CDC Reports Significant Increase in Heroin Use and Overdose Deaths, Positive Correlation with Prescription Opioid Use

[The Anti-Targ]

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm64e0707a1.htm?s_cid=mm64e0707a1_e

Annual average rates of past-year heroin use increased from 1.6 per 1,000 persons aged ≥12 years in 2002–2004 to 2.6 per 1,000 in 2011–2013. During 2002–2013, heroin overdose death rates nearly quadrupled in the United States, from 0.7 deaths to 2.7 deaths per 100,000 population, with a near doubling of the rates from 2011–2013 (1). Although it has been postulated that efforts to curb opioid prescribing, resulting in restricted prescription opioid access, have fueled heroin use and overdose, a recent analysis of 2010–2012 drug overdose deaths in 28 states found that decreases in prescription opioid death rates within a state were not associated with increases in heroin death rates; in fact, increases in heroin overdose death rates were associated with increases in prescription opioid overdose death rates (6). In addition, a study examining trends in opioid pain reliever overdose hospitalizations and heroin overdose hospitalizations between 1993 and 2009 found that increases in opioid pain reliever hospitalizations predicted an increase in heroin overdose hospitalizations in subsequent years (7).

So, who the hell came up with the notion that reducing prescription rate for prescription opioids would lead to an increase in heroin use and overdose? If Ya don't get people into the habit, they ain't likely to develop a habit. Assuming (and it seems like a pretty good assumption) prescription opioids is a pathway into heroin addiction, it is only logical that the long term effect of reducing opioid prescription rates will lead to a reduction in heroin use rates.

But that is surely not the only thing driving increased heroin use. Though maybe it is "By 2011–2013, opioid pain reliever abuse or dependence was more common among heroin users than alcohol, marijuana, or cocaine abuse or dependence." Could there be another driver of the return to popularity of heroin? Do drugs just tend to cycle through a popularity trend? People get tired of the highs they get from one drug, so they move on to another one, and somehow a climbs the ladder of ascendancy and becomes the drug of choice for an increasing number of users?

The other thing is, I hear cannabis is as effective, or even more effective, as a pain reliever, and it is no more likely to lead to long term addiction than prescription opioids. Yet there seems to be a mental impairment among many govt agencies about making cannabis legal as a prescription pain medicine. How many people die from cannabis overdoses every year? Is it because opioids aren't actual heroin, so govts can use that as a fig leaf to pretend that there's no hypocrisy and ignore the significant risk of addiction? Whereas cannabis is cannabis so you can't make a distinction other than the form in which it is consumed, which is not a sufficient distinction for govt agencies to be comfortable?

You might also note a subtle pattern in the CDC article when it lists other substances of abuse. Even though association with marijuana use is actually very low "the largest adjusted odds ratio (aOR) for heroin abuse or dependence was found among persons with opioid pain reliever abuse or dependence (aOR = 40.0; 95% CI = 24.6–65.3), followed by persons with cocaine abuse or dependence (aOR = 14.7; 95% CI = 7.4–29.2), marijuana abuse or dependence (aOR = 2.6; 95% CI = 1.5–4.6), and alcohol abuse or dependence (aOR = 1.8; 95% CI = 1.2–2.9)" when the article lists the associated substances marijuana is often the first or second substance to be listed, which from a reading perspective makes the reader associate marijuana more strongly with heroin than the other substances, because we naturally associate position in a list with importance or significance. Deliberate or subconscious?

Seems crazy, but I guess not surprising, that there is an ideological and cultural bias against cannabis that is causing people to become addicted, via the legal medical system, to a much more dangerous substance. I also note that making cannabis a legal prescription pain relief drug is not suggested anywhere in the CDC article, when it seems like that solution should definitely be part of the conversation, even if it is ultimately rejected, for non-legitimate reasons.

[Guest]

I'd be stunned if the rise in heroin use isn't mostly caused by the opiate use rise. It's more or less the same substance, but people eventually get cut off by their doctors or can't effectively doctor shop or whatever, and heroin is cheaper.

Regardless of the cause, hopefully we'll see more availability of Noloxone, a remarkable drug that can stop an opiate-based overdose dead in its tracks.

[Arch-MaesterPhilip]

My sister starting shooting because the supply of pills dried up.

[Guest]

My sister starting shooting because the supply of pills dried up.

Terribly sorry to hear that, but that appears to be quite common.

I think that opiate pills are doubly tempting because it's a very powerful substance that comes from a doctor (and even when you don't get a script, it still feels like it came from a doctor somewhere), so it's a "clean" way to get high. There's a barrier to using that a needle-based drug possesses that a pill does not even when they're essential the same substance.

[mcbigski]

Is the strength of illicit opiates higher now than in the past? That could be a reason why people who become addicted, perhaps through prescriptions, end up ODing.

[jarl the climber]

Is the strength of illicit opiates higher now than in the past? That could be a reason why people who become addicted, perhaps through prescriptions, end up ODing.

IDK, the US has been messing around in Afghanistan for 15 or so years and that's the heroin capitol of the world, so probably there is some "good stuff" out there. I think it's a little more common than it was twenty years ago.

[Guest]

I think that over time there has been an increase in the potency of the Rx pills, but that's not what's driving what's going on now. Strong-ass pills have been out there for a long time now. I don't claim to know all of the underlying causes, but it seems like there's an epidemic of overprescribing that seems to be worse in some parts of the US than others. Now why that is is a big question.

[White Walker Texas Ranger]

I don't have any hypotheses as to why opoids abuse seems to be on the rise, but I read this interesting essay few months back on heroin addiction treatment.

[Baitac]

My sister starting shooting because the supply of pills dried up.

OMG, Philip, I'm so very sorry. Did she overcome it? :(

[Baitac]

It's a complicated issue. I have to get more info from hubby, but my understanding is that there was a real shift in how pain was to be treated. Whereas before there was a "deal with it" attitude, pain was now going to be treated as a separate condition. Doctors were proactive in prescribing. There were abuses on both sides. As pill mills were actively sought out and those involved prosecuted, the availability was lessened. This increased the cost per pill. Heroin is now cheaper and easier to find. It's a terrible situation. Those people had a real problem that caused real pain. In the end, everything went to shit and lives were destroyed.

[Kindly Old Man]

I don't have any hypotheses as to why opoids abuse seems to be on the rise, but I read this interesting essay few months back on heroin addiction treatment.

Suboxone works to treat withdrawal, but it is a cash cow for doctors who basically lie to their patients about it. It works if you plan to stay on it for maybe a week or two, but it you stay on it long-term and try to kick it, it is harder to kick than opiates - somewhat less intense withdrawal over a much, much longer time period (it can be months) which generally leads to people just going back to opiates. It's similar to methadone that way. You can stay on it forever, I guess, but most people trying to get clean don't want to be on a maintenance drug forever, they want to be clean.

[My Lady Ashalind]

Baltimore has a huge heroin problem. There was just an article in the paper warning about heroin that's been laced with fentanyl - a pain reliever prescribed to cancer patients and those in chronic pain. 39 overdose deaths so far this year.

http://www.baltimoresun.com/health/blog/bs-hs-fentanyl-in-heroin-20150706-story.html

[Guy Kilmore]

I think that over time there has been an increase in the potency of the Rx pills, but that's not what's driving what's going on now. Strong-ass pills have been out there for a long time now. I don't claim to know all of the underlying causes, but it seems like there's an epidemic of overprescribing that seems to be worse in some parts of the US than others. Now why that is is a big question.

From what I understand it is a combination of things (here comes opininated stuff). The first is that doctor's were getting dinged in civil suits for not treating people's pain, the second is physicians aren't really trained well to deal with addicts, and the third being Big Pharma marketing. I think the second one is the biggest issue, personally.

[Guy Kilmore]

Suboxone works to treat withdrawal, but it is a cash cow for doctors who basically lie to their patients about it. It works if you plan to stay on it for maybe a week or two, but it you stay on it long-term and try to kick it, it is harder to kick than opiates - somewhat less intense withdrawal over a much, much longer time period (it can be months) which generally leads to people just going back to opiates. It's similar to methadone that way. You can stay on it forever, I guess, but most people trying to get clean don't want to be on a maintenance drug forever, they want to be clean.

While I agree Suboxone could be a money maker persay, I don't think I have ever really heard about doctor's telling lies to get people on it. I'm not necessarily a fan of it, but I have worked with some individuals who probably would be dead without this options for their treatment.

I will say that I have worked with a significant amount of people taking Suboxone vs. Methodone and I find that those on Suboxone tend to be much higher functioning.

[Guest]

From what I understand it is a combination of things (here comes opininated stuff). The first is that doctor's were getting dinged in civil suits for not treating people's pain, the second is physicians aren't really trained well to deal with addicts, and the third being Big Pharma marketing. I think the second one is the biggest issue, personally.

I have to think you're right that it's a combination of things like that. No doubt Big Pharma marketing plays a part. No doubt there are some "pill mills" where certain docs go to town on writing scripts. I know the least about the first issue that you mention, but that's fascinating and also seems plausible.

Per my comment earlier, without being able to break it all down, I know that another factor is that different states within the US have different regs about prescribing. For a crude example, in one state it might be really easy to go from one doc to another and complain of pain and get yet another Rx for pills whereas in a different state they track users and prescribers to track that very thing.

ETA: I am very skeptical of the idea that suboxone is being largely prescribed by lying, profiting doctors, but I can be swayed by evidence if you can provide it, Kindly Old Man.

[Kindly Old Man]

While I agree Suboxone could be a money maker persay, I don't think I have ever really heard about doctor's telling lies to get people on it. I'm not necessarily a fan of it, but I have worked with some individuals who probably would be dead without this options for their treatment.

I will say that I have worked with a significant amount of people taking Suboxone vs. Methodone and I find that those on Suboxone tend to be much higher functioning.

W/r/t methadone I was just talking about withdrawal, in terms of effects it is much different - methadone has euphoric effects similar to other opiates, Suboxone does not (hence the higher functioning you mention). In the linked article they mention tapering down off of Suboxone, which I'm sure is the Suboxone manufacturer's company line. What they don't mention is that even if you taper down to next to nothing, the withdrawal will be quite intense, and if you re on subs for any length of time, it will be very long. Like I said above, it works if you use it for really short time periods, or if you plan to stay on it forever. But there is not much profit in short term prescriptions, and people would opt not to take it if they knew they'd be on it forever, so they act as if tapering is going to be easy. And doctors don't question this, because why would they? It's what they've been told, they have no first-hand experience with withdrawal that would make them question it, and they make more money with longer prescriptions. So they're probably not all lying deliberately, but patients are definitely being misinformed. I'm inclined to be less than charitable b/c several friends have had experiences where all Suboxone related doctor visits were cash only.

I definitely think it is an effective treatment that should be used often, but people should know what they're getting into.

[Lily Valley]

I'd be stunned if the rise in heroin use isn't mostly caused by the opiate use rise. It's more or less the same substance, but people eventually get cut off by their doctors or can't effectively doctor shop or whatever, and heroin is cheaper.

Regardless of the cause, hopefully we'll see more availability of Noloxone, a remarkable drug that can stop an opiate-based overdose dead in its tracks.

I love Narcan and I keep it in my house for emergencies. There. I said it here.

Edit: Obviously with a telephone equipped with emergency services nearby.

[Raja]

Regardless of the cause, hopefully we'll see more availability of Noloxone, a remarkable drug that can stop an opiate-based overdose dead in its tracks.

You mean availability thorough medics/ doctors? Is it not available where you are?

[Ramsay B.]

W/r/t methadone I was just talking about withdrawal, in terms of effects it is much different - methadone has euphoric effects similar to other opiates, Suboxone does not (hence the higher functioning you mention). In the linked article they mention tapering down off of Suboxone, which I'm sure is the Suboxone manufacturer's company line. What they don't mention is that even if you taper down to next to nothing, the withdrawal will be quite intense, and if you re on subs for any length of time, it will be very long. Like I said above, it works if you use it for really short time periods, or if you plan to stay on it forever. But there is not much profit in short term prescriptions, and people would opt not to take it if they knew they'd be on it forever, so they act as if tapering is going to be easy. And doctors don't question this, because why would they? It's what they've been told, they have no first-hand experience with withdrawal that would make them question it, and they make more money with longer prescriptions. So they're probably not all lying deliberately, but patients are definitely being misinformed. I'm inclined to be less than charitable b/c several friends have had experiences where all Suboxone related doctor visits were cash only.

I definitely think it is an effective treatment that should be used often, but people should know what they're getting into.

I was on suboxone for two different periods of time after being hooked on oxy's for a few years. The first time I was on them for over a year and something happened with my doctor so I was abruptly cut off while on like 2mg per day(I started at 16mg which is too much IMO)and the withdrawal was complete hell. It last for 3 weeks straight before I got back into pills. I could barely even function. I had absolutely no energy, anxiety, sleeplessness and just horrible depression basically. So after doing pills for maybe another 8 months, I got back on 8mg of suboxones at the start and tapered down to nothing after 6 months. There was little to no withdrawal after tapering down and I've been good ever since and that was like 3 years ago.

The doctor I dealt with was $125 per visit every 2-3 weeks. Suboxone is a good way to kick the habit but it also costs money and has the same withdrawal effects as "normal" opiates. My complaints with the few doctors I've known who deal with this is they basically keep you on it for as long as possible(as Kindly Old Man implied). I had to put my foot down the second time and say I'm tapering off and that's it. I know a few friends who have been on it for like over 3 years now and I just fear for when they have to get off it because it's no joke. It's not like doctors hold a gun to our heads but there is some manipulation about them saying we're not ready to taper down yet and that sort of talk. The doctors are making an absolute killing on this but it did help my life out tremendously so there are positives if taken like it's supposed to be.

As to the heroin linked to opiate addiction, there is really no question about it. I've seen first hand many times people who started on pills and they are just too expensive so they switch over to sniffing heroin then eventually shooting it.

[karaddin]

I'll make a more detailed post later, but I just wanted to say that it's very easy for people not suffering chronic or acute pain to make judgements about opiate availability and declare they are over prescribed. I'm coming off 5 months on slow release oxycodone/naloxone for acute post operative pain. Without the doctor that trusted me enough to prescribe it, it would have taken me 2.5 months to get to see a pain doctor and in that time I would have been either on heroin or dead by suicide, the pain was way beyond what I could have lived with. 1 week and I was ready to jump in front of a bus. Yes cannabis should be available as a painkiller, and it's fucked up that we let scaremongering over recreational use impair the availability of a medical substance, but opiates need to be available for those that need them too. They are dangerous from dependence and over dose perspectives, but other drugs that are pushed instead carry much higher adverse effects and in some cases worse dependence, and patients aren't even warned about this and its not seen as an issue, because the drugs can't get you high and are cheaper. Fuck that. I barely dodged one of these drugs despite not remotely fitting the profile for it and the adverse effects being very bad for my situation.