NEJM Report: Opiod-Heroin Link Varies

NEJM Report: Opiod-Heroin Link Varies

By Ed Coghlan

A study published in the prestigious New England Journal of Medicine concludes people who use prescription opioids for nonmedical reasons is rare, and the transition to heroin use appears to occur at a low rate.

The study, published on January 14, emphasizes the nonmedical use of prescription opioids is a strong risk factor for heroin use.

The study is co-authored by Wilson M. Compton, M.D., M.P.E., who is Deputy Director of the NIH’s National Institute of Drug Abuse, Christopher M. Jones, Pharm.D., M.P.H., of HHS and  the CDC’s Grant T. Baldwin, Ph.D., M.P.H.

“Although some authors (of other studies) suggest that there is an association between policy-driven reductions in the availability of prescription opioids and increases in the rates of heroin use, the timing of these shifts, many of which began before policies were robustly implemented, makes a causal link unlikely,” they write in their conclusion.

The report says that in 2014, a total of 10.3 million persons reported using prescription opioids non-medically – meaning they were using medications that were not prescribed for them or were taken only for the experience or feeling that they caused.

Pain Patient Advocates have been concerned over the past year about how this debate on the use of opioids – much of it fueled by two federal agencies – has focused on the nation’s serous addiction problem but has overlooked the role opioids play in helping chronic pain patients manage their lives.

“This is positive news for people with chronic pain who use their medication responsibly,” said Paul Gileno, founder and President of the U.S. Pain Foundation. “As the federal government, especially the CDC and DEA read this study, we trust that they will conclude that the discussion about addiction is extremely important and needed but equally important is the discussion of how we can best treat the person with pain.”

A recent 60 Minutes segment on linkage between using opioids leading to heroin was the catalyst for a series of articles on the National Pain Report about the topic.

The Centers for Disease Control also ignited a strong debate on the topic when it drafted its 2016 Guideline for Opioid Prescribing for Chronic Pain without input from the chronic pain community. That pressured the agency to open up a public comment period which closed last week (January 13). Some 4,000 comments were issued. The CDC will meet again on January 28 to discuss next steps.

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Authored by: Ed Coghlan

There are 10 comments for this article
  1. Kristine (Krissy) at 5:21 pm

    BL – I am well aware of the monitoring system and have been since its inception. I’ve been on strong meds forever, and I traveled the east half of the US in my motorhome last year and got my Rx’s filled in several states. Most were happy to fill, with calling my doc, checking the databases and even some called the BOP. I was merely pointing out that no matter what, there are plenty of illegal actions still going on. The most recent I read about was a pharmacist who had more than 100,000 pills in his stash and was making quite the dough before he got caught. As more prevention for such things are put in place, hopefully this problem will get better. I’m sure it already has since I was on the road as new laws, fears and arrests have been made.

  2. BL at 6:30 pm

    Kristine (Krissy), All 50 States have their own Prescription Monitoring Program. This is where pharmacists must turn in Schedule II prescriptions, and usually others, that they fill within a short time frame. By Law pharmacists must check this database Before they fill Schedule II prescriptions. In most states every dr must check the PMP databse Before they write a Schedule II prescription. Each State has additional laws for what information in included in the database. The name of the patient, dr, date written and date filled, name of medication, mg, amount prescribed, amount given, directions, how many days the prescription will last is taken as prescribed, the method that the person used to pay for the prescription, etc are all standard PMP info. The people that are authorized to access the PMP database is also governed by State Laws. Pharmacists and drs are standard in every state. In some states law enforcenment and state agencies like Medicaid can also access the database. Others can request permission.

    In addition there are at least 30 states that are also connected to their bordering states PMP. More states are being added.

    You can’t believe everything someone tells you.

  3. Kurt W.G. Matthies at 2:38 pm

    People living in pain who require prescription medicine to perform basic tasks — like caring for children, doing the laundry, shopping for and preparing food — understand the value of these essential medications.

    The evidence continues to demonstrate that there is little abuse in this population.

    Ed’s story reminded me of a piece I did last July. It covered a University of Georgia (UGA) study exploring behavioral characteristics common to people who misuse or abuse prescription drugs.

    I encourage you to review my July story, as it complements this month’s NEJM study. It can be found here:

    http://nationalpainreport.com/new-data-on-the-gateway-to-prescription-abuse-8826839.html

    These reports present strong data on the inconvenient facts of pain medicine when used to treat the suffering of America’s millions in chronic pain. The anti-analgesic avengers who believe that if only those irresponsible doctors would stop writing so many pain prescriptions, the whole problem of addiction, unintended overdose, and the “scourge of drugs” on American society would just go away, seem to overlook the certain conclusions found in these reports, that study the responses of tens of thousands of “recreational” drug users, whose drugs of choice happen to be pharmaceutical-grade opioids.

    Some people take prescription pain drugs for fun.

    And social science continues to show that drug abuse doesn’t happen because those irresponsible doctors over treat a bad sprain with “Heroin pills”, or because grandma left that darn medicine cabinet open again, and state and federal regulatory agencies that receive tens of billions of dollars for managing and policing their use in medicine is asleep at the wheel.

    There is a bustling market for these prescription drugs in American streets, play grounds, schools, and other places known to non-medical users of opioid-based analgesics.

    Drug abuse — just like alcohol and other substance abuse — appeals to a certain percentage of the population. It always has, and it always will. We learned to brew alcoholic beverages over ten-thousand years ago.

