Friday, June 8, 2012

Crackdown on Rx-Opioids Fuels Heroin Abuse

In The NewsAccording to recent news reports from MSNBC [here] and Join Together [here], the crackdown on prescription opioid analgesics in the United States is fueling a resurgence of heroin abuse and addiction. And, experts note, heroin today is inexpensive, powerful, and more destructive to individuals and society than Rx-opioids.

Law enforcement officials report that there is a flood of cheap heroin coming from Mexico — now a leading source of the drug in the U.S. — and it is appearing in new areas than before, including upscale suburbs, where the drug was once hard to find. With an increased availability of heroin has come a spike in the number of visits to emergency departments for issues related to substance abuse, according to the national DrugAbuse Warning Network [here].

Until recently, heroin addiction was seen mostly in men living in urban areas, many of them minorities, the news reports observe. Today, in states like Ohio, most people entering treatment programs for heroin addiction are white, and many are young. They come from both poor areas and wealthy suburbs, and many are female.

While new regulations and law enforcement efforts have significantly reduced the illicit supply of Rx-opioids, those efforts have inadvertently driven many users to heroin. For example, the news reports note that, in Ohio, “doctor shopping” for opioid pain-relievers has become more difficult since the state’s database to track prescriptions went online. The state also passed a law last year to help fight “pill mills” that liberally dispense analgesics.

Similar steps to fight prescription drug abuse have been taken across the nation. Combined with new abuse-deterrent formulations that make certain Rx-opioids harder to crush for snorting or injection, the efforts have curbed the supply and the appeal of opioid analgesic abuse. However, this has had unexpected effects.

Rx-opioids have become expensive and often hard to obtain on the street. They now sell for anywhere from $30 to $80 dollars per pill; whereas, a more readily-available $10 bag of heroin offers a similar or better high. Therefore, unable to find pills, or to afford them, drug abusers go looking for something else to feed their craving — heroin is cheap, potent, and plentiful.

It is also deadly. In fact, the news reports indicate that Ohio saw a record number of heroin-related deaths in 2010, which now account for 1 in every 5 overdose deaths in the state. In early May 2012, one county in Ohio saw 5 fatal overdoses in 10 days due to a batch of overly potent, or badly cut, heroin. Experts worry other counties in Ohio may soon follow suit, and that those dying might be among the fastest growing demographic of heroin users — young people between 20 and 35 years of age. And, it may only be a matter of time before these trends sweep across the nation.

COMMENTARY: The Wrath of Unintended Consequences

As we have noted previously, it is clear that America has substance abuse problems of unprecedented proportions, as do most other countries worldwide. At the same time, well-meaning efforts to curtail the prescribing and distribution of opioid analgesics may be headed in the wrong direction by provoking several unintended consequences:

  • As we cautioned more than a year ago [here], and the above news reports now confirm, there has been a renewed upsurge in heroin abuse and addiction, which is largely related to tightened controls on prescription opioids.

  • Along with that, it probably will not be long before there are reports of increasing heroin-associated morbidity — eg, HIV/AIDS, hepatitis, tuberculosis, other infections — with attendant mortality. This not only has a devastating impact on individuals, but on families, communities, and society overall.

  • New and restrictive rules governing pain management with opioid analgesics — such as those in Washington state — are limiting access to these essential medications for legitimate patients with chronic pain who benefit from strong-analgesic therapy.

  • Left with few or no alternatives, some of those patients with undertreated or untreated chronic pain may be among a new generation of heroin abusers.

The most recently available government data are almost always several years old. So, federal reports of Rx-opioid abuse outdistancing illicit drug problems may not reflect current realities, and the news reports may be early warning signals of a tsunami of heroin-related morbidity and mortality to come.

Essentially, what we may have here is a “balloon effect”: squeeze a balloon in one place and it will expand somewhere else; curtail the availability of prescription opioids and heroin expands to fill the void — the illicit-drug cartels and dealers are happy to help this along. To be clear, however, this is not a justification for recklessly liberalizing Rx-opioid availability; rather, it is a reminder that societal problems of substance abuse and addiction are complex and multifaceted, and simplistic solutions that seek only to restrict drug supply have never succeeded in reducing demand.

And, in the case of prescription opioid restrictions, legitimate patients end up paying a terrible tariff in pain due to the misbehaviors of a small minority of the population and misguided or ineffective attempts at stemming the tide of drug abuse and addiction.

eNotifications Don’t Miss Out. Stay Up-to-Date on Pain-Topics UPDATES!
Register [here] to receive a once-weekly e-Notification of new postings.