Is There Really a Heroin Epidemic in the US?

Over the past couple years, the focus has shifted slightly from the devastating effects of opiate painkiller abuse and addiction to the equally deadly issue of heroin use and dependence – and for good reason. Rates of abuse of the drug have increased significantly since tighter painkiller prescription regulations have pushed many people struggling with opiate addiction to look for a more accessible alternative.

Heroin filled the bill easily. Cheaper than buying painkillers with a prescription or on the street and just as potent, heroin offers users a similar effect, allowing users to maintain an opiate addiction while avoiding the ongoing struggle to get more and more pills. For many people, heroin became the best option when they ran out of pills. Many people who originally developed an opiate addiction by using a legitimate prescription for painkillers now use both drugs regularly. But are we truly at epidemic status?

Stats and Facts

The  National Survey on Drug Use and Health (NSDUH) reports that in 2013, about 289,000 Americans said they used heroin in the past month – up from 161,000 in 2007. This is an 80 percent increase in just six years. Similarly, the Centers for Disease Control and Prevention (CDC) reports that, in the same time period, the number of deaths linked to heroin use increased 172 percent – from 3,041 in 2007 to 8,257 in 2013.

Not only do these numbers indicate that rates of heroin abuse have risen significantly in the past decade but that today’s heroin users are more likely to suffer an overdose as compared to heroin users a few years back. Higher dose users, more regular users, and an increase in potency in the heroin available on the street have all likely contributed to this development.

The Shift from Painkiller Abuse to Heroin Use

For many, heroin use was the answer to the question of how best to maintain a painkiller addiction when painkillers became too difficult – or too expensive – to come by. From around 2000 to about 2010, painkiller prescriptions were handed out easily by doctors in an attempt to help people manage pain. Unfortunately, prescribing physicians did not necessarily realize the high potential for abuse and addiction and did not convey that information to patients. As a result, many thought that painkillers were safe simply because they were okayed by a doctor and dispensed at a pharmacy. Some took more than prescribed, others combined them with use of other substances, and still others used leftover pills without a prescription for recreational or other purposes – and ultimately experienced overdose or developed an addiction as a result.

It didn’t take long for the medical community to change how they managed painkiller prescriptions, which made it more difficult for people who were living with an addiction to easily get the pills necessary to maintain an opiate addiction. Many sought out other sources to fend off withdrawal symptoms – and heroin was the easiest and cheapest choice. In fact, a study published in the journal JAMA Psychiatry found that young adults seeking treatment for heroin addiction report that the problem began with use of prescription painkillers, an issue that is not as common among older people seeking help in overcoming heroin addiction. An estimated 90 percent of people addicted to heroin who began their use of the substance after switching from use of opiate painkillers said that they made the shift because heroin was far easier to access and less expensive as well.

The major problem with this change is that, while painkillers are uniform in consistency and makeup, heroin is not. It is impossible for a user to know if last week’s “normal” dose will be enough to create the high they seek or if it will be an overwhelming dose that causes respiratory depression that is fatal.

Multi-Drug Issue

Though heroin use is an increasing problem on its own, many people who die of overdose or suffer from accidents while under the influence are also under the influence of another substance at the same time. For some, it is a concurrent dependence upon both opiate painkillers and heroin that is at issue. For others, heroin is a recreational drug used in combination with cocaine, alcohol, and other substances.

Though the structure of abuse behaviors matters very little in terms of outcome – addiction and death due to overdose occur in both situations – it is important to investigate the context of drug use and the other substances of abuse commonly used even when heroin is the drug of choice in order to ensure that comprehensive and directed support are provided during treatment.

Treatment Options for Heroin Abuse and Addiction

For those who experience withdrawal symptoms when without heroin, the first step in recovery is opiate detox. Clients can opt to kick the habit “cold turkey” – that is, without the use of any addictive medications at all – or use a medication maintenance option that “replaces” heroin use with the use of a regulated drug that provides similar effects and that can be lowered in dose slowly over time.

For those who struggle with a heroin abuse problem – which has just as much potential to cause overdose and sudden death as heroin addiction – and for those who are stabilized after or during detox, long-term therapeutic intervention is the next step. This phase of treatment and recovery can and should last years with varying degrees of intensity based on the client’s specific needs and circumstances. The more support one has in recovery and the longer one spends actively engaged with therapeutic resources and a positive and supportive community, the easier it will be to move past addiction and build a new life without drug use of any kind.

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