One of the nation’s largest drug screening companies has released a new report claiming there is “concrete evidence” linking prescription painkillers with the rising use of heroin.
In a study of drug tests collected from 171,061 chronic pain patients, Ameritox detected heroin in 2,206 of the patients’ urine samples. Although that is just 1.3% of the total number of pain patients studied – it is greater than the 0.3% in the general population that use heroin. Ameritox said the data was a sign that “chronic pain patients are using heroin with painkillers” and “prescription opioids are the new gateway to heroin abuse.”
According to the Substance Abuse and Mental Health Services Administration, heroin use has nearly doubled in United States. The number of people reporting that they have used heroin rose from 373,000 people in 2007 to 620,000 people in 2011.
“Part of the story of heroin’s resurgence is how it is manifesting itself in the lives of chronic pain patients, and that makes this epidemic unique from heroin scourges of the past,” the Ameritox report states. “More and more opioid users are turning to heroin, most often when the prescriptions become difficult to obtain and users find that heroin is easier and cheaper to get.”
The study – and Ameritox’s presentation and interpretation of the results – came under sharp criticism from Mark Collen, a pain patient and longtime critic of the drug testing industry.
“If this graphical display is what Ameritox is calling ‘a research report that provides concrete evidence linking prescription drug abuse to heroin abuse,’ then I’d have to say that the people at Ameritox may not understand the meaning of the words ‘science,’ ‘research report,’ or ‘concrete evidence.’ I could imagine a junior high school student coming up with a similar conclusion based on their graphics but of course he would fail, much like Ameritox has at their attempt at ‘science.’” Collen wrote in an email to National Pain Report.
Other key findings in the Ameritox study:
- 66% of heroin users used both heroin and a prescription painkillers in the last month
- 56% of the positive heroin samples did not contain a prescribed painkiller
- 20% of heroin users tested positive for a non-prescribed sedative such as Xanax or Valium.
“This is challenging (report) to respond to, because it’s a bunch of thrown-together facts without any discussion to hold them together and get them to a meaningful conclusion,” said Bob Twillman, PhD, Deputy Executive Director of the American Academy of Pain Management.
“Some of it is not surprising, especially the parts that indicate that people bounce back and forth between prescription opioids and heroin — after all, those who use these drugs for purposes of abuse get the same effects from both sources. I suspect that some will use prescription drugs whenever they can get them because, if swallowed, they expose the individual to lower risk of complications like hepatitis and HIV, but when their supply runs out, they will turn to heroin if they can find it.”
Another recent study also found that many heroin users are attracted to the drug not only for the “high” that it brings, but because it’s cheaper and easier to get than prescription painkillers. Researchers said many drug abusers started with prescription opioids and then switched to heroin when the painkillers became too expensive.
The average cost for a single dose of heroin is $10, while an 80mg dose of oxycodone costs $80 on the black market.
But Twillman believes the overprescribing of opioids – not just its cost – may be what’s driving the increase in heroin use.
“I do think that it’s entirely possible that the sharp increase in opioid prescribing after about 1995 has contributed to this problem by exposing more people with a vulnerability to substance abuse/addiction to opioids than were exposed in the past,” Twillman said in an email to National Pain Report.
“The conclusion is still the same—we need to be judicious in our prescribing; very closely monitor people for whom we prescribe to intervene as soon as there’s an indication that they may have an issue; and make maximum use of non-opioid medications and non-medication options in treating chronic pain. Opioids need to be part of our toolbox to treat pain, but they shouldn’t be the only tool.”