Today’s Heroin Problem Linked to Prescription Painkillers
Today’s Heroin Problem Linked to Prescription Painkillers

WASHINGTON—The tragic death of Oscar-winning actor Philip Seymour Hoffman has ignited media discussions on the attraction of heroin, the apparent cause of his death. Hoffman had sought treatment in May, reportedly, for a prescription painkiller dependency that had led him to return to heroin. 

Reports from the Drug Enforcement Administration (DEA) see heroin making a comeback, and one of the main reasons is that addicts substitute heroin for prescription drugs, especially painkillers.

“Because there has been tighter control on prescription drugs, addicts have begun to trend more directly to non-prescribed opiate use. Typically, the prescription opiates have been the gateway to increased non-prescription use,” said Bankole A. Johnson, D.Sc., M.D., chairman of the Department of Psychiatry, University of Maryland School of Medicine, and a leading expert in neuroscience and the psychopharmacology of addiction research, in an email.

Chemically, heroin has a lot in common with prescription painkillers.

“Heroin is an opioid drug that is synthesized from morphine, a naturally occurring substance extracted from the seed pod of the Asian opium poppy plant,” according to National Institutes of Health’s (NIH) National Institute on Drug Abuse. 

Painkillers marketed as OxyContin, Percocet, and Vicodin are also based on morphine.

The National Institute on Drug Abuse states, “Prescription opioid pain medications such as OxyContin and Vicodin can have effects similar to heroin when taken in doses or in ways other than prescribed, and they are currently among the most commonly abused drugs in the United States.”

Heroin More Dangerous

Heroin is more dangerous than the prescription painkillers. The DEA reported, “Those abusers who have recently switched to heroin are at higher risk for accidental overdose.” Heroin varies in strength in a way prescription drugs do not.

Johnson said, “The risk of overdose is increased because addicts, thinking they are using their usual amount, are actually getting a bigger dose, with less whole body tolerance.” 

Toxicologist Christina Hantsch, M.D., of the Loyola University Health System in Maywood, Ill., specializes in emergency medicine. “I have seen more fatal and near-fatal cases from heroin overdoses compared with other drugs of abuse,” she stated in a university press release.

Heroin is also highly addictive. “Those who use heroin can get hooked on the drug the first time they try it,” Hantsch stated. “They also often require increasing amounts over time to get high or to prevent withdrawal.”

Johnson said that heroin is likely the most addictive substance and very hard to wean or detox from. “In some European countries, heroin addicts are weaned by using increasingly smaller doses of heroin because such addicts often refuse to try a less stimulating opiate like methadone. Heroin addicts do not typically switch to OxyContin; the opposite is more likely,” he said. 

Painkiller users who can’t get their drug of choice are turning to heroin, because it is cheaper now than the black market price for pharmaceutical pain pills. Heroin tends to be stronger now than the heroin available in past decades.

Heroin Stronger, Cheaper

According to, “OxyContin, Percocet, and Vicodin have become increasingly hard and costly to obtain on the black market in recent years,” while the supply of heroin from Mexico has increased, bringing prices down.

For the price of one oxycondone pill, which in New York is going for $30, one can get high six times on heroin, according to Erin Mulvey, a DEA spokeswoman in New York, the LA Times reported.

Demographic evidence that painkillers are becoming a gateway to heroin was found in the Substance Abuse and Mental Health Services Administration (SAMHSA) report. In a an August 2013 news release SAMHSA stated that four out of five heroin first-time users (79.5 percent) “had previously used prescription pain relievers nonmedically.”

Further proof of a connection developing was the study’s finding for the people aged 12–49 who used prescription pain relievers. They were 19 times more likely to have initiated heroin use within the past year of being interviewed—0.39 percent versus 0.02 percent—than the others in the age group. 

This is a very disturbing finding indicating that many recreational pain pill users have turned to heroin as a substitute. But even 0.39 percent is still merely a fraction of 1 percent of the pain reliever abuser population.

Another factor made heroin attractive. In 2010, OxyContin changed its formula. OxyContin is designed to be released into the system slowly. Drug abusers who want an immediate rush would crush the pills and inhale the powder, or dissolve the pills in water and inject the solution.

The new formula made inhaling or injecting much harder to do. 

“Our data show that OxyContin use by inhalation or intravenous administration has dropped significantly since that abuse-deterrent formulation came onto the market,” said Dr. Theodore Cicero, a professor of neuropharmacology in psychiatry at the Washington University School of Medicine. Cicero said that OxyContin users were switching to heroin.

The National Survey on Drug Use and Health (NSDUH) regularly surveys illicit drug use. It found that the number of persons who received treatment for heroin dependency increased from 2002 (277,000 persons) to 2012 (450,000 persons), a 62 percent increase. More than twice as many people sought treatment for painkiller dependency in 2012 (973,000). 

  • HeyJude

    I’m not sure there is an answer for this one. You cannot stop people from seeking out mind altering and addicting substances if that’s what they choose…whether it’s alcohol, pot or painkillers. Maybe the first thing we should do is quit making addicts into criminals, they do not belong in jail unless their addiction has led them to crimes against others. What we can’t do is put a hold so tight on painkillers that they become out of reach for people who really need them. We have the ability with these drugs to minimize suffering and give quality of life to people who would otherwise be immobilized with pain.
    We have scared people from using them when appropriate, too. I work with the elderly, and it is amazing how many times the doctor can write a prescription for a pain killer that would ease the suffering and provide a painfree existance for debilitating conditions, only to have a family member say “but we don’t want Grandma addicted.” Jeeez, Grandma is 90 years old and in pain, is taking 2 pills a day for the rest of her life really an issue if they are pain free days????

    • FDRliberal

      Maybe the first thing we should do is quit making addicts into criminals, they do not belong in jail unless their addiction has led them to crimes against others

      Sounds like basic common sense to me.

      • GeauxGhoti

        Unfortunately… There’s this to consider…

        • FDRliberal


      • OnyxE

        Nobody in my city has ever been sent to jail for being an addict in my memory. It’s not happening. They shoot up freely in plain sight on the Downtown Eastside.

        “Constable Al Arsenault, along with six other policemen, document the
        people on their beat to create a powerful film about drug abuse. This
        group of officers developed a unique relationship with addicts in
        Vancouver’s Downtown Eastside. In this documentary, drug addicts talk
        openly about how they got to the streets and send a powerful message of
        caution to others about the dangers of drug abuse.”

        The other thing is their addiction does lead to them committing crimes, because stealing and prostitution is how they get the money to pay for their drugs. But we have a revolving door legal system in BC so I don’t think many actually even go to jail for that.

        Vancouver even has crack pipe vending machines now as well as the safe injection site, Insite.

        “The group that backed a supervised heroin injection site in Vancouver’s Downtown Eastside to improve addicts’ health and safety has launched another project in the same neighbourhood: crack-pipe vending machines that allow users to acquire new, clean pipes for a quarter.”

        And this enabling has not noticeably lowered the drug addiction problems here one iota.

    • OnyxE

      Are we making addicts into criminals in 2014? I just don’t see that in Vancouver at all