The Changing Face of Heroin Abusers

Prescription painkiller abusers appear to be switching to heroin because it is cheaper and easier to get

/ Author:  / Reviewed by: Robert Carlson, M.D Beth Bolt, RPh

(RxWiki News) In recent years, pharmaceutical companies have put safeguards on medications to make it harder to abuse certain prescription painkillers. But those changes may be leading some to use illegal drugs.

A new study has uncovered a changing pattern of the kind of people entering drug treatment programs for heroin addiction.

The research revealed that those seeking help for heroin addiction tended to be opioid painkiller abusers before using heroin. These people often said that they used heroin not only because of the "high" it produces, but also because the drug was a cheaper and easier to obtain alternative to prescription painkillers.

While most new heroin users in the 1980s were white and nonwhite alike, the vast majority of people who started using heroin within the last 10 years were white.

"Seek immediate medical help if you are abusing drugs."

In a press release, lead researcher Theodore J. Cicero, PhD, professor of neuropharmacology in psychiatry at Washington University School of Medicine in St. Louis, said, "In the past, heroin was a drug that introduced people to narcotics, but what we’re seeing now is that most people using heroin begin with prescription painkillers such as OxyContin, Percocet or Vicodin, and only switch to heroin when their prescription drug habits get too expensive.”

In August 2010, medication manufacturers altered the formula of the opioid OxyContin to make the pills harder to crush and less likely to dissolve. The formula change was made as a preventive measure to stop drug abusers’ immediate high while still providing pain relief for patients with doctor-ordered prescriptions.

In a 2012 letter to The New England Journal of Medicine, Dr. Cicero stated that the formula change had made it harder for opioid abusers to snort or inject OxyContin, but that the change could be a major reason why many abusers have switched to heroin.

“If you make abuse-deterrent formulations of these drugs and make it harder to get high, these people aren’t just going to stop using drugs,” Dr. Cicero said. “As we made it more difficult to use one drug, people simply migrated to another. Policymakers weren’t ready for that, and we certainly didn’t anticipate a shift to heroin.”

For this recent study, Dr. Cicero and his fellow researchers reviewed data from more than 150 private and public drug treatment centers across the US. 

Over 9,000 patients who were dependent on opioids and narcotic painkillers completed questionnaires from 2010 to 2013. A total of 2,797 patients listed heroin as their primary drug of choice.

The researchers noted that there were three dominant reasons for the uptick in heroin use:

  • Heroin is readily available, meaning it can be located with minimal effort
  • Heroin can be easily snorted or injected, offering a similar painkiller-like high
  • Heroin is obtainable at a fraction of the cost of opioids and narcotics.

As one questionnaire respondent told the researchers, "Heroin is cheaper and stronger than the prescription drugs listed, and the supply is typically pretty consistent. It is also much easier to use intravenously than pills and other prescriptions, which often take more complex methods to break down."

According to Dr. Cicero, “The price on the street for prescription painkillers, like OxyContin, got very expensive. It has been sold for up to a dollar per milligram, so an 80 milligram tablet would cost $80. Meanwhile, they can get heroin for $10.”

Past research reported that in the 1960s and 70s, over 80 percent of heroin abusers were young (beginning around the age of 16), male minorities living in crowded inner cities.

“Our earlier studies showed that people taking prescription painkillers thought of themselves as different from those who used heroin,” Cicero stated.  “We heard over and over again, ‘At least I’m not taking heroin.’  Obviously, that’s changed.”

Overall, participant questionnaires revealed a noticeable shift in the demographics of heroin users seeking treatment over the past several decades. The researchers found that heroin was no longer an inner-city issue among minorities. Its deadly lure now extends to white, middle-class people living outside of major cities.

The study further revealed that 90 percent of recent heroin addicts are older, white men and women with an average age of 23 who primarily live in non-urban areas. These people often started by abusing prescription painkillers and later switched to heroin when opioids and narcotics became too costly and harder to obtain and abuse.

Dr. Cicero said he was surprised that a drug like heroin has gained such popularity in suburban and rural areas. However, he said that additional studies of individuals in treatment programs may help to reveal the overall source of the heroin abuse problem.

“The overdose deaths and hospitalizations are symptoms of a problem that we really need to deal with,” Dr. Cicero said. “You can’t effectively treat people or prevent addiction unless you know why they are taking drugs, and we don’t really have a handle on that yet. Unfortunately, the problem with heroin is it’s the most powerful opiate ever created, and even if people think they are being careful, it can kill.”

This study was published May 28 in JAMA Psychiatry.

Study questionnaire data was collected from the nationwide Survey of Key Informants’ Patients (SKIP) Program, a key element of the postmarketing Researched Abuse, Diversion, and Addiction-Related Surveillance (RADARS) system, and funded through an unrestricted research grant by the Denver Health and Hospital Authority, which collects fees from 14 pharmaceutical firms. 

No specific financial information was given, and no conflicts of interest were disclosed.

Review Date: 
May 30, 2014
Last Updated:
June 3, 2014