Fatal Heroin Overdoses on the Increase as Use Skyrockets: Health Officials Battling Opiate Epidemic

By Krisberg, Kim | The Nation's Health, May 2014 | Go to article overview

Fatal Heroin Overdoses on the Increase as Use Skyrockets: Health Officials Battling Opiate Epidemic


Krisberg, Kim, The Nation's Health


AT THE HEIGHT OF THE prescription drug abuse epidemic in rural Scioto County in south-central Ohio, so-called pill mills were pumping out enough pain pills to provide every single county resident--nearly 80,000 people--with 123 pills every year.

The problem was so bad that in 2010, county officials declared a public health emergency and went into incident command mode.

"It was awful," said Lisa Roberts, RN, public health nurse at the Portsmouth City Health Department in Scioto County. "The place was just crop-dusted with opium ... (Pain pills) became a form of commerce here. Pretty much everyone I knew had an addicted kid. It became completely mainstream."

[ILLUSTRATION OMITTED]

Today, thanks to state wide efforts to restrict easy access to painkillers, prescription opioids such as oxytocin are hard to find on the street, Roberts said. However, that gap has been quickly filled by another opioid: heroin.

"We've had a nearly 100 percent transition to heroin (among people) in our needle exchange program," Roberts told The Nation's Health.

Unfortunately, Scioto County is not alone. According to the National Institute on Drug Abuse, heroin use has been on the rise since 2007. In 2012, about 669,000 Americans reported using heroin in the past year, up from about 373,000 in 2007. The greatest increase in heroin use was among young people ages 18 to 25. Heroin overdose deaths have risen as well, increasing by 45 percent between 2006 and 2010. Closely tied to the rise in heroin use is the rise in prescription opioid abuse, which in 2008 was involved in more overdose deaths than heroin and cocaine combined.

In 2010, national drug surveys found that more than 12 million people reported using prescription painkillers for nonmedical reasons. Not surprisingly, surveys have found a strong link between the use of prescription opioids and heroin initiation: Nearly 80 percent of people who reported initiating heroin use in the past year had previously abused prescription pain medication; whereas, only 3.6 percent of people who began abusing painkillers reported heroin use in the previous five years. In March, U.S. Attorney General Eric Holder called the rise in both heroin- and prescription drug-related overdose an "urgent public health crisis."

"It's impossible to understand the heroin problem without first understanding the prescription pill problem," Rafael Lemaitre, MA, communications director in the White House Office of National Drug Control Policy, told The Nation's Health.

Wilson Compton, MD, deputy director of NIDA, said that while there are indicators that the prescription drug abuse epidemic is connected to the rise in heroin use, the availability and purity of heroin has increased. He said that even though state and local efforts to restrict the flow of prescription opioids may have steered some people toward heroin, the natural progression of addiction also plays a role.

"As someone uses prescription drugs more and more regularly, the propensity to try other forms of opioids goes up," Compton said. "In many ways they're not two separate epidemics--it's just one opiate epidemic."

There is no data to suggest that gains made in restricting easy access to prescription painkillers are being voided by a switch to heroin, said Len Paulozzi, MD, MPH, medical epidemiologist in the Division of Unintentional Injury Prevention at the Centers for Disease Control and Prevention's National Center for Injury Prevention and Control.

"We can't say that the prescription problem is being replaced by heroin," Paulozzi said. "The safest assumption is that we have a new problem on top of the old problem."

In tackling the opioid abuse problem, both Paulozzi and Compton said health officials have to look upstream. In particular, Compton said prevention strategies need to take a long-term approach, such as reducing the kinds of early childhood trauma that often lead to risky behaviors in adulthood. …

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