Do the policies and practices designed to reduce prescription opioid misuse fuel the increase rate of heroin use and deaths? In an effort to prevent shifting the problem from prescription opioids to heroin, a recent review explores this question through discussing four major topics:
- The pharmacological similarities between heroin and prescription opioids. Although heroin is similar pharmacologically to prescription opioids, this section discusses how some individuals could perceive prescription opioids as “less”, “more”, or “equally” rewarding as heroin.
- The pattern of heroin use among individuals that misuse prescription opioids. This section cites multiple studies that all demonstrate a clear association between heroin and prescription opioids, including evidence that the majority of current heroin users often cite misusing prescription opioids before initiating heroin use.
- Current trends in heroin use. This section reports statistics revealing that heroin use is on the rise amongst misusers of prescription opioids, but also among misusers of other prescription drugs, cocaine users, binge drinkers, and marijuana users. In addition, it also discusses studies that suggest misusing prescription opioids first is not necessary to initiate heroin use.
- Effects of opioid-prescribing interventions on heroin use. Many heroin users that initiated with prescription opioids cite cost and availability as primary factors that fueled their transition. As such, this section documents multiple studies that compare the timeline between policies initiated to curb opioid prescribing with the years 2006-2007, when the U.S. began to experience a rise in heroin use and deaths.
Take Away: This review argues that while prescription opioid misuse transitions to heroin use for many individuals, the misalignment between the timelines for this transition and policies initiated to combat prescription opioid misuse do not facilitate a clear cause and effect relationship. However, both prescription opioid misuse and heroin use each play a role in a larger opioid epidemic, suggesting a more comprehensive, integrated action plan may help enhance current prevention, intervention, and treatment efforts.