Drug abusers are not completely abandoning prescription opioids for heroin. Instead, many use the two concurrently based on their availability.
A new survey of 15,000 patients at drug-treatment centers in 49 states also suggests regional variations in the use of heroin and prescription painkillers, researchers say.
“On the East and West coasts, combined heroin and prescription drug use has surpassed the exclusive use of prescription opioids,” says senior investigator Theodore J. Cicero, professor of neuropharmacology in psychiatry at Washington University in St Louis. “This trend is less apparent in the Midwest, and in the Deep South, we saw a persistent use of prescription drugs—but not much heroin.”
“If users can’t get a prescription drug, they might take whatever else is there, and if that’s heroin, they use heroin.”
According to the study, published in the New England Journal of Medicine, across the country in 2014, almost 42 percent of drug users in treatment reported they had taken heroin and prescription painkillers within a month of entering treatment, up from 23.6 percent in 2008.
“We see very few people transition completely from prescription opioids to heroin; rather, they use both drugs,” Cicero says. “There’s not a total transition to heroin, I think, because of concerns about becoming a stereotypical drug addict.”
Although heroin has spread beyond inner cities into suburban and rural areas, many users still connote the drug with junkies they’ve seen depicted in movies and on television, he says.
[Heroin, painkiller addiction goes hand-in-hand]
“People used to tell us quite often, ‘At least I’m not using heroin,’ when we asked about their drug abuse,” Cicero says. “But in recent years, many have come to ignore that aversion, both because heroin is cheaper and accessible and because they’ve seen friends and neighbors use heroin.”
For the study, researchers conducted anonymous surveys when users entered drug treatment, asking about drugs of choice and patterns of use and abuse.
Survey takers also had the option of giving up their anonymity to answer more detailed questions about their drug use. The study included detailed data from 267 such patients. Of them, 129 reported they had abused prescription opioids prior to heroin, and 73 percent cited factors such as cost and accessibility when explaining why they began using heroin.
[Many ER patients don’t know painkillers are addictive]
The federal government’s push to shut down “pill mills” and doctors illegally prescribing painkillers has made it harder to get prescription painkillers, Cicero says. For those who are addicted, heroin has been the supplement of choice.
“If users can’t get a prescription drug, they might take whatever else is there, and if that’s heroin, they use heroin.”
Private funds from Washington University School of Medicine in St. Louis and the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS) System supported the work.
