The Heroin/Prescription Painkiller Connection

By the 1990s, heroin use in the United States had seemingly flatlined. The drug still occupied a niche on the illegal drug circuit, but compared to its heyday in the 1960s and 70s, heroin had become something of a paper tiger.

Flash forward to the present, however, and that paper tiger has suddenly changed to a roaring lion on the rampage. While heroin use has not reached epidemic levels, it has expanded dramatically since the year 2000, filling hospital beds and treatment facilities with its unfortunate victims.

At the present time more than 500,000 Americans are estimated to be addicted to heroin, and if recent trends hold, more than 8,000 of these men, women and adolescents will die of a heroin overdose in the coming year.

These statistics raise an obvious question. Why has heroin made such a strong comeback now, after its destructive effects had given it such a bad reputation?

The answer to that question can be found on your doctor’s prescription pad, and on the prescription pads of doctors from all across the country.

From Prescription Drugs to Heroin: An Unholy Journey

Oxycodone and hydrocodone, most commonly sold under the brand names OxyContin and Vicodin, are by far the most popular narcotic painkillers on the market among doctors and patients alike. If you currently have a prescription for OxyContin or Vicodin, you are not exactly part of an exclusive club—in 2012, the most recent year for which we have records, there were 259 million prescriptions for opioid painkillers given out by medical professionals in the United States. That is more than enough to supply every adult in the country with at least one bottle of pills.

These drugs are highly effective against chronic pain, which is the main reason they are prescribed so freely. Unfortunately they are also opioids—just like heroin—and they can be every bit as addictive as their more disreputable cousin.

Since opioid painkillers came into widespread use in the late 90s, the number of people addicted to them has skyrocketed. OxyContin in particular has proven effective at creating addicts out of innocent people who only wanted relief from their suffering. An OxyContin addiction progresses slowly, cravings for the drug gradually intensifying until they become impossible to ignore and difficult to resist.

While 500,000 heroin addicts in the United States sounds like a lot, there are four times as many people addicted to opioid painkillers. Approximately 17,000 people will die annually from prescription opioid misuse and abuse, which represents almost half the total number of prescription drug overdose victims. Thanks to the proliferation of legally prescribed opioids, drug overdose has now become the leading cause of injury-related death in the United States, surpassing automobile accidents and homicide.

So what does this have to do with heroin addiction? A lot, as it turns out.  From the standpoint of the brain receptors that respond to these drugs, one type of opioid is indistinguishable from the other, meaning that if you have an addiction to OxyContin, heroin will do just fine as a substitute.

Despite their popularity as painkillers, prescription opioids are expensive and still relatively hard to obtain, while heroin is cheap and widely available through the black market. Insurance or Medicaid might help pay for OxyContin when it is originally prescribed, but once a habit develops, more and more pills are needed and the subsidized health care system is no longer accessible as a source. Consequently, many people who start out on prescription opioids eventually switch to heroin because it is all they can find and afford.

In an article published in the July 2014 edition of the peer-reviewed journal JAMA Psychiatry, researchers discussed the results of a study that looked at the life histories of heroin addicts from two eras. While those who started taking drugs in the 1960s almost always began their opioid use with heroin, about three-fourths of modern-day heroin addicts said they had abused prescription opioids first.

Passing Through the Gateway to Danger

The “gateway” drug idea has always been controversial. The concept has been particularly abused with respect to marijuana, which was demonized for decades as a gateway drug that supposedly predisposed users to eventually try much harder substances.

But prescription painkillers like OxyContin are gateway drugs that can and do lead people to heroin. This is not undocumented opinion but rather cold, hard fact.

If you or anyone you know has been taking OxyContin or any other type of narcotic prescription painkiller, you need to be aware of how dangerous these substances can be. They should only be used as prescribed and you should never be hunting for extras when the original order runs out. Ideally they should only be taken as a last resort after other pain management strategies have failed.

You or your loved one may really believe you need prescription painkillers to help you manage your pain. Nevertheless, you should still talk to your doctor before you continue taking them (especially if you have been taking them beyond a single prescription) to see if he or she might have recommendations for alternative pain therapy.

Of course the fact that others have moved from prescription opioids to heroin does not mean the same thing will happen to you or to someone in your family. However, the risk is real and it is not one you can afford to take lightly. No one plans to become addicted to medication, but it does happen on occasion and you need to be aware of that reality and all the potential hazards that accompany it.

If you have any reason to suspect your prescription opioid use is becoming excessive, you should consult with a physician or addiction specialist for advice and guidance.  But if you have already moved on from prescription drugs to heroin, you are in extreme danger and should seek professional help immediately.