Letters to the Editor

Probable Relationship Between Opioid Abuse and Heroin Use

Am Fam Physician. 2003 Mar 1;67(5):942-945.

to the editor: The abuse of OxyContin has received considerable attention in the past few years. Other prescription opioid analgesics are also widely abused. The Ohio Substance Abuse Monitoring (OSAM) Network,1 a statewide epidemiologic surveillance system, has identified a significant increase in opioid abuse in Ohio. Data from the national level have indicated the same trend.2 We documented a connection between prescription opioid abuse, subsequent heroin use, and the adoption of high-risk behaviors.

The OSAM Network is supported by the Ohio Department of Alcohol and Drug Addiction Services and operated by Wright State University School of Medicine.1 The purpose of the OSAM Network is to gather timely epidemiologic data on substance abuse trends throughout Ohio for public health officials and policy-makers. Regional epidemiologists use data from individual and focus group interviews with drug users, treatment providers, and law enforcement officials, as well as statistical data from county coroners, local law enforcement agencies, and regional crime laboratories to develop biannual epidemiologic reports.

Between June 2001 and January 2002, the OSAM Network conducted an investigation of recently initiated heroin users. In Dayton, 10 subjects, aged 18 to 33 years, were interviewed. Five subjects reported abusing prescription opioids, most notably OxyContin, before initiating heroin use. They reported tolerance to the drug's effects and physical withdrawal symptoms when deprived of OxyContin. They reported that heroin was more readily available and less expensive than OxyContin and that they would never have tried heroin had they not become addicted to OxyContin. This trend has been identified throughout Ohio, and similar patterns have been identified in other areas of the United States.36

These findings are limited by the small convenience sample. However, we continually identify persons who report a similar progression from prescription opioid abuse to heroin injection. Death statistics from several county coroners' offices corroborate this increase in opioid abuse. A county in rural southeast Ohio reported seven or eight opioid-related overdose deaths in 2001, most involving heroin. Montgomery County (Dayton) reported a 36 percent increase between 2000 and 2001 in drug-related deaths involving opioids, most involving heroin and/or prescription opioid analgesics.

The results of this investigation suggest that the abuse of opioid analgesics constitutes a new route to heroin abuse, placing new populations at risk for heroin addiction. This is a reversal of the classic pattern in which heroin users would turn to prescription opioids when heroin was unavailable. In addition, although many new heroin users may begin by snorting the drug, most progress to injection drug use as their tolerance develops and the quality of heroin varies. The implications for the spread of blood-borne pathogens, such as human immunodeficiency virus, hepatitis B virus, and hepatitis C virus, are clear.

Drug abuse prevention programming aimed at young people needs to address the dangers of prescription opioid abuse as well as heroin use. In addition, physician education is needed to raise awareness of the differences between patients seeking drugs for their euphoric effects and those seeking pain relief.

REFERENCES

1. Siegal HA, Carlson RG, Kenne DR, Starr S, Stephens RC. The Ohio Substance Abuse Monitoring Network: constructing and operating a statewide epidemiologic intelligence system. Am J Public Health. 2000;90:1835–7.

2. Results from the 2001 National Household Survey on Drug Abuse. Rockville, Md.: US Dept of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies; 2002. DHHS publication SMA 02-3758.

3. Hart A. Savannah arrest shows problem of prescription pill abuse. Savannah Morning News. August 28, 2002. Retrieved January 2003 at: http://savannahnow.com/stories/082802/LOCPHARMA.shtml.

4. Callahan J. Medications led to student's death. The Star Banner. August 29, 2002. Retrieved January 2003 at: www.mapinc.org/drugnews/v02/n1610/a04.html.

5. Information bulletin. OxyContin diversion and abuse; 2001. Publication no. 2001-L0424-001. 2001. Retrieved January 2003 from: www.usdoj.gov/ndic/pubs/651.

6. Pulse check: trends in drug abuse, July-December 2001 reporting period. Washington, DC: Office of National Drug Control Policy; 2002.

Send letters to Kenneth W. Lin, MD, MPH, Associate Deputy Editor for AFP Online, e-mail: afplet@aafp.org, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680.

Please include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.

Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the American Academy of Family Physicians permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.


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