The prescription drug epidemic may be showing signs of easing, according to new federal statistics, but the news isn’t as positive as it may sound. Every day in the U.S., 114 people die as a result of drug overdose, and the majority of these deaths are due to prescription medications. Newly released figures from 2012 show a reduction in prescription painkiller overdoses, but there has been a concurrent increase in heroin overdoses, which raises concerns that many prescription drug abusers are switching to the illicit opioid. The findings show that efforts to curb prescription drug abuse are enjoying some success, but they also raise serious concerns about the effectiveness of focusing on specific substances rather than addiction on the whole.
Prescription Drug Abuse, Overdose Deaths
Most deaths from drug overdose are now due to prescription medicines, and the vast majority of these relate to prescription opioids like oxycodone (OxyContin), fentanyl (Duragesic) and hydrocodone (Vicodin). In 1999, these substances were responsible for 4,030 overdose deaths, but by 2011 this figure had more than quadrupled to 16,917. Between 1999 and 2006, the death rate increased by 18 percent per year, but this slowed to an increase of around 3 percent per year from 2006 to 2011. When looked at alongside the size of the population, the deaths from opioid painkillers increased from 1.4 per 100,000 in 1999 to 5.4 per 100,000 in 2011. Since 2008, opioid painkillers have been responsible for more deaths than heroin and cocaine combined.
Painkiller Deaths Starting to Decrease
The new figures show a 5 percent decrease in opioid painkiller-related deaths, down to 16,007 in 2012. For all categories of prescription drugs, there has been a 3 percent decrease in the number of deaths. Michael Botticelli, director of the White House Office of National Drug Control Policy, said, “It’s some really encouraging news after many years of really grim news.”
Many approaches have been implemented to attempt to reduce the number of overdoses from prescription drugs, and it appears that they are having an effect. Prescription drug monitoring programs are one example, which are centralized records of who receives a prescription for drugs like opioid painkillers, aiming to prevent people from visiting more than one doctor to get multiple prescriptions of the same medicine (“doctor shopping”). These programs were only present in 20 states in 2006, but this has since risen to 48 states. There have also been crackdowns on doctors who over-prescribe the medicines, not to mention a lot of awareness-raising around their risks. Other approaches, like abuse-resistant forms of medications like OxyContin, have also had a role to play.
Are Prescription Drug Abusers Switching to Heroin?
The downside is that the findings also provide evidence of an increase in heroin use. In 2011, there were 4,397 deaths from heroin overdoses, but in 2012 this had increased to 5,927. The problem is that heroin and prescription opioids interact with the same part of the brain in the same basic way, which means that those who develop an addiction to prescription painkillers can continue to get their fix with the illicit substance.
The fact that heroin overdoses have increased while prescription opioid overdoses have decreased is cause for concern. It could indicate that measures to prevent abuse of prescription drugs are reducing their availability, but instead of kicking their addictions to opioids, more people are simply switching over to the cheaper, often more accessible but illicit drug.
According to Botticelli, fewer than 5 percent of prescription painkiller abusers move to heroin, but other evidence from a study of people in treatment for heroin abuse suggests that three-quarters of those who began using opioids after 2000 started on prescription medicines. There is also evidence that the new abuse-resistant version of OxyContin successfully reduced abuse of OxyContin, but users predominantly either switched over to another prescription opioid or to heroin.
Reducing Access to Pills or Reducing Addiction?
The reduction in prescription painkiller deaths shows that the approaches specifically designed to reduce abuse of medications work. However, the switch to heroin highlights the shortcoming of that approach: the problem is addiction itself, not prescription pill abuse. Reducing access to one drug doesn’t stop someone from using other substances as a poor coping mechanism for emotional, social or psychological issues. The maladaptive patterns of coping still continue; the only difference is that they can’t be expressed in exactly the same way. In short: stopping pill abuse simply isn’t enough; you have to tackle addiction if you really want to get somewhere. It might not be as easy to solve, but if we’re able to reduce addiction, the positive results with one substance won’t be marred by increases in the use of another.