Path to heroin addiction skips Rx opioids

The Terrifying New Trend in Heroin Addiction – VICE – Oct 2017 by Maia Szalavitz

By now, many Americans have heard sad stories that begin with a white teen innocently ingesting a prescription obtained from a pharma-influenced doctor. Often, these tales end with the degradation of heroin—a good kid accidentally addicted, driven to crime, and maybe even dead.

But if legitimate prescriptions were ever the chief pathway to heroin—and strong evidence has long existed that they might not be—new research and stories like Lesser’s suggest the pathway for people who get addicted to opioids is changing.  

Just like I did in the 1980s, heroin users in America appear to be increasingly going straight to the street drug, skipping the flirtation with pharmaceuticals.

Not that the people making drug policy seems to be noticing.

This tunnel vision focus on prescription drugs as the key factor in America’s opioid crisis is shared widely throughout the government.

a bipartisan group of state attorney generals earlier this month released a letter claiming that people “often develop opioid addiction through prescribed medical usage, with no intent by the patient to engage in abusive behavior, simply because of the addictive properties of opioid drugs.”

Except this is an overly simplified picture.

The fact is that the government’s own statistics show most people start misusing prescription pills that are not prescribed to them.

And the myth of innocent white addiction has led to policy that relentlessly focuses on reducing medical access, regardless of harm to pain patients

With President Trump set to finally declare the opioid crisis an official national emergency next week, now is as good a time as any to take stock of what America’s prescription crackdown gets wrong—and how we can do better.

New research is increasingly finding that cutting the supply of prescription opioids isn’t even stopping opioid initiation—just changing which drug people try first.

A study released this year of nearly 6,000 people treated for opioid-use disorder across the US over a ten-year period found that in 2005, only 9 percent of new users reported losing their opioid virginity to heroin.

By 2015, however, this number had more than tripled, to just more than a third.

Although most users still get their first taste from one of several prescription pills, heroin is now the single most common individual opioid taken by people first trying this class of drugs, the study found.

“It makes complete sense that in a context of suppressed prescription drug supplies, people are starting on alternative sources of opioids,” added Leo Beletsky, associate professor of law and health sciences at Northeastern University in Boston, who noted that without addressing factors that really drive demand like inequality, unemployment, mental illness and despair, substitution is hardly surprising.

In other words, cracking down on prescription drugs has not stopped people from starting opioid use. In fact, it may just be sending more first-time experimenters to the most dangerous stuff on the black market.

Another recent study published in Health Affairs found that, the number of admissions for heroin increased by 31 percent each year between 2008 and 2014

Similarly, CDC statistics show that while opioid prescribing rates peaked in 2010 and fell about 5 percent per year between 2012 and 2016, heroin overdose rates have quadrupled since 2010 and overdoses linked to synthetic opioids like fentanyl increased 72 percent between 2014 and 2015 alone.

by the time they get to opioids, even those who do start by misusing a legitimate prescription have typically more than just experimented with recreational use of alcohol, cigarettes, weed, and often psychedelics and cocaine. Going hard or exclusively after prescription drugs is not going to disrupt that.

even among those whose opioid addiction apparently began with medical exposure, 95 percent had previously taken other drugs recreationally.

Lesser’s experience of medicating symptoms like anxiety and poor emotional control seems to be the rule, rather than the exception among people who develop opioid problems.

“Psychiatric issues are very common,” Ellis explained. “Roughly two-thirds of our sample indicate they have been diagnosed and treated for a psychiatric disorder, primarily depression and anxiety.”

In yet another study with the same sample, Ellis’s group found that a similar proportion “indicated they used prescription opioids to self-treat psychological issues, and 80 percent indicated they did so to ‘escape’ from daily stressors, past trauma, [or other] issues going in their lives,” he recalled.

Fellow researchers’ data has long suggested that early life stress, trauma, and mental illness—not the first drug someone happens to try—are the real gateways to addiction.

And overhyping the dangers of certain substances clearly also runs the risk of doing more harm than good.

If America doesn’t address why people find opioid escape so compelling right now, cutting the supply of medical drugs with known strength and purity may just push users to more dangerous and unpredictable street substitutes like fentanyl.

Humans have always used chemicals as ways to change their moods.

To prevent overdose death and help people avoid damaging addiction, we need to offer alternatives—and to be creative when addressing supply so that the inevitable substitution leads to less harm, not more.

Original article: The Terrifying New Trend in Heroin Addiction

2 thoughts on “Path to heroin addiction skips Rx opioids

  1. Kriss

    I think when researchers talk about an individual having anxiety and depression as a reason to avoid opioids they need to realize and state that having one or several pain conditions that remain undiagnosed perhaps for years and not receiving adequate releif as well as the inhumane, biased, ignorant medical proffessionals encountered can bring on both anxiety and depression. In addition to being put through the ringer trying to prove the pain is real and sometimes finding out the condition is intractable,incurable and then, realizing all the time you will never get back while endless tests, procedures and mandated trial and error with all the off label pharmaceuticals and their awful side effects, many times people have great coping skills in the beginning but after such a long road it completely wears you down. They should be smart enough to recognize that anxiety and depression can be rather normal after all don’t most have PHDs?

    Liked by 1 person

    1. Zyp Czyk Post author

      It’s impossible to completely untangle and separate the mental and physical aspects of human functioning: chronic pain has many and deep influences on our mental state.

      I agree that studies on pain cannot simply exclude anyone with a “mental disorder” because it would only be a matter of degree.

      Mental illness or not, without opioids many chronic pain patients are “living in a world of pain, with no hope of relief”



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