The Path to Opioid Addiction & Treatment
Those changes include targeting pill mills, reformulating drugs to make them harder to abuse, and establishing prescription drug monitoring programs.
While these are crucial for keeping new addicts from being added to the ranks, it does nothing for those already trapped in their painkiller addiction except increase the attractiveness of a chemical cousin to their prescription drugs — heroin, that other opioid.
The Roots of the Heroin Epidemic
Heroin use has soared 145% since 2007, and that has led many to conclude that the greater restrictions around prescription painkillers are the reason why. While it certainly plays a part, the picture is more complicated than that, according to a recent review of opioid data published in the New England Journal of Medicine (NEJM). It notes that many of the policies that made it tougher to get and abuse prescription painkillers were put in place after heroin use began surging. It also points out that the proportion of those who make the transition from abusing prescription opioids to heroin is relatively small — about 3.6% (although it’s important to note that this still translates to several hundred thousand new heroin users).
What isn’t rare, however, is the number of heroin users who say they first abused prescription opioids. One 2012 study put the figure as high as 86%. Such findings point to the fact that some are more vulnerable to the rewarding effects of opioids, and what we are likely seeing is the progression of addiction among this high-risk group.
Helping that along are market forces. Increasingly, heroin has become cheaper and more available. For some teens, in fact, it’s become easier to buy heroin than beer. It’s also more pure, and for some it can deliver a more powerful effect — one that the user increasingly needs to keep withdrawal at bay.
The problem with all opioids, of course, is that the more they are used, the more is needed to achieve the same effect. It becomes a downward spiral. Eventually, pleasure plays no part in the process; it’s just a desperate attempt to stave off the anxiety, sweating, nausea and cramps of withdrawal.
While both prescription painkillers and heroin can be deadly, heroin also has the added element of unpredictability because of how it’s taken — it can be shot directly into a vein, for example, for an almost immediate rush; prescription drugs have largely been reformulated to make them impossible to turn into a liquid and inject. Heroin’s danger is exacerbated by the growing use of the drug fentanyl as an ingredient in heroin. This extremely deadly drug — it’s 100 times more powerful than morphine — is thought to be a major driver in recent surges of heroin overdose deaths.
As it stands now, opioids have pushed us into the worst drug addiction epidemic in U.S. history. Since 2000, the rate of overdose deaths from prescription painkillers has quadrupled from 1.5 deaths per 100,000 people to 5.9. Heroin deaths, while still much lower than deaths from prescription painkillers, have quintupled since 2000 to 10,574 deaths in 2014, the NEJM study notes.
This moment may well be our most precarious point in that epidemic. Yes, we are making inroads against initial use with new restrictions on prescription drugs, but what of the huge pool of people who are already dependent on painkillers and will become increasingly desperate as traditional sources for the pills continue to dry up?
What’s needed is a medical community trained to spot those struggling with prescription painkillers and get them into treatment before they make the transition to heroin. Just as important, everyone prescribed painkillers — whether it’s Vicodin for wisdom teeth removal or OxyContin after surgery — needs to educate themselves about the risks they face and the need to reach out for help if they start having problems.
That education starts with an understanding of what makes a person vulnerable to developing a dependence on opioids in the first place. That includes:
- The younger a person is when they use opioids, the more likely they are to become dependent. That means parents must be blunt in communicating risks to their kids.
- A history of problems with other substances such as alcohol.
- Mood disorders such as depression and anxiety.
- It can be described this way: People are prescribed an opioid because they are in pain, but they sometimes continue to take them because life is a pain.
- Genetic makeup, which is thought to account for about 30% of the risk.
If you have any of these risk factors, communicate these to your doctor. And if you are prescribed an opioid, ask these key questions:
- If it’s the best option
- If there’s anything else that would be as effective
- How long you should take the medicine and at what dose
That last part is especially important. If you are told you’ll likely only need a couple of pills a day for three days and you’re in pain a week later, this is your signal to talk to your doctor about what might be amiss — not to simply keep trying to numb the pain with additional pills.
Medical professionals, for their part, need to understand the limits of opioids for pain and to be vigilant in weighing risks vs. benefits. When they do prescribe opioids, oversight is critical so that any problems can be dealt with as soon as they crop up.
What has been documented many times over is the sooner help is received, the more treatment options will be available to the person and the more likely they will be to reclaim their life rather than become another sad statistic.