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Opioid Addiction: From Prescription Painkillers to Heroin

Many people who abuse prescription pills will make the switch from prescription painkillers to heroin. According to the National Institute on Drug Abuse (NIDA), almost 80 percent of heroin users reported having misused prescription opioids prior to using heroin. One study by the Substance Abuse and Mental Health Services Administration found that people who abuse legal painkillers such as oxycodone, hydrocodone, and codeine are 19 times likelier to use illegal heroin. Though these drugs may be a precursor to heroin, additional research would need to be done to characterize the individuals that do transition from meds to heroin.

Both drugs bind to opioid receptors in the brain, inducing a flood of dopamine and re-wiring the brain’s physical structure. This re-wiring prevents the natural recycling of neurotransmitters in the brain, which creates tolerance and, ultimately, dependence on substances that can facilitate this artificial euphoria. Prescription opioids and heroin can produce similar highs due to their similar chemical makeup.

Though there is a link between prescription medication abuse and picking up heroin, few people actually make the switch. Less than four percent do so within five years, according to data from the National Survey on Drug Use and Health.

Some studies have suggested that this practice is common for young intravenous drug users infected with hepatitis C. The risk of contracting this disease, as well as infectious blood disease HIV, goes up considerably when one starts injecting heroin in favor of prescription opioids.

Painkillers to Heroin: Why do people make the switch?

It is common for people to go from prescription painkillers to heroin, because heroin is usually more accessible and a lot cheaper. Heroin is a cheaper alternative to prescription opioid pain relievers and gives users a similar high, making it an appealing solution to the higher cost of medication. It is also easier to obtain than drugs for which a prescription is required. These two facts— lower cost and access— were cited by 94 percent of people in treatment for opioid use disorder as the reason for switching to heroin.

Because tolerance requires that opioid users take higher, more frequent doses to achieve the desired results, it can lead to overdose. Opioid overdose is a major issue in the U.S., with opioids killing over 115 Americans every day and drug overdose generally killing 72,000 people last year (Centers for Disease Control and Prevention, CDC). Much of the opioid crisis has its roots in the sale of fentanyl and fentanyl analogs.

A deadly synthetic opioid, fentanyl is 50 times stronger than heroin, making one three-milligram dose lethal. Narcan, a naloxone nasal spray, may be used to reverse the effects of opioid overdose, but only effective addiction treatment and expanded access to education and treatment resources can prevent overdose.

How can this addiction development be avoided?

Most people who are prescribed opioid painkillers never abuse them, but for the few who do, developing a heroin addiction can be fatal. To avoid this, people who are prescribed opioids for pain relief should not take more than prescribed and should not re-fill a prescription without a doctor’s suggestion. Extra/leftover pills should also be disposed of.

Also, if you are aware that you have another substance use disorder, or someone in your family has one, you may be at higher risk of abuse prescription opioids. If a doctor wants to prescribe you these medications for chronic pain or for a routine surgery, you may be able to request a non-addictive alternative. The risk in going from prescription painkillers to heroin is too great not to explore non-addictive alternatives.

Treating opioid addiction

If you or a loved one has an opioid use disorder and needs help, please reach out to our admissions team at (877)-RECOVER today. Royal Life Centers at Puget Sound is a full-service drug and alcohol medical detox and residential inpatient facility located in Sumner, Washington. We treat dependence on alcohol, benzodiazepines, cocaine, methamphetamine, and opioids. Our holistic approach to treatment uncovers the roots of addiction to help our guests build sober foundations for themselves.

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