Thursday, March 24, 2011

Could New Opioid Regs Lead to Tsunami of Heroin?

Briefly NotedVarious states in the U.S. and federal agencies seem justifiably determined to stem the rising tide of opioid-analgesic abuse, addiction, and diversion. However, an unintended consequence of new approaches for ameliorating these problems might be a powerful resurgence of heroin overdoses and deaths.

As noted in a recent UPDATES article [here], Washington state has forged new and restrictive rules governing the management of chronic noncancer pain with opioid analgesics. Along with that, some manufacturers have introduced new, abuse-deterrent formulations of prescription opioids. Expectedly, such measures would avert the misuse and abuse of such products.

Now, a recent news report from a rural county just north of Seattle, Washington, comments, “Police say a string of heroin overdoses in Snohomish in the past weeks is tied to OxyContin abusers switching to heroin as their drug of choice. …they expect overdoses will continue because users switching from OxyContin to heroin are likely to misjudge how much heroin is too much for their bodies to handle” [see Snohomish County Tribune News here].

Several heroin overdoses were reported during early March in this one rural county and it is part of a regional spike in such adverse events during just this year, according to police sources. Part of the reason for the switch to heroin was introduction of a new formulation of OxyContin® — a long acting version of oxycodone — making the pills more difficult to abuse, and possibly a lack of access to alternative prescription opioids. The news report continues, “More than half of the [police] department’s drug arrests these days are tied to heroin, and about 90 percent of the department’s drug investigations are for heroin.”

COMMENT: Despite the emphasis in government reports on escalating abuses of prescription-opioids, heroin is still very much present and accessible throughout America. As we have emphasized in prior UPDATES, abuse deterrent formulations of opioid analgesics and laws or regulations restricting opioid prescribing could negatively impact patients with pain while doing little to dissuade persons determined to abuse some form of opioid for nonmedical purposes. Apparently, heroin dealers may be benefitting from the new formulations and regulations.

Could reports from Washington state of heroin’s comeback represent the first warning waves of a deluge coming toward us from over the horizon? As usual, reader opinions are welcome — comment below.


Hope Demain said...

It is totally unsurprising to me. There is no upside in restricting the prescribing of opiods/narcotics - all it does is reduce the quality of life for patients who have chronic pain. People who are willing to illegally acquire pain medication will go illegally acquire something else. Maybe, if they want to reduce those heroin overdoses, they should have free, anonymous classes on how to manage heroin use? :-|

(I know it sounds like a terrible thing that would encourage further use/addiction, but there could also be included several encouragements to enter rehab, etc., and to reduce the spread of AIDS and other infectious diseases many states already have free needle programs...)

Anonymous said...

I have several pain patients that are using a specific amount on a daily basis to control their pain because they can't get a legitimate pain prescription and take it to a legitimate pharmacy. Patients will do what they must to be functional. They were not addicts, nor did they ever have dirty urines and I fight to get them into Methadone clinics to be told, "You have to use Heroin for a year" before they'll see you. I love the State of Washington....I can't wait until my lease is up and move.

SB. Leavitt, MA, PhD said...

Thanks for the comments. It is interesting to note that heroin originally was developed as a "better, less addictive," form of morphine. Of course, the problems with heroin today are multifold, not the least of which is that it is of unknown strength or purity, and its sale/purchase supports criminality. Plus, compared with today's improved opioid analgesics, heroin is not a very good alternative for pain management. So, current legislative and regulatory trends -- which do not address the underlying problems -- could end up harming both legitimate and illicit users of opioids. Not a very good overall public health solution in our opinion. --SBL

Ian MacLeod said...

"justifiably determined to stem the rising tide of opioid-analgesic abuse" Justifiably my ass! The whole myopic policy of criminalizing drug use and demanding draconian punishments is the CAUSE of the problem. Even people who have severe, potentially deadly pain problems can't get the meds they need because the DEA and DOJ just reinterpret the laws to mean what they want them to mean, ignore the science behind the Medical Standard of Care, attacking "guilty" and innocent alike. Heroin on the street can be cut any way the dealer wants, so it might be anywhere from 5% to 50% pure. Someone used to shooting up the 5% drug/95% cut mix will OD on the higher-dose mix, and they have no way to test it other than to use it and see.

There ARE NO "less addictive" opiates, because the vulnerability to addiction is in the person, not the drug. And anything the chemists can do to make the pills harder to "abuse" the users can defeat. The control over these drugs MUST be taken out of the hands of the law enforcement people, the "victimless crimes" need to be gotten rid of as the obscene oxymoron they are, and the drugs need to be legalized, sold to any competent adult, taxed and regulated like alcohol is and marijuana should be. People with a problem could get treatment or, since the majority of "addicts" can control their use just fine if they have access to their drug of choice, your number of ODs would drop like a rock. So, unfortunately, would the HUGE amount of drug war funding for cops and the DOJ, the warehousing fees for the private prison industry, the high-profile busts that look so good on an ambitious judge's resume would be out the window... No, people hwo need opiates to survive, pain patients or addicts, are simply too profitable as they are: victims.


Anonymous said...

Thank you Ian, finally someone who understands both "users of opiods" and not afraid to say the truth. I am a chronic pain patient and although I have no trouble (thank you doc)I have two friends that have to find new dr.'s and cannot get their med's right now.