The Rise in Heroin Use May Be Linked to the Decline in Prescription Drug Abuse

prescription drug bottles

In the middle of January, an issue of the New England Journal of Medicine featured a report that was heralded as a cause for celebration. The report carried news that the rates of prescription painkiller abuse and addiction in the United States were finally starting to decline, after years of alarming increases. Astonishing numbers of Americans had gone from using painkillers medically to abusing their pills, and finally many became addicted. Things got so bad that more than 15,000 people were dying every year, in what the Centers for Disease Control and Prevention termed a “deadly epidemic” of painkiller abuse. So with things having gotten as bad as they did, any news that the clouds were parting would, of course, be welcomed and provide considerable encouragement. But there is another facet to the situation which must not be overlooked before a final verdict is laid down and a decision is made as to whether we are finally on the verge of winning this battle in the war on drugs. That facet is heroin.

prescription drugs and heroin

Heroin has for many years been a fringe drug, one which did not top the lists of most commonly abused substances. It seemed to have had its heyday in decades past, and to have been a drug most commonly associated with inner cities and sub-cultures. Now, however, heroin is making a major comeback, and it has spread to the suburbs and become common in communities throughout the U.S. and across all socioeconomic strata. The reason for this is tied closely to the news that prescription drug abuse is on the decline. Though they come from very different sources — heroin generally being produced using opium grown in Afghanistan or in Southeast Asia’s “Golden Triangle,’ and prescription painkillers being manufactured by large pharmaceutical drug companies — the two share the fact that they are both derived from opium. Because of this, it is easy for one to serve as a substitute for the other, given that they both have similar effects on the brain and create a similar high. Evidently, much of the decline in rates of prescription painkiller abuse can be attributed, not to fewer people using drugs, but to a shift in the trends of drug abuse. Many of the people who got started abusing their pain pills have transitioned over into using heroin, which has been categorized as being both the most addictive and most harmful drug available.

Why do painkiller addicts switch to heroin?

A major driving factor behind the spread of painkiller addiction lay in the fact that many patients didn’t realize that their medications were dangerous, and the addiction crept up on them unknowingly. Why would so many of them be willing to switch to a drug which is well known to make junkies out of people and is widely recognized as being cripplingly addictive? What seems to be occurring is that as efforts to prevent painkiller abuse have taken effect, many addicts have felt the squeeze and moved to heroin as a substitute when their supply dried up. For example, doctors in most areas of the country are now under greater scrutiny to avoid writing unnecessary prescriptions, and patients are monitored for the frequency with which they seek a refill, with state oversight programs to ensure that pain medications aren’t being passed out through “pill mills” or by “doctor shopping.”

Painkillers are not only becoming harder to obtain, but they are also harder to abuse in many cases. Pharmaceutical companies have taken the initiative to prevent painkiller abuse by introducing crush-resistant pills which are more difficult to grind into a powder which can be injected or snorted, and the pills often come in extended release formulations which prevent an immediate rush from taking a dose. Just as firefighters will sometimes successfully halt a blaze in one area of a forest only to see flames spring up elsewhere, the recent success in curbing rates of painkiller abuse has had an unintended consequence by providing a new market for heroin. Rather than playing a game of whack-a-mole in working to stamp out drug abuse in different arenas, we need to address the underlying problems which drive a person to abuse drugs and which encourage drugs as a solution to all life’s problems. Effective education and prevention are the answers to winning the war on drugs.


Karen Hadley

For more than a decade, Karen has been researching and writing about drug trafficking, drug abuse, addiction and recovery. She has also studied and written about policy issues related to drug treatment.