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.