    The current phenomena of drug abuse in America is nothing new, but it is being sensationalized for a variety of reasons, one of which may be the current major polical power struggle in American today. The problem of “drugs in America” has been earning political capital for American candidates for 100 years.

    The UGA study (produced in Athens, GA, an ironic hour’s drive from the CDC headquarters in Atlanta), investigated patterns in the non-medical use of pain medicine. Dr. Orion Mowbray, an assistant professor in the School of Social Work and the UGA study’s lead author summarized his groups report in these words:

    “Male or female, black or white, rich or poor, the singular thing we found was that if they were an illicit drug user, they also had many, many times higher odds of misusing prescription pain relievers.”

    Can we please take the blinders off to conclusions like these, or in http://www.nejm.org/doi/full/10.1056/NEJMra1508490, and in so many other examples that repeatedly demonstrate the existence of two populations of people with two different behaviors when it comes to the use of pain medications.

    One population requires analgesia — with high dosing of strong opioid-based medications.

    The other population is looking to get stoned. Their drug(s) of choice include opioids.

    Could it really be that reported increases in America’s drug abuse problem and the recent rise opioid-related mortality figures may be due to a coincidence?

    Who is asking the question — why is there so much pain in America?

    The only epidemic here is one of human suffering on an overwhelming scale, if the IOM’s report is correct. I pray that we have the wisdom to consider all the evidence before our actions condemn a large percentage of Americans to a life of suffering.

    @kwgmatthies

  4. Scott michaels at 7:13 am

    Chrissie that was pre 2012 before the DEA GOT SO INVOLVED. Not 2014, with the data bases they use, its way to difficult to fill that rype of prescription. If a dr writes too many prescriptions, the pharmacy and dea is all over it. The drug addicts have either gone to rehab or TURNED TO HEROIN. ONCE SOMEONE TRYS HEROIN THEY ARE EITHER HOOKED OR DEAD. ITS VERY EASY TO GET, ITS PURE AND ITS CHEAPER THEN EVER, A DRUGGIE ISNT GOING TO DEAL WITH DRS AND DEA ANY MORE. OF THEY ARE WiTHDRAWING THEY JUST END UP IN AN ER OR STEAL Pain pills from a family member who really needs it

  5. Scott michaels at 7:05 am

    we all have to take urine tests, they are also testing to make sure the drugs are in their systems along with any other drug they may have taken. i found out where they got the 10.4 million people.. othey bent over as far as they could and looked up behind them and was their butts and grabed asany numbers they could.LOL ITS A JOKE WHAT THESE SO CALLED GENIUSES WRITE AND and PUBLISH AS TBOUGH ITS TRUTH

  6. Marty at 4:02 am

    I feel like real chronic pain patients are finally being heard. At least it’s a step in the right direction. I can’t help but feel lie maybe it’s the younger group they should be watching. Us older ones have worked our entire lives and dealt with pain as best we could until the body just can’t keep up with the pain anymore. I am thankful every day for for my pain pills that ease my pain a little. Last thing I would ever do is sell pills. Life means to much to me.

  7. Kristine (Krissy) at 6:56 pm

    I am really exhausted right now and can barely see, but I’ll do the best I can here.

    I do believe that number of non-patients have gotten opioids — pills. The re-sell market from legit Rx’s is huge for one, pharmacists have done it everywhere- and many have become addicts themselves (an old pharmacist friend did it and told me a lot), in Miami medical professionals are doing it and at a $40,000 salary job, making more than 10 times that, until they get caught or quit, teens steal, adults steal, and imports are a factor. I wasn’t even surprised. I don’t believe everything I read; I don’t believe a great deal of what I read, but let’s hope this is a start to something! It is far easier for illegal users to get these drugs on the streets than it is for legit patients to get them in many counties/states. We have to think positively in order for our work to be effective. Otherwise it would be too easy for us to throw up our hands and give up.

  8. BL at 11:14 am

    I read nothing that says that it is Not chronic pain patients that are using their pain meds for the way they make them feel. You have to pay as much attention to what is Not said as you do to what i said. I’m willing to bet that within the next few months it comes out that chronic pain patients as well as non chronci pain patients are included in this number. It also concerns me that “they” may come back and say that chronic pain patients aren’t being responsible with their meds and they don’t really need them so they are selling them.

    I also question how the numbers were obtained. I agree with Scott michaels, “where did they find 10.4 million people to admit they took the medication illegally. cmon.” What age groups were involved ? Was the info obtained over the internet, from printed media, drs, etc ?

  9. Michelle at 10:30 am

    Amen! I wonder how long the chronic pain community will sit on our hands? There needs to be a consorted effort. We need to at last ban together and raise our voices. Until the media can no longer ignore our
    cries for help!

  10. Scott michaels at 9:34 am

    where did they find 10.4 million people to admit they took the medication illegally. cmon. There dea said 450k to 1.5 million people use heroin. They at least have a huge gap in their made up number.
    why are these well respected groups allowed to consistently make up numbers. With out real facts its just a story. i dont believe 10.4 million people were able to get there hands on opioid medication illegally, there are too many safegards in place. as a legal chronic pain patient its almost impossible to get my medicine, i couldnt imagine trying to get them illegally. Thats probably the real number of how many people use heroin. They just dont want to admit such a faliure.