covering just 10% of their claims, it will add up to billions. The Medical Industry too, now they have virtually no Liability for any long term Chronic Pain conditions due to their negligence. If they deny someone care, and they later die, they are acting in their interest, because they could have become addicted. No more of those Lawsuits either, for failed surgeries, that was adding up and they had to come up with a remedy.
    The Corporate media has been having a field day with this too. Those so called “Liberal Media” stories where they venture into the “heartland” always disparage some poor person on Opiates. The story is no longer a failed surgery, lack of access to healthcare, or too many years working at a psychically demanding job. Now the narrative is a patronizing blaming of drugs for the economic inequality, while they spout the same old false narrative.
    now every sanctimonious ignorant person is “informed” about addiction, many with emotional stories of a cousin or someone they knew. They never tell the whole story. Even when the Media does do any “Coverage” it is all anecdotal, one person somewhere who went through a “Program.” They have made it very clear that sensationalism sells,and is very profitable. The corporate Media has kept us all in the dark about a lot of things. It is all a matter of distraction. They take people’s attention away from things that might actually affect them and create narratives to justify it. The problem in Middle America isn’t Corporate greed, and corruption leading to economic collapse, it is “Drugs.” this is re-reinforced every night on the “News” with a story of some drug related Crime,
    Now they are pushing the “Cures Bill” through Congress, a Trojan Horse of so called progress. hidden in their is more Industry power and profit. They even dangle funding for “Addiction.’ This is as they tout these Companies in the Business pages. They are poised to make even more money, while most people are not paying any more that superficial attention. The name “Cures” makes it appear like a wonderful thing, very misleading. Anyone who questions this is an awful person because we need “cures.” Most of these FDA approved Medication and devices that have been sold to the unsuspecting public has been found to have used misleading tactics regarding the safety or efficiency of these. We only know when this stuff has a really bad and obvious outcome. They don’t really collect any meaningful data, because it is all about marketing and appearances. This will be another win for the big industries. by the time it becomes apparent that whatever they are selling does not work or is dangerous, they will have already made their billions. Just like the Addiction Industry, there is no clear definition of an Addict, so even people who aren’t addicted can appear to be cured. They don’t mention that fact that most of these programs don’t work. There is just enough opinion and appearances in the marketing that it does not have to. Now everyone is an “Addict” the grandma with a couple of hip surgeries, the device failed, but she is now a drug addict not a surgical mistake. The injured big box store worker, no longer a person who worked too hard pursuing the “American Dream” who listened to “You can Do it.” Now he is just a malingerer, and drug addict, they don’t discuss the physical damage to his body due to the heavy lifting day in and out. They don’t even acknowledge that any kind of injury can be painful, they just don’t mention it. The same tactics that the media used to hide reality from the populace works just fine in medicine. After all the Physician does not care if they have ruined a persons potential and quality of life. They don’t have to see the repercussions, that same Physician is brainwashed into blaming the patients for his failure to achieve his level of success. Physicians are now dependent and on the big Corporate healthcare Companies. They are told to blame patients for their situation. They have also signed gag orders and non disclosure agreements so they can’t even discuss anything anymore that isn’t for the benefit of the billion dollar corporation. Any deviation or discussion outside of the popular narrative is not allowed. Retribution is swift, their career is at stake. This is no longer about curing anything or the betterment of humanity, it is all about profits. All about false narratives and misdirection, there is a lot of money at stake. Not just the Addiction Industry.

    Liked by 1 person

    1. Zyp Czyk Post author

      I must agree that all the latest “policies” on opioids can be understood best if you just “follow the money”.

      There’s always someone making a huge profit from such government decrees, which they have openly (or secretly) initiated and/or supported (like PROP has done with the CDC guidelines).

      People think pharma profits from selling pain pills, but more and more of them are generic by now, so they need to create a market for new drugs (non-opioid pain relievers and anti-addiction drugs).

      Also, because addiction, like pain, cannot be imaged and measured, they can say whatever they want about its cure – there’s no science supporting it and no regulation to rein it in.


      1. Kathy C

        I found this on an Irish News Site,

        This would have be censored by our Media and most certainly by Medical “News” The Subject mentions “Failed back surgery” and other things that are not complimentary to the Industries. This is part of how we got here. They left the real story out of the “News.”
        If we do see a version of this, it wil be without mention of any failure on the part of the “System.” It will be run as a “feel good Story.” A tale of overcoming the odds, and perseverance. They won’t mention the Failed Device, the failed back Surgery or his paralysis due to Medical incompetence.



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