Statistics show that opioid addiction, overdose, and death in the United States have increased dramatically since 2000, leading to the opioid epidemic. Millions of people in the US receive prescriptions every year for narcotic painkillers, which are synthetic or semisynthetic opioid drugs related to the first synthetic painkiller, morphine.
Although the press is making the public more aware of the growing problem of prescription opioid addiction, along with the similarly growing heroin epidemic, many people may assume that prescription painkillers are much safer than heroin since they are prescribed by their doctor. Unfortunately, for many people in the US, that has not been the case. Instead, too many people have received prescriptions for opioid analgesics, become addicted to these potent narcotic drugs, and, when they were no longer able to get their prescription pills, turned to cheaper, easy-to-find heroin.
Early Problems with Heroin
To put the current opioid epidemic into perspective, morphine has been considered a dangerous, addictive substance since the 19th century. In fact, heroin – an opioid so addictive and dangerous that the Drug Enforcement Administration (DEA) lists it as a Schedule I substance with no medical use – was originally developed as a replacement painkiller so fewer people would become addicted to morphine.
Throughout the 19th and early 20th century, opiates were primarily abused by women. Once heroin became tightly restricted by the federal and state governments, it became a problem among a specific demographic. Low-income industrial areas in the north became the main hub of heroin addiction in the mid-20th century, until the jazz era brought heroin abuse into popularity among middleclass people in the 1930s and 1940s. It became popular in the Beatnik subculture in the 1950s, leading to a cultural link between marijuana and heroin, which became popularized in the concept that marijuana is a gateway drug directly causing opiate addiction. As young men became heavy users of the drug, abuse of heroin spread into Vietnam, with an assumed addiction rate of 15 percent among servicemen in 1971. Upon returning to the US, street heroin spread to young, low-income men in the 1980s and 1990s, with first use typically beginning around 16 years old.
Because addiction problems had long been associated with opioid analgesics, prescribing practices around these drugs were strict until 1999. This is when pharmaceutical companies began pushing the safety of hydrocodone, oxycodone, and codeine, stating that these medications could be more widely prescribed without fear of increasing addiction rates.
Opioid Painkiller Prescriptions from 1999 to 2010
Between 1994 and 2007, the rates at which doctors prescribed opioid painkillers almost doubled, according to the American Society of Addiction Medicine (ASAM). Although many commonly prescribed opioids, like Percocet and Vicodin, were developed in the 1970s, these drugs were carefully monitored and not widely prescribed due to ongoing fear of addiction. These fears turned out to be founded; due to the prescription drug abuse crisis, fueled primarily by the opioid addiction epidemic, more people die from drug overdoses every year than in car accidents.
By 2001, pain treatment was considered a priority in the medical field, as an attempt to prevent suffering. Opioid drugs began to be prescribed after nearly every surgery, including minor dental surgeries or accidents like broken bones or back injuries. The idea was that patients would take the medications as long as they had pain and would, with a little oversight from their doctor, gradually wean themselves off the drugs when they no longer needed them. For example, if a dental patient had a root canal, they would receive a prescription for hydrocodone lasting a few days; at the end of that time, their pain should be completely gone, and their body could take over the healing process. Similarly, a person who suffered a spinal injury at work would receive a prescription for a longer-lasting drug like OxyContin; this would allow them to move without much pain during the day, attending rehabilitation so they could stop taking OxyContin after a few weeks or months and safely return to work.
According to the Centers for Disease Control and Prevention (CDC), between 2007 and 2012, prescriptions for opioids were most commonly given for the following reasons:
- Pain management: 49 percent
- Post-surgery pain: 37 percent
- Physical/rehabilitation purposes: 36 percent
One in five patients received prescriptions for opioids in an office-based setting, the CDC reported, which means that primary care physicians represented the bulk of prescribers.
In 2013 alone, medical professionals wrote almost 250,000 prescriptions for opioids – enough for every adult in America to have a bottle of opioid drugs. While there was variability in prescribing rates in each state – for example, Alabama wrote the most prescriptions and Hawaii the least – underlying health issues in the population were not found to be correlated with the number of opioid drugs prescribed. This suggests that many people did not have chronic or acute pain but instead struggled with addiction to their original prescriptions. As of 2017, about 1,000 people per day go to the emergency room in the United States because they use prescription opioids inappropriately.
The Joint Commission removed pain assessment standards in 2009 in response to the prescription opioid crisis. In 2010, the US – especially states like Florida, which was home to the most pill mills in the country – began to crack down on pain management clinics, rescheduled hydrocodone and oxycodone to Schedule II drugs for better tracking, and started to more strongly enforce laws around nonmedical abuse of these substances.
Heroin Becomes an Epidemic – Again
Prescription narcotics are still a large problem. In 2014, an estimated 10.3 million people reported abusing prescription opioids for nonmedical reasons. The drugs are still overprescribed, but prescribing practices appear to be changing. Between 2010 and 2012, new prescriptions for opioid painkillers leveled off. Unfortunately, the tighter control and surveillance around opioid prescriptions appear to be turning people to heroin.
Although rates of opioid overdoses and deaths began to drop, the rate of heroin addiction, overdose, and death skyrocketed. In Florida, the number of deaths from oxycodone overdose dropped 69 percent. In contrast, reports show that in 2000, the number of people who died from a heroin overdose in the entire country was 1,842 people; by 2014, that number quintupled to 10,574. Between 2007 and 2014, the number of people who reported that they had used heroin in the past month doubled to 620,000 people.
By 2015, the rate of heroin addiction and overdose began to outpace that of prescription opioid drugs, according to the CDC. The federal Department of Health and Human Services (HHS) found that 3,900 people per day begin abusing prescription opioids for nonmedical reasons, and 580 people begin to abuse heroin. Almost 13,000 people died in 2015 from a heroin overdose. An estimated 21,000 adolescents in 2015 alone used heroin at least once in the past year, with 5,000 reported as currently struggling with heroin addiction, according to ASAM.
Moving from Prescription Opioids to Heroin Addiction
Many people who struggle with heroin addiction self-report that they intentionally sought out heroin when they were no longer able to easily acquire prescription opioid painkillers. With many addictions beginning in the doctor’s office, demographics around the heroin epidemic are changing.
- Introduction to opioids is occurring at a later age; the average age of first opioid use is now 22 years old.
- Non-Hispanic whites are most likely to struggle with heroin addiction now because most turn to heroin after becoming addicted to a prescription.
- Overdose rates are highest among people ages 25-54.
- Men are more likely to overdose, but as more women struggle with opioid addiction, that gap is closing.
- More people in suburban areas struggle with heroin and prescription opioid addiction in 2017 than in 1999.
- As of 2017, 91 people die from an opioid overdose every day – from both heroin and prescription narcotics.
As the prescription opioid epidemic reached its peak in 2011, researchers became concerned about a growing population addicted to heroin and wondered if there were a causal link between prescription opioids and the street opioid. They found that 85 percent of teenagers reported abusing prescription painkillers, especially OxyContin and Vicodin, first and then moving to heroin later. Typically, painkiller abuse began two years before the teenager tried heroin. Another study from data gathered between 2002 and 2012, and reported through the National Institute on Drug Abuse (NIDA), found that nearly 80 percent of those who struggled with heroin addiction reported using prescription opioids first.
The most comprehensive report was published in the Journal of the American Medical Association (JAMA) and uncovered the changing demographics among people struggling with heroin addiction. The researchers used the Survey of Key Informants’ Patients Program (SKIP), which about 85 percent of those seeking treatment responded to. Their survey of recent heroin users found:
- The average age of those abusing opioids was 22.9 years old, with many being in their early 30s.
- There were slightly more men than women.
- Seventy-five percent of respondents lived in less urban areas.
- Seventy-five percent used prescription drugs first.
The 75 percent who took prescription drugs first and then moved to heroin reported that it was not a matter of seeking out a more intense high but of finding a drug more widely available and less expensive than the now highly regulated prescription painkillers. Around 94 percent of respondents replied that availability and expense were determining factors in switching to heroin, and 98.1 percent noted that the heroin “high” was important, suggesting that prescription opioid use was nonmedical.
Both heroin and prescription opioid addiction are very serious, and both can lead to overdose and death. It is important to follow a doctor’s prescription guidelines when taking narcotic painkillers. If one finds that they are unable to stop taking prescription pills and have no medical reason to continue, it is very important to seek help to overcome this addiction.