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Heroin Versus Prescription Pain Meds – Are They Really More Alike Than You Think?

“This epidemic that we are in the grips of is taking a heartbreaking toll on American families. We are in the midst of an epidemic, and sadly, no one is immune, no individual, no family, no community.” ~ United States Attorney General Loretta Lynch For the last few years, America has been experiencing what the Centers for Disease Control and Prevention has called an “epidemic” of opioid abuse, addiction, and fatal overdoses. Law enforcement officials, legislators, and medical professionals alike are scrambling to come up with the right response to this unprecedented drug scourge. Opioids are a class of painkilling drugs derived from the opium poppy. They include prescription medications such as morphine, oxycodone, hydrocodone, and fentanyl, as well as the illicit Street drug heroin. pill body

Opioid Statistics in the United States

Take a look at some statistics about the opioid problem in America, as released by the American Society of Addiction Medicine:

  • In 2014, there were nearly 22 MILLION US citizens aged 12 years or older that had a substance abuse disorder. Almost TWO MILLION of those of those had a SUD that involved prescription opioid painkillers, and just under 600,000 more abused heroin.
  • Drug abuse leads to overdose – In 2014, 47,055 Americans died because of fatal overdoses – the #1 cause of accidental death in this country.
  • Opioids are responsible for a disproportionately large number of those deaths:
    • Prescription painkillers – 18,893 deaths
    • Heroin – 10,574 deaths

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Why are Prescription Pain Medications and Heroin So Dangerous?

Besides the high potential for abuse, the biggest reason why there are so many overdoses from opioids is that one of the side effects is the suppression of normal breathing. ALL opioids make it harder for a person to breathe – especially at higher doses. One of the levels on the continuum of addiction is tolerance – a need for continually-increasing amounts of the drug in order to achieve the same desired effect. A person abusing opioids for the high will continually have to up their dosage. At some point, that dosage becomes toxic.

  • Drug abuse also causes confusion – a person may take more of the drug than they intended, worsening its effects.
  • When these drugs are bought on the black market, manufacturers and dealers will frequently mix in or even substitute other substances to intensify the high. This is extremely hazardous – the two most-frequently-substituted drugs are MUCH more powerful than prescription medications or heroin, and when a person is unaware, they will try to use their accustomed dosage – with deadly results.
    • Fentanyl – 50 X more powerful than heroin
    • Carfentanil – 10,000 X more powerful than morphine. This drug is and even used on humans – it is a sedative for large animals like elephants.
  • Most opioid abusers also misuse other substances, particularly alcohol. When alcohol and opioids are combined, the risk of overdose intensifies.


The Similarities between Prescription Pain Medications and Heroin

When experts are talking about the “opioid epidemic”, they aren’t talking about two different threats – prescription drugs and heroin – they’re talking about ONE problem: the abuse of opioids. Both:

  • Attach to specific molecules called opioid receptors, which are found on nerve cells in the brain, decreasing feelings of pain.
  • Are popular drugs of abuse, because they also cause a person to feel happy and relaxed – almost euphoric.
  • Are HIGHLY addictive
  • Produce harshly-unpleasant symptoms of withdrawal when an addicted person tries to quit.
    • Uncontrollable yawning
    • Excessive sweating
    • Runny nose
    • Extreme anxiety and agitation
    • Dilated pupils
    • Insomnia
    • Chills
    • Accelerated heartbeat
    • Heightened blood pressure
    • Abdominal cramps
    • Nausea
    • Diarrhea
    • Muscle pain

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Prescription Painkiller Abuse Fuels Heroin Abuse

Over the past 20 years, the use of prescription opioids as the first-line treatment for pain management skyrocketed. For example, in 2012, there were 259 MILLION prescriptions written for opioid painkillers – more than enough to give every US adult their own personal bottle of pills. But as the rate of prescribing increased, so did the rates of abuse, addiction, and overdose:

  • Between 1999 and 2010, sales of prescription painkillers quadrupled.
  • The 2009 admissions rate for heroin addiction treatment centers was 6X what it was in 1999.
  • Between 1999 and 2008, the rate of fatal overdoses quadrupled.

Lawmakers and medical professionals have begun addressing these issues by changing the recommendations on how and when prescription opioids should be dispensed and by creating patient databases that make it harder for opioid abusers to obtain prescriptions from multiple doctors. Consequently, the death rate from prescription opioids seems to have plateaued, and in some areas of the country is even decreasing. But as prescription opioids are becoming harder – and more expensive – to obtain, suffering addicts are switching to a cheaper, more readily-available alternative – heroin.

  • 80% of new heroin users began by abusing prescription pain pills.
  • People who are addicted to prescription opioids are 40 X more likely to abuse or become addicted to heroin.
  • In a 2014 survey, 94% of individuals who are being treated for opioid addiction reported that they use heroin because prescription painkillers were “far more expensive and harder to obtain.”
  • Within the past decade, the annual average rate of past-year heroin usage went up by more than 62%.
  • 23% of everyone who tries heroin will become addicted.
  • 45% of people who use heroin are also addicted to prescription painkillers.
  • Between 2001 and 2014, the total number of deaths due to heroin overdose increased sixfold.

Initiation of heroin use can introduce the abuser to a tragic new world of addiction:

  • 96% of heroin users also report using at least one other drug within the past year.
  • 61% reported using three or more other drugs.
  • People who use cocaine are 15 X more likely to abuse or become dependent upon heroin.
  • Marijuana users are 3X more likely to abuse or become dependent upon heroin.
  • Among alcohol abusers, the risk of heroin abuse doubles.

For the manufacturers of illegal drugs – primarily, Mexican cartels – the increased demand for heroin could not come at a better time. As marijuana is enjoying an increasingly-legal status in America, the demand for Mexican cannabis has plummeted.

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Seeing the demand, many growers are switching from marijuana plants to opium poppies. Furthermore, many Mexican drug labs are meeting that demand by making record amounts of synthetic opioids. This means that the availability of black market opioids is greater than ever.


What Does All of This Mean?

People in authority are aware of the problem and already taking steps – from your family doctor to local law enforcement to your state government to the US Surgeon General to the President of the United States:

  • Prescription drug take-back days
  • Revised prescribing guidelines
  • Awareness and prevention campaigns
  • Increased funding
  • Shared databases
  • New legislation
  • Increased availability of emergency anti-overdose medications

For the individual, this means that if they need to see a physician for pain, they should be prepared to have a frank, two-way discussion with their doctor about alternatives to risky prescription opioids – exercise, physical therapy, weight loss, etc. Addiction can happen to anyone – even when the abused substance is a properly-prescribed medication. And when that medication is a powerful opioid, even more care must be taken to avoid starting down a dangerous and slippery path.