Why Prescription Painkiller Addicts Turn to Heroin

Despite the U.S. only being home to 5 percent of the world’s population, 80 percent of prescription pain pills are consumed here. Prescription painkiller overdoses now kill more Americans than car accidents, with one death every 19 minutes on average. These statistics are shocking, but Dr. Sanjay Gupta, writing for CNN, puts forward the case that our attempts to rectify these issues are actually leading to an increase in heroin abuse. Taking evidence from several pieces of research, including a new study looking at the increase in heroin abuse among rural and suburban whites, he explains how we need to focus on the underlying issue of addiction rather than directing our efforts toward specific substances.

Prescription Painkillers and Heroin

The first thing you need to understand is that prescription painkillers are predominantly opioid drugs and, from the brain’s perspective, they’re basically the same thing as heroin. Both the illicit substance and the FDA-approved medications are derived from the same poppy plant, and their chemical structures are so similar they bind to the same parts of the brain as each other. Both legal and illegal heroin-like substances create euphoria, fight pain, cause drowsiness and, most importantly, can lead to addiction. Just like heroin, overdoses of prescription painkillers such as oxycodone (branded as OxyContin) slow users’ breathing and can lead to death. We may use one for legitimate purposes, but speaking in a strictly biological and chemical sense, they’re effectively the same thing.

The Changing Face of the Heroin Addict

Research from the 1960s showed that most heroin addicts were young men from low-income areas, who took up heroin at the average age of 18. They went straight to the illicit substance, and their demographics roughly fit in with our assumptions about opiate addicts. However, a newer study looking at the demographics of heroin abusers found that things have changed quite notably. Now, heroin addicts start using the drug at an average age of 23, are more likely to live in the suburbs (and other higher-income areas) and are likely to have started using opioids through prescription painkillers before moving onto the illicit drug. In line with this, a medical center in Charlotte, North Carolina investigated the sort of people attending heroin detox, and found that lawyers, cops, nurses and even ministers were coming in for treatment rather than the typical “addict” stereotypes. Their stories were usually the same: they went from popping prescription pills to injecting heroin, unwittingly lured into opioid addiction.

Prescription Painkillers: The New Route to Heroin Addiction

Understanding why somebody would go from a more reliable source of opioids to a street corner deal cut with who-knows-what is easier than it seems. It’s largely related to our efforts to stamp out prescription drug abuse. There are two different approaches to this issue that Dr. Gupta uses as examples.

Firstly, crackdowns on prescribing practices—as occurred in response to Florida’s “pill mills”—lead recreational users to have more difficulty obtaining opioid medicines. Between 2010 and 2012, these types of restrictions led to a 23 percent decrease in opioid overdose deaths in the state. Another method is to come up with abuse-resistant forms of drugs like OxyContin. When the new formulation of the drug came out, it seemed to have the desired effect, reducing the use of OxyContin among drug abusers from 35.6 percent to 12.8 percent. The problem is, 90 percent of patients who abused OxyContin beforehand (who were interviewed for a study on the new formulation’s impacts) either switched to another opioid drug or found a way to beat the abuse-deterrent formulation. The most common response was to switch from OxyContin to heroin.

The problem is that when access to prescription drugs is reduced, there is little the addicted individuals feel they can do other than find another way to get high. Heroin, in contrast to prescription pills, is cheap, easy to access and much harder for the government to control. And of course, the fact that most heroin abusers inject the drug means the risks of collapsed veins, infections of the heart lining, abscesses, HIV and other illnesses are added to the existing possibility of fatal overdose and other dangers from opioid abuse.

Treating the Disease, Not the Symptoms

Dr. Gupta has a solution to the problem of increasing heroin abuse stemming from prescription drug addiction, but it isn’t the “easy way out” we may be hoping for. In fact, his argument is that the quick fix solutions that have been tried so far invariably target the specific drug (either by reducing prescriptions of it or making it harder to abuse) rather than the underlying problem of addiction. If somebody is addicted to painkillers but has his supply cut off, it would be foolish to think this would magically “cure” his addiction. The exact same problem still exists, and this is why most users unable to get their chosen opioid simply switch to other drugs. While Gupta argues that the crackdown on prescription opioids is a good thing, he says as a solution to the problem it’s like treating the symptoms rather than the underlying disease.

There are no easy answers to the problem of opioid abuse in the U.S. The reasons people turn to substances like oxycodone and heroin are complex, and require psychological treatment to truly address and overcome. To really solve the problem, we need to help more people in need get into treatment, but more importantly, we need to address the underlying social and cultural issues that make the U.S. the leading consumer of prescription narcotic painkillers worldwide. We won’t accomplish this overnight, but the only way we’ll ever get there is if we start taking lasting, meaningful actions to address the deep-rooted issues in our society as a whole.

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