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Does Cracking Down on Prescription Opiates Lead to More Heroin Use?

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With prescription pill use on the rise everywhere, our nation has begun cracking down on over-prescribing, "doctor shopping," pill mills and misuse of medication. However, recent data suggests an alarming trend - people dependent on opioid pain relievers may switch to heroin if their supply of medication is cut off.

Recent research, such as the National Survey on Drug Use and Health and several peer-reviewed scholarly reports, point to a correlation between levels of prescription opiate abuse and spikes in heroin use. No study has been conducted on causation, or whether cracking down on "doctor shopping" directly causes those patients to turn to heroin as a substitute, but the correlation is nonetheless disturbing. The use of pain relievers for nonmedical purposes and heroin have both risen substantially within the past decade, and most people reporting heroin use initially started on pills.

The possibility that people are using heroin as a substitute for pain relievers makes sense given the similarities between the drugs. OxyContin, and heroin, for example, are both derived from opium and can be used to relieve pain and create a sense of sleepy euphoria. From a pharmacological perspective, there are few differences between the two drugs, which is why the transition from abuse of prescription opiates to heroin so often occurs. Heroin is usually cheaper than OxyContin and easier to procure, which tempts many who began their dependency on pills to make the switch. To give an example, after receiving a $600 million fine for misrepresenting the addictiveness of OxyContin, in 2010 Purdue Pharma reformulated the drug in a tamper-resistant case to make it more difficult to crush for snorting or injecting. In a survey of drug treatment residents for whom opiate pills was their drug of choice, their preference for OxyContin dropped 64%, while within the same group of residents, reports of heroin use nearly doubled.

Recently many states have implemented prescription drug monitoring programs, or PMPs, designed to track physician prescription practices and pharmacy dispensing and to flag suspicious behavior. The alerts might result in disciplinary action against a prescriber or pharmacy that gives out too many pills or a patient who appears to be seeking medication from multiple sources. PMPs are gaining popularity, but more research is needed to determine whether the programs reduce drug abuse or merely divert it. One study reported that PMPs were not significantly associated with lower rates of prescription opioid abuse or overdose and that the effect of PMPs on preventing drug abuse appeared to be minimal.

The possibility of an increase in heroin use is particularly sobering when one considers that lately state and municipal leaders have been slashing budgets for drug treatment, medication-assisted treatment centers, and other methods of reducing addiction. With drug overdose now the leading cause of accidental death in the United States, it's imperative that leadership consider the consequences - financial and human - of allowing addiction to go untreated.

There are several ways to combat the problem of patients switching from opiate pain relievers to heroin, the first of which is to start at the source of the problem - doctors over prescribing opiates. Undoubtedly, many people in the United States are living with chronic pain or forced to undergo excruciating treatments for cancer and other serious illnesses. In these cases, opiates are necessary for pain relief and to allow the person to live as comfortable and normal a life as possible. Dependency may occur, but arguably, opiate addiction is preferable to a life of pain.

But in recent years, due to pharmaceutical companies creating incentives for doctors to prescribe more opiates and a shifting attitude in the country regarding pain medication, doctors are prescribing strong pain relievers to patients with relatively minor ailments that in some cases could be resolved with an aspirin. This practice should stop. In order to reduce our national dependency on pain relievers, doctors should be receiving adequate education on when it is acceptable to prescribe strong, potentially addictive opiates and when simpler pain medication will suffice. We should also work to reduce the influence of pharmaceutical companies on doctors and their prescribing practices.

Likewise, we need to prepare to deal with the potential increase in overdose deaths from a rise in opiate use, whether prescription misuse or heroin. Several states have recently passed 911 Good Samaritan laws, which remove the fear of law enforcement involvement if a person experiencing or witnessing an overdose calls for help. While more research is necessary to evaluate the impact of these laws, initial results indicate that the presence of 911 Good Samaritan legislation does encourage people at risk to seek help, and could help reduce premature death from overdose.

Additionally, many states have passed laws to encourage the prescription and administration of naloxone, an effective, non-abusable medication that reverses opiate overdose to restore normal breathing patterns. Naloxone is safe enough to be administered by nonmedical personnel, such as the friend or family member of someone experiencing a drug overdose, and reports indicate that over 10,000 lay overdose reversals have taken place nationwide. Increasing access and availability to the overdose antidote, naloxone, will go a long way towards decreasing fatalities.

Lastly, states need to prioritize drug treatment facilities. Too many people seek help to combat addiction and are turned away by lack of available treatment centers or prohibitive costs. Improving access to treatment, including medication-assisted treatment such as methadone maintenance and buprenorphine, are essential to address the problem of drug abuse and addiction in our communities.

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