MedicalResearch.com Interview with:
Christopher M. Jones, Pharm D., M.P.H.
Senior advisor, Office of Public Health Strategy and Analysis
Office of the Commissioner, Food and Drug Administration
Medical Research: What is the background for this study?
Dr. Jones: Heroin use and overdose deaths have increased significantly in the United States in recent years. Most heroin users have a history of nonmedical use of prescription opioid pain relievers as well, and an increase in the rate of heroin overdose deaths has occurred concurrently with an epidemic of prescription opioid overdoses.
Although it has been postulated that efforts to curb opioid prescribing, resulting in restricted prescription opioid access, have fueled heroin use and overdose, a recent analysis of 2010–2012 drug overdose deaths in 28 states found that decreases in prescription opioid death rates within a state were not associated with increases in heroin death rates; in fact, increases in heroin overdose death rates were associated with increases in prescription opioid overdose death rates.
In addition, a study examining trends in opioid pain reliever overdose hospitalizations and heroin overdose hospitalizations between 1993 and 2009 found that increases in opioid pain reliever hospitalizations predicted an increase in heroin overdose hospitalizations in subsequent years. Thus, the changing patterns of heroin use and overdose deaths are most likely the result of multiple, and possibly interacting, factors. Moreover, there is a lack of research examining recent trends in the prevalence of other substance use among persons using heroin, especially among the high-risk population of heroin users who meet diagnostic criteria for heroin abuse or dependence.
We wanted to better understand how heroin use is changing and identify the demographic and substance using groups that are at greatest risk for use. Knowing this information can help prevention efforts.
HHS Secretary Sylvia M. Burwell has made addressing opioid abuse, dependence, and overdose a priority and work is underway within HHS on this important issue. The evidence-based initiative focuses on three promising areas: informing opioid prescribing practices, increasing the use of naloxone – a drug that reverses symptoms of a drug overdose, and using medication-assisted treatment to slowly move people out of opioid addiction.
The Obama Administration is also committed to tackling the prescription drug and heroin epidemic, proposing significant investments to intensify efforts to reduce opioid misuse and abuse.
Medical Research: What are the main findings?
Dr. Jones: Heroin use has increased significantly across most demographic groups. There were significant increases in heroin use among demographic groups that have had historically lower rates of heroin use, including women, the privately insured, and people with higher incomes. In fact, the gap between men and women, low and high incomes, and people with Medicaid and private insurance have narrowed in the past decade.
Heroin use is occurring in the context of broader poly-substance use, including marijuana, alcohol, cocaine, and prescription drugs. The use of heroin with other substances increases the risk of overdose. Nearly all (96%) people who reported heroin use also reported using at least one other drug in the past year. More than half (61%) used at least three other drugs.
Among heroin users in 2011-2013:
- 45% had past-year prescription opioid painkiller abuse or dependence
- 36% had past-year alcohol abuse or dependence
- 25% had past-year cocaine abuse or dependence
- 24% had past-year marijuana abuse or dependence
As heroin abuse and dependence have increased, so have heroin-related overdose deaths. From 2002 through 2013, the rate of heroin-related overdose deaths nearly quadrupled.
The strongest risk factor for heroin abuse or dependence was opioid pain reliever abuse or dependence followed by cocaine abuse or dependence.
Medical Research: What should clinicians and patients take away from your report?
Dr. Jones: Clinicians can follow best practices for responsible painkiller prescribing to reduce opioid painkiller addiction, the strongest risk factor for heroin addiction. This entails
- 1) using state prescription drug monitoring programs and asking patients about past or current drug and alcohol use prior to considering opioid treatment;
- 2) prescribing the lowest effective dose of an opioid and only the quantity needed for each patient; and
- 3) linking patients with substance use disorders to effective substance abuse treatment services, including the use of medication assisted treatment for people with opioid use disorders.
Patients and others can learn more about the risks of using heroin and other drugs and become trained in how to recognize and respond to an opioid overdose. For people who are struggling with substance abuse problems, they can call 1-800-662 HELP for assistance.
Medical Research: What recommendations do you have for future research as a result of this study?
Response: More research is needed to evaluate the impact of interventions designed to reduce prescription opioid and heroin abuse. We also need to conduct additional research to further understand the risk and protective factors for heroin initiation and heroin addiction.
Christopher M. Jones, Pharm D., M.P.H. (2015). Heroin Addiction Most Often Preceded by Opioid Abuse