Prescription opioid use is increasingly likely to lead to heroin abuse
Senior investigator Theodore J. Cicero, PhD, has been researching heroin, its effects and its abuse since the 1970s.
During this time, he has witnessed large changes in the way that heroin is used, and the demographic of its users.
Over recent decades, heroin abuse in the US has vastly changed its appearance. Once the reserve of poor inner-city men, it has rapidly spread its tendrils into suburbia and more rural settings.
"Individuals who began using heroin in the 1960s were mostly young men in their mid-teens whose first opioid drug was heroin, more recent initiates have a very different profile. Most were in their mid-20s and predominantly white (90%), lived in suburban or rural areas, and began abusing prescription drugs before trying heroin."
When asked during an interview with JAMA Psychiatry what the current demographics of a heroin user are, Cicero answered:
"The typical heroin user in our population is a white, middle-class male or female. Historically, females were a minority of heroin users. Most are in their mid-20s and fairly well educated. It's not who you would picture a heroin addict to be."
In his most recent study, Cicero, in conjunction with researchers at Washington University School of Medicine in St. Louis, conducted a large scale survey.
The survey was designed specifically to investigate joint use of prescription opioids and heroin. The survey covered 15,000 patients at drug-treatment centers in 49 states.
The major findings were that users of painkillers were often taking heroin within the same time frame.
The primary questionnaire was anonymous. A further 267 participants waived their rights to anonymity to answer additional, more detailed questions about their drug use. Of these, 129 reported they had abused prescription opioids prior to trying heroin, and 73% cited factors such as cost and ease of access when explaining why they started to use heroin.
The changing face of heroin abuse
In 2008, 23.6% of drug users currently in treatment had taken prescription opioids and heroin in the first month of starting treatment. This figure has risen sharply, and in 2014, almost 42% had taken both drugs within the first month.
Cicero described the results, which were published on October 29th in a letter in The New England Journal of Medicine:
"On the East and West coasts, combined heroin and prescription drug use has surpassed the exclusive use of prescription opioids. This trend is less apparent in the Midwest, and in the Deep South, we saw a persistent use of prescription drugs - but not much heroin."
During past research, Cicero often heard prescription drug abusers say "at least I'm not using heroin." Historically, people have been averse to trying heroin because of its negative connotations in the news and movies.
Cicero says that this is slowly changing:
"In recent years, many have come to ignore that aversion, both because heroin is cheaper and accessible and because they've seen friends and neighbors use heroin."
Recently, the federal government has made strong efforts to shut down the so-called "pill mills" and make prescription opioids more difficult to come by.
Cicero himself was involved in a project to make OxyContin more difficult to abuse. They altered the tablet's composition so it could not so easily be snorted or injected. This caused an initial decline in the abuse of OxyContin, but it also heralded a "dramatic" rise in heroin abuse.
The conclusions of this research are that if a drug user is addicted to prescription painkillers and unable to source their normal drug, they are increasingly likely to turn to heroin, which is becoming a public health concern.