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By Monica E. Oss

A quick scan of the headlines reveals a lot about the increase in deaths from heroin – between 2012 and 2013, heroin overdose deaths in the United States increased by 39%, from 5,925 in 2012 to 8,257 in 2013 (see Heroin Overdose Deaths Up 39% In 2013 and Heroin Overdose Deaths In U.S. Have Tripled Since 2010). Those stats certainly caught my attention. But, a little investigation reveals that in the U.S., the deaths due to heroin are still dwarfed by deaths due to prescription drugs.

In 2010, 22,134 deaths involved legal prescription pharmaceuticals (see 75% Of Drug Pharmaceutical Overdose Deaths Involve Prescription Opioid Pain Relievers), and from 1999 through 2011, the rate of opioid-analgesic poisoning deaths increased by nearly 400% – from 1.4 per 100,000 in 1999 to 5.4 per 100,000 in 2011 (see 400% Increase In Drug-Poisoning Deaths Involving Opioid Analgesics Between 1999 & 2011).

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I must admit I was pretty shocked at these numbers. I had expected to focus this piece about the need for treatments to address heroin addiction. But, it turns out, the bigger problem is prescription painkillers. According to the Centers for Disease Control and Prevention (CDC), in 2012, health care professionals wrote 259 million prescriptions for painkillers (see Opioid Painkiller Prescribing). To put this in perspective, in any given year, over one-third of Medicare Part D enrollees use a prescription opioid, accounting for about five percent of total prescriptions and spending for drugs covered under Part D (see Potentially Inappropriate Opioid Use In Medicare Part D). In 2011, 11.5 million Medicare beneficiaries (36%) filled at least one prescription for an opioid, and total spending cost $2.7 billion. And, a recent Mayo Clinic study estimates that 12% of the U.S. population is currently using an “opioid analgesic” and 13% are currently using an antidepressant. (For more, see Age and Sex Patterns of Drug Prescribing in a Defined American Population.)

Along the way, our team learned some other interesting statistics about the use and misuse of prescription opioids. In 2013, there were 124 million Hydrocodone prescriptions and 53 million Oxycodone prescriptions (see America’s Addiction to Opioids: Heroin and Prescription Drug Abuse). By way of reference, this compares to about four million methadone prescriptions in 2009 (most recent year available) (see Prescription Painkiller Overdoses).

According to the American Society of Addiction Medicine (ASAM) report, Advancing Access to Addiction Medications: Implications for Opioid Addiction Treatment, nonmedical use of opioid pain relievers costs U.S. health insurers (a group that includes Medicaid) approximately $72.5 billion annually in health care costs.

I’m not discounting the problems with the current rise in heroin overdoses. But the reality is that they are probably linked to the prescription opioid problem. One theory is that users are moving to heroin from painkillers due to increased federal restrictions and the “affordability” of heroin. A 2014 study published in JAMA Psychiatry, The Changing Face of Heroin Use in the United States, found users cited heroin as “more readily accessible and much less expensive than prescription opioids.” And, if you are looking for more of a connection, a 2013 JAMA article using federal data from 2011 found that 80% of people who had used heroin in 2010 had also used prescription painkillers (see Pain Medication Abuse a Common Path to Heroin: Experts Say This Pattern Likely Driving Heroin Resurgence).

It’s easy to make the connection between drug addiction and illegal drugs – but it’s much harder to see prescription drug abuse. In the 1960’s heroin users were predominantly young men in urban environments. In more recent years, heroin users were older, more evenly split between men and women, more likely to be white, and located more in suburban areas. This change is due, in part, to the increase in the abuse of prescription opioids over the last 20 years (Demographics Of Heroin Users Change Over Past 50 Years ).

To combat these problems, we’ve seen a number of new programs, policies, and treatment programs – from the development of new, addiction resistant prescriptions (see FDA Approves Vivitrol for Opioid Dependence and FDA Approves Targiniq ER, An Abuse-Resistant Opioid Pain Medication), to decision support tools designed to bring problems of opioid overuse to the attention of physicians (Veterans Affairs Accelerates Deployment Of Opioid Therapy Tool To Reduce Adverse Effects ). As this is a problem without a simple solution, I expect that we’ll continue to see policymakers searching for new treatments and programs to address prescription drug abuse.

As the health care system continues to move toward the concept of “whole person” health, addressing addictive disorders will be central to the equation. It just turns out that we need to not only look at the expected illegal substance abuse, but to focus on where the big problems are – the use of prescription opioids.


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