Prescription painkillers increasingly appear to serve as gateway drugs for heroin use, facilitated by the widespread availability of cheap heroin, endemic prescription narcotic use, and formulaic measures that have made Oxycontin difficult to crush. Whether or not heroin use is on the rise nationally is a subject of debate; but its migration into the suburbs, the arena for prescription painkillers at the turn of the millennium, is a well-known fact; and, although deaths by prescription painkillers remains more prevalent than heroin, there is a strong link between the two. Could prescription painkiller be a gateway to heroin use?
The recent death of actor Philip Seymour Hoffman sounded an alarm that brought attention to the narcotic issue, from which a tangled web of confusion about the prevalence of heroin abuse appears. For example Time last month published an article insisting that heroin use remains the same as in 2002, and blamed high-profile drug deaths for public misperception of abuse rates, while another source claims that the data used to support this claim was interpreted incorrectly.
However, data does exist that supports the claim that heroin use is on the rise among teens and adults, while that of prescription painkillers have seen a decline in this population. Interestingly, this information comes from 2012 National Survey on Drug Use and Health, the same source used by Time. The data shows that, from 2007 to 2013, heroin use increased from 373,000 to 669, 000 among people 12 years old and up. Conversely, prescription drug use fell among young adults 18 to 25 years old, between 2009 and 2012, from 6.4 to 5.3 percent. Although the years and ages for these two pieces of data do not align, it’s not inconceivable to hypothesize that the increase heroin use may have taken place, at least partially, at the expense of gateway prescription painkillers.
This kind of information, though, does not address the subtleties of the changing demographics of heroin and narcotic use in the United States. For instance, articles on heroin use tend to focus on teen and high school students. Yet prescription narcotic medication remains most prevalent among adults; so the potential for a gateway to heroin is clearly greater in the latter group. Also, heroin use has risen drastically in the suburbs whereas its use had been traditionally confined to the cities. Prescription pain killers became prevalent in U.S. suburbs from the 1990s into the early 2000s.
In the early 1990s, the manufacturer of oxycodone, a prescription narcotic up to two times as potent as morphine, formulated the medication into long-acting tablets. These become available in larger doses released over 12 hours instead of four to six. Narcotic injectors were quick to find that they could crush the pills, thus enabling the immediate release of the entire strength of a medication intended for slow, sustained release. In 2010, the manufacturer, Purdue Pharma L.P., reformulated the tablet so that it could not be crushed, deterring its use as an injectable drug.
Add to the mix the heroin from Mexico that has become easily available and that its sells for as little as ten dollars per bag. As politicians and health advocacy groups clamor for tighter restrictions that reduce access to prescription painkillers, they may very well be opening the gateway to heroin use.
An Editorial By: Robert Wisnewski
Substance Abuse and Medical Health Services Administration