Why Do Prescription Opioid Abusers Start Using Heroin?

Significant numbers of people throughout the U.S. abuse prescription opioid medications such as OxyContin and Vicodin. In turn, substantial numbers of the individuals who abuse these medications will eventually transition into use of the powerful opioid drug heroin. In a study published in May 2014 in the American Medical Association journal JAMA Psychiatry, researchers from two U.S. universities explored the reasons some prescription opioid abusers eventually initiate heroin use. These researchers concluded that any given person commonly has any one of three potentially overlapping reasons for making the transition from opioid medications to heroin.

Opioid Abuse in the U.S.

In most cases, doctors prescribe opioid medications to treat serious short- or long-term pain, although other legitimate uses for these substances also exist. According to the most up-to-date figures compiled by the federal Substance Abuse and Mental Health Services Administration, opioid painkillers are by far the most commonly abused medications across the U.S. In any given month, roughly 1.9 percent of the country’s teen and adult population will participate in prescription opioid abuse. Throughout the 2000s, the rate of people abusing prescription opioids has hovered between a low of 1.7 percent (in 2011) and a high of 2.1 percent (reported in the years 2006, 2007 and 2009). Broadly speaking, people in their mid- to late-teens and their 20s have the highest chances of abusing opioids or some other illegal or illicit drug or medication.

From Opioid Medications to Heroin

Since they come from a common source (namely, the opium poppy), opioid medications and opioid drugs like heroin produce their effects on the brain and body in the same basic manner. However, when taken in the amounts typically prescribed by doctors, opioid medications do not produce the same level of intense pleasure as heroin; partly for this reason, they also don’t trigger the same level of risk for opioid addiction. The situation changes when a prescription opioid user takes a given medication in amounts substantially greater than those that doctors usually prescribe. In these circumstances, opioid medications can have effects that more closely mimic the effects of heroin; in turn, recurring prescription opioid abuse comes with a clearly increased risk for the development of an addiction. Current evidence reported by the National Institute on Drug Abuse indicates that close to 50 percent of all young adults in the U.S. who inject heroin had a prior history of opioid medication abuse.

Why Does the Transition Occur?

In the study published in JAMA Psychiatry, researchers from Washington University in St. Louis and Nova Southeastern University used information from a long-term project called the Survey of Key Informants’ Patients (SKIP) Program to analyze the reasons some prescription opioid abusers make the transition to heroin use. This project gathers anonymous data from thousands of opioid abusers and addicts receiving treatment at over 100 public and private facilities located throughout the U.S. In addition, small numbers of the SKIP Program participants break their anonymity in order to provide researchers with more detailed information on their substance-using behaviors.

Altogether, the researchers identified 2,797 heroin users among the SKIP Program participants. Unlike previous generations of heroin users (many of whom had no prior experience with any form of opioid substance), most of these individuals had first used/abused a prescription opioid. When the researchers probed the reasons for the switch to heroin, they identified three main factors: a preference for the specific type of opioid “high” provided by heroin intake, the relative ease of obtaining heroin compared to the ease of obtaining prescription opioids and the relative ease of taking heroin by snorting the drug through the nose or injecting it into a vein or under the skin.

The study’s authors note that the price of even a single tablet of an opioid medication can be as much as eight times higher than the price of a typical dose of heroin. In addition, one of the most commonly abused prescription opioids, OxyContin, has been reformulated to reduce its potential for misuse through snorting or injection. In combination, these facts may act as major motivations for the transition to heroin use among many previous prescription opioid abusers. The authors also note that heroin, once typically considered a drug of choice for non-whites and people living in highly urbanized areas, has now become largely a drug of choice for whites, as well as for people living outside of heavily urbanized areas. Previous exposure to prescription opioids may play a crucial role in both of these demographic trends.

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