Many health professionals have suspected it for a while, and now it’s official: a study published in October in Health Affairs, and written up by HealthDay, reports that heroin has once again become more popular than prescription opioid painkillers as the opioid of first use.
This turnaround is reminiscent of the 1960s—but back then the percentage was much higher: more than 80% of people who were dependent on opioids said their opioid use had begun with heroin.
Heroin was cheaper in those days than prescription opioids, and easier to get; and the same is true today.
The chart directly below shows the percentages behind patients’ initial choices of an opioid in 2005, and 10 years later.
Patients’ Choice, Opioid of First Use (%)
| 2005 | Opioid Selected | 2015 |
| 8.7 | Heroin* | 33 |
| 42.4 | Oxycodone
Hydrocodone |
24.1
27.8 |
*In the 1960s, patients selected
heroin more than 80% of the time.
If the trend continues, additional follow-up studies could show a further shift—but this time from heroin to synthetic opioids, such as fentanyl. That’s the prediction of Lindsey Vuolo, JD, MPH, associate director, health law and policy, The National Center on Addiction and Substance Abuse. Ms. Vuolo, who was not an author on the study, was interviewed by Dennis Thompson for the HealthDay article, along with Tina Hernandez-Boussard, PhD, associate professor and senior researcher at the Stanford University School of Medicine, and senior author on the Health Affairs study.
Overdoses
The research team behind the Health Affairs article analyzed national data on hospital and emergency department admissions for opioid overdoses. They found a marked change in the overdose situation in recent years. Between about 2010 and 2014, treatment rates for prescription opioid overdoses fell by about 5% each year. But at the same time, cases of heroin overdoses skyrocketed—up by more than 31% a year, according to HealthDay.
Who’s at Risk?
The profile of the person at risk of opioid overdose has changed as well, according to Dr. Hernandez-Boussard. Back in 1997, the person at risk of opioid overdose was a young white male living in the northeastern United States. Today, all groups are at roughly equal risk; women and men, the young and the old; people of all backgrounds, living in all parts of the country.
A Near-Tripling in Opioid-Related Deaths Leads to Controls on Rx Opioids—and Heroin Deaths Resurge
In 2010, President Barack Obama issued orders resulting in action against the prescription opioid epidemic. The result was a significant annual drop in prescription opioid overdose rates of 5% for hospitals and emergency departments. The drop continued to 2014.
But was there a price to pay?
It’s since been suggested that many people who become addicted to prescription opioids—and eventually can no longer get them—turn to heroin. And it’s been pointed out that the yearly 31% rise in treated cases of heroin overdose began at around the same time as the regulations came into effect, while the overdose rate for prescription opioids dropped.
Dr. Hernandez-Boussard offered a different explanation: perhaps the real problem is that America’s response to the opioid epidemic hasn’t included an adequate focus on treating addiction.
Ms. Vuolo agreed. “People who are already addicted to prescription opioids are not being connected to treatment, and therefore moving to other forms of opioids,” she told HealthDay.
Needed: Resources for Patients
According to both Dr. Hernandez-Boussard and Ms. Vuolo, there aren’t enough resources—treatment centers and facilities—to combat addiction and help people addicted to opioids. The two experts also said that the doctors caring for these patients are failing to connect their patients with treatment.
To back this up, Ms. Vuolo pointed to a recent study of a Pennsylvania Medicaid program. That study found that only 33% of patients treated for a heroin overdose, and 15% of those treated for a prescription opioid overdose, were dispensed buprenorphine, naltrexone, or methadone within six months of the overdose. The two experts agreed that the hospital staff, health professionals, and police need better training on steering patients into treatment.
Dr. Hernandez-Boussard told HealthDay that, now that some patients are living through a heroin or prescription opioid overdose, “we need to think about strategies regarding recovery programs and managing opioid dependence.”
In their concluding statement, the authors of the Health Affairs article expressed a similar sentiment, adding that “specific treatment programs need to be implemented for patients discharged with opioid misuse.”
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References
Tedesco D, Asch SM, Curtin C, et al. Opioid abuse and poisoning: Trends in inpatient and emergency department discharges. Health Aff (Millwood). 2017;Oct 1;36(10):1748-1753. PMID:28971919. doi:10.1377/hlthaff.2017.0260.
Thompson D. Heroin taking bigger share of U.S. opioid ODs. HealthDay. https://consumer.healthday.com/mental-health-information-25/addiction-news-6/heroin-taking-bigger-share-of-u-s-opioid-ods-727030.html. Published October 2, 2017. Accessed October 25, 2017.
Cicero TJ, Ellis MS, Surratt HL, et al. The changing face of heroin use in the United States: A retrospective analysis of the past 50 years. JAMA Psychiatry. 2014;71(7):821-826. doi:10.1001/jamapsychiatry.2014.366.
