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Does Prescription Opioid Use Increase the Chances of Heroin Use?

As the opioid epidemic has worsened over the past few years, people have started to point the finger at pharmaceutical companies. Opioid prescribing rates have increased dramatically increased over the past 20 years, hitting their peak in 2012. 

The U.S. Centers for Disease Control and Prevention reports that more than 191 million opioid prescriptions were issued in 2017. However, 15,482 of the 47,600 overdose death rates in 2017 involved heroin. In that same year, 28,000 deaths were caused by synthetic opioids like illicit fentanyl. 

Prescription opioids were involved in 17,029 deaths in 2017, but many of these overdose cases also involved other opioids, such as heroin and synthetic opioids. Since illicit opioids seem to have such an impact on the opioid crisis, is the overprescription of opioids related to heroin use?

According to the National Institute on Drug Abuse (NIDA), prescription opioid use is a risk factor for later heroin use. More specifically, the abuse of prescriptions may lead to a substance use disorder that results in the use of illicit opioids. According to NIDA, almost 80 percent of heroin users reported using prescription drugs before switching to heroin. 

Why Do People Go from Prescriptions to Heroin?

The vast majority of people who take opioid prescriptions as directed do so without developing substance use problems. However, taking the drugs in high doses or for too long can result in chemical dependency and addiction. Recreational use of opioid prescriptions can also cause a severe substance use disorder. 

Overprescription contributes to addiction when people give extra pills to friends and family members who don’t have a prescription for the medication. However, once an addiction to pills develops, it’s hard to keep it up. People in this position may start out doctor shopping, looking for multiple doctors who will continue to give them opioids without realizing they no longer have a medical need. They may also be able to buy prescription pills illegally, but they are expensive and hard to find. 

According to NIDA, heroin is cheap and easy to find. In fact, heroin is the second most easily attainable illicit drug on the market after marijuana. Heroin is trafficked into the United States by transnational criminal organizations and distributed by Mexican cartels and local gangs. The market is flooded with heroin, which means prices drop, making it much easier for people to find and afford it. 

Dealers also tamper with heroin to increase profits and spread out their supply. To mask weakened heroin, they sometimes include extremely potent synthetic opioids, such as fentanyl. However, contaminating heroin with fentanyl and its analogs makes the drug even more dangerous and raises the risk of having an overdose. 

Increased Availability or Increased Demand?

According to NIDA, it’s unclear whether heroin’s popularity is a result of increased availability or increased demand. The fact that the majority of heroin users report using other opioids first may suggest that increased demand has led to increased supply. However, NIDA also reports that studies have found that the vast majority of people who switched from prescription to heroin did so because it was so cheap and easy to find.

Sources

CDC. (2018, October 3). U.S. Opioid Prescribing Rate Maps. Retrieved from https://www.cdc.gov/drugoverdose/maps/rxrate-maps.html

CDC. (2019, April 2). Synthetic Opioid Overdose Data. Retrieved from https://www.cdc.gov/drugoverdose/data/fentanyl.html

Hoffman, J. (2019, August 26). Johnson & Johnson Ordered to Pay $572 Million in Landmark Opioid Trial. Retrieved from https://www.nytimes.com/2019/08/26/health/oklahoma-opioids-johnson-and-johnson.html

National Institute on Drug Abuse. (2018, January). Prescription opioid use is a risk factor for heroin use. Retrieved from https://www.drugabuse.gov/publications/research-reports/relationship-between-prescription-drug-heroin-abuse/prescription-opioid-use-risk-factor-heroin-use

National Institute on Drug Abuse. (2018, January). Heroin use is driven by its low cost and high availability. Retrieved from https://www.drugabuse.gov/publications/research-reports/relationship-between-prescription-drug-abuse-heroin-use/heroin-use-driven-by-its-low-cost-high-availability

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