As Prescription Opioid Use Decreases, Heroin Use Increases in US

Cicero TJ, et al. N Engl J Med. 2015;doi:10.1056/NEJMc1505541.

From 2008 to 2014, prescription opioid use decreased while concurrent heroin use increased, with significant regional differences in the U.S., according to recent findings.
“From 2010 through 2013, there was a notable downturn in abuse of prescription opioids and a coincident increase in abuse of heroin in the United States. Given that there is some evidence of a relationship between the two trends (eg, some persons who abuse prescription opioids switch to heroin for a number of reasons and drug interchangeability has been observed), we sought to examine this relationship more closely,” Theodore J. Cicero, PhD, of Washington University, St. Louis, and colleagues wrote.
Researchers collected data on past-month opioid abuse quarterly from January 2008 through September 2014, using self-administered surveys completed by 15,227 individuals with opioid dependence entering nonmethadone-maintenance treatment programs in the United States. Of these, 267 individuals completed online interviews to further interpret findings from the national survey.
From 2008 through 2010, rates of exclusive prescription opioid abuse remained stable at 70% but then steadily decreased, with an average annual reduction of 6.1%, to less than 50% in 2014.
Concurrent abuse of heroin and prescription opioids in the past month increased from 23.6% in 2008 to 41.8% in 2014, with an average annual increase of 10.3%.
Exclusive heroin use doubled from 4.3% in 2008 to 9% in 2014 among individuals using prescription opioids, despite low use.
Researchers found regional differences in abuse patterns, obscured by national data.
“On the East and West coasts, combined heroin and prescription drug use has surpassed the exclusive use of prescription opioids,” Cicero said in a press release. “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.”
To determine contributing factors to the study’s finding of decreased prescription opioid use and increased heroin use, researchers analyzed responses from the subgroup of 267 individuals. Among the 129 participants who reported prescription opioid abuse prior to heroin use, 73% cite practical factors, such as accessibility and cost, as a primary factor for transitioning to heroin.
“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 said in the release. “If users can’t get a prescription drug, they might take whatever else is there, and if that’s heroin, they use heroin.” – by Amanda Oldt