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Federal leaders seek to debunk notion that Rx crackdown caused heroin crisis

January 13, 2016
by Gary A. Enos, Editor
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A review article published in the Jan. 14 New England Journal of Medicine cites several studies to counteract the oft-stated theory that government crackdowns on access to prescription opioids caused a spike in heroin use and overdose.

Co-authored by leaders at the National Institute on Drug Abuse (NIDA), the Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC), the article suggests that while non-medical use of prescription opioids remains a strong risk factor for heroin use, research findings paint a very different relationship from what is often depicted at public forums attended by addiction professionals. The review concludes that:

  • Heroin use among users of prescription opioids is relatively rare;

  • Upward trends in heroin use surfaced well before the mainly state-level policies to combat prescription drug misuse were enacted; and

  • Market factors around access and price are primarily responsible for the heroin surge.

The article states that “there is no consistent evidence of an association between the implementation of policies related to prescription opioids and increases in the rates of heroin use or deaths, although the data are relatively sparse.”

NIDA deputy director Wilson M. Compton, MD, is the review article's lead author; the article states that while several federal colleagues provided input into the content, the views expressed are those of Compton and his two co-authors and do not necessarily reflect those of their respective federal agencies.

Amid an atmosphere in which federal leaders have aggressively resisted embracing the notion of a link between government actions on prescription drugs and patterns of heroin use, it remains to be seen whether this review article will alter the dialogue among many treatment professionals who appear convinced that a strong link exists.

Question of timing

Much of the journal article's emphasis centers on when patterns of increased heroin use and consequences began to emerge, and how that might relate to trends in prescription drug misuse. The article cites national surveillance data and information collected by poison control centers that show increases in heroin use starting in the 2006-2007 period.

“It appears that the shift toward heroin use among some nonmedical users of prescription opioids was occurring before the recent policy focus on prescription-opioid abuse took hold,” the article states. State-level actions such as implementation of state prescription drug monitoring programs (PDMPs) and enforcement actions against blatantly inappropriate prescribing patterns largely began to take hold after 2010.

Moreover, the article states that a data review published in 2013 found that only 3.6% of nonmedical users of prescription opioids initiated heroin use within five years of starting to misuse prescription drugs. These and similar findings led authors of the latest review article to state that nonmedical use of prescription opioids “is neither necessary nor sufficient for the initiation of heroin use and that other factors are contributing to the increase in the rate of heroin use and related mortality.”

Issues of economics

Chief among those other factors, according to the authors of the latest article, are cost and availability. The authors say that thoughout the period from the late 1990s to 2013, these ranked as the key considerations that users of prescription opioids cited for initiating heroin use.

The authors did add, “Some interviewees made reference to doctors generally being less willing to prescribe opioids as well as to increased attention to the issue by law enforcement, which may have affected the available supply of opioids locally.”

Yet the article also cited five studies—one a multi-state analysis and the other examining trends in North Carolina, Wisconsin, Florida and New York—that suggest that state policies did not directly lead to increases in heroin use. The study in Florida, which in 2010 and 2011 instituted a major crackdown on prescription opioid supply by targeting “pill mill” operations, found that while prescription opioid overdose deaths dropped by 27% in the aftermath of these actions, the declines were accompanied by a scant increase of 60 in deaths related to heroin.

The journal article concludes with a call for a unified approach to combating prescription opioid and heroin addiction, with recommended strategies that include universal family-based prevention, expanded access to naloxone to reverse overdose, and greater access to medication-assisted treatment of an adequate duration.

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Comments

As a man in recovery, from opiate and benzo addiction, who also lives in what once was the pill mill capital, state of Florida, I can tell you the Feds are absolutely wrong.

When the pill mills started to get shut down because addicts were coming into Florida for scripts from all over the nation, it became increasingly difficult to get what I felt I needed to avoid withdrawals. I had prescriptions that allowed me to take 19 x 350/10 mg percks and 2 x 3 mg Xanax bars everyday. I wasn't selling them, I was hooked and I went crazy when it became difficult to obtain.

Everyone I associated with was addicted. When none of us could find pills, heroin read it's ugly hear and next thing I knew, all my buddies were hooked on that. It was a hell of a lot cheaper than the pills and from what I understand, the high was awesome. Fortunately, I am afraid of needles, and with having lost a few friends to hiv I wasn't going to even mess with a needle to do what all my friends were doing.

About two days after the pills were dried up, my dealer got into a motorcycle accident and was killed. He was the only one that could get me anything, anytime I was in withdrawals. That was an eye opener for me and after two years of substance abuse, I decided to check myself into rehab.

My story can go on forever. Everyone in recovery has a story and no two are ever exactly alike. Between rehab, suboxen and God giving me the will power to survive I was able to taper off my scripts. Today, I'm living proof of how rehab saved my life and how I am here today to share my joy of living. I now work for a drug and alcohol treatment center www.oceanbreezerecovery.com and I'm inspired to help others who want to be helped.

Sorry, I got off point while sharing my joys :)
Feds are wrong and I can say that without a doubt because I was in the height of all of the rx bust and working in the treatment center, each person going in and out of there due to heroin would say the same thing. The war on drugs committee sure screwed up the planning process when they decided to close the pill mills. At least there were less od's when it came to pills. These days I hear of heroin taking someone's life almost daily.

Robert from Ocean Breeze Recover in pompano beach, fl.

Ahhh yes, the bootlickers are doing their job deflecting blame from their clients. My answer is here http://bit.ly/1TjE1jJ

South Florida is ground zero for this epidemic.
JC's Recovery Center- a Faith Based Addiction Treatment Center