Renaissance Recovery Blog

While it may seem that painkiller abuse often serves as the stepping stone that leads toward heroin abuse, a recent study reveals that many are, in fact, using painkillers and heroin concurrently depending on their availability. The study was published in a letter in the New England Journal of Medicine in late October.

The study was led by senior investigator Theodore J. Cicero, PhD, of Washington University School of Medicine in St. Louis. Researchers surveyed 15,000 patients at drug-treatment centers in 49 states. The surveys were conducted anonymously when users entered drug treatment and asked for details about drugs of choice and patterns of use and abuse. Those who participated in the survey also had the option of giving up their anonymity to answer more detailed questions about their drug use. Of the 267 patients who chose to offer this more detailed information, 129 reported they had abused prescription opioids prior to using heroin, and 73% mentioned factors such as cost and accessibility when explaining why they began using heroin in the first place.

The study also found that nearly 42% of drug users who were entering treatment had used both heroin and prescription painkillers within a month of entering treatment. This number is up from 23.6% in 2008. Senior investigator Theodore Cicero summed up the current state of heroin and prescription drug use this way: “We see very few people transition completely from prescription opioids to heroin; rather, they use both drugs … There’s not a total transition to heroin, I think, because of concerns about becoming a stereotypical drug addict.”

Cicero also offered some explanations for the rise in concurrent heroin and prescription drug use. He stated, “People used to tell us quite often, ‘At least I’m not using heroin,’ when we asked about their drug abuse … But in recent years, many have come to ignore that aversion, both because heroin is cheaper and accessible and because they’ve seen friends and neighbors use heroin.” Cicero added that since the federal government has been taking strong measures against illegal painkiller prescriptions, painkillers have become less accessible than they were in the past. Heroin, then, has become the supplement of choice. It very much seems to be a function of drug availability.

The study also noted some regional trends surrounding painkiller and heroin abuse. According to Cicero, “on the East and West coasts, combined heroin and prescription drug use has surpassed the exclusive use of prescription opioids.” He added, “This trend is less apparent in the Midwest, and in the Deep South, we saw a persistent use of prescription drugs—but not much heroin.”