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Here’s a chilling fact: it is statistically likely that a person addicted to heroin was first addicted to opioid prescription painkillers, a dependence that might have developed within the first few days of taking them.
There is a fine but crucial difference between opioid dependence and addiction. According to Dr. Scott Gottlieb, FDA Commissioner;
- “Addiction requires the continued use of opioids despite harmful consequences on someone’s life. …But someone who is physically dependent on opioids as a result of the treatment of pain but who is not craving the drugs is not addicted.”
Dependent In Days
A recent study, published by the Centers for Disease Control and Prevention (CDC), found a spike in long-term opioid use among patients that used prescription painkillers for as little as five days. The report also details how the probability of long-term use increases after just 13 days and, yet again, at more than 30 days of opioid painkiller therapy.
This CBS article states “Doctors who limit the supply of opioids they prescribe to three days or less may help patients avoid the dangers of dependence and addiction, a new study suggests. Among patients without cancer, a single day’s supply of a narcotic painkiller can result in 6 percent of patients being on an opioid a year later, the researchers said.”
“Every day, more than 130 people in the United States die after overdosing on opioids,” according to the National Institute on Drug Abuse (NIDA). “The misuse of and addiction to opioids – including prescription pain relievers, heroin and synthetic opioids such as fentanyl – is a serious national crisis that affects public health as well as social and economic welfare.”
- What’s staggering is that more than 80 percent of people addicted to heroin started their addiction by misusing prescription opioids.
NIDA also reports the following:
- More than 25 percent of patients prescribed opioid painkillers misuse them. About 12 percent of those patients develop a dependence on the medications
- Among patients that misuse prescription opioids, an estimated 4 to 6 percent will graduate to heroin abuse
- Opioid overdoses increased by 30 percent in 45 states from July 2016 through September 2017. In the Midwest, the increase was 70 percent
Opioid Epidemic and Its Origins
There is little debate about the roots of the opioid epidemic. It started in the late 1990’s when pharmaceutical companies, like Purdue Pharma, convinced healthcare providers that newly formulated opioid pain relievers were not as addictive as opioid treatments in the past. As a result, physicians began prescribing opioid analgesics – Vicodin, OxyContin, oxycodone, hydrocodone, codeine, Percocet et al – at higher rates and for less than critical types of pain management.
Opioid painkiller prescriptions reached records heights in 2012 with more than 255 million prescriptions, at a rate of 81.3 prescriptions per 100 persons, according to the CDC.
Though opioid prescription rates are down, the CDC says they are still high at 191 million prescriptions in 2017. In certain regions of the country, the agency adds, prescription rates were seven times higher than the average.
Are Prescription Opioids Responsible For The Heroin Epidemic?
There’s no denying a connection between prescription painkillers and the rise in overdoses because of heroin and synthetic opioids, such as fentanyl. How direct the link is, at least among some experts, is up for debate.
Though opioid painkillers can be a “gateway” drug to heroin, research shows that the 4 to 6 percent of users that changeover from painkillers to heroin are not necessarily pain patients. The National Survey on Drug Use and Health reports that more than 75 percent of opioid users get prescription painkillers from sources other than a physician, specifically friends and relatives.
While various state regulations regarding opioid painkillers and the new CDC guidelines for prescribing these meds is aimed at curbing the epidemic of overdoses, legitimate pain patients are not really the problem. Studies points to another demographic that is more likely to jump from painkillers to heroin.
“Having a prior or current addiction to another drug is the best predictor of developing problems with prescription drugs – not pain care,” writes Washington Post Contributor Maia Szalavitz, citing a University of Georgia School of Social Work study.
The slew of new regulations enacted to prevent the misuse and abuse of opioid painkillers has inadvertently affected some physicians’ ability to treat their patients’ chronic pain issues, especially during end-of-life care.
“The whole effort of the law is to reduce opioid use, prevent addiction, misuse and abuse,” Dr. James Forshee, chief medical officer at Priority Health, in Michigan, told Modern Healthcare. “That is not an issue with palliative care and hospice treatment. Pain control is the primary purpose.”
The Heroin Crisis
In a 2016 survey, around 948,000 Americans said they had used heroin in the past year. Of those heroin users, an estimated 170,000 of them reported being first time users. The number of people that admit to heroin use has steadily increased since 2007 and the actual amount of users is very likely higher due to underreporting.
The latest data is not encouraging. Fatal opioid-related overdose rates have increased – more than 70,000 in 2017 – due in large part to the deadly, synthetic opioid fentanyl. Much of the time, heroin users are unaware that dealers have cut their product with fentanyl, which is often made in underground, overseas labs that ship it illegally into the U.S. at low prices.
Sadly, the crisis is so dire that drug overdoses are among the leading cause of death for adults under the age of 55 and life expectancy in the U.S. has declined as a result.
Taken responsibly and as directed, prescription opioid painkillers still pose a risk of addiction. Misused or abused, especially in combination with other substances, such as alcohol, and the risk of addiction increases substantially.
That opioid addiction, which could potentially lead to using heroin or synthetic opioids, can develop in mere days of misusing prescription painkillers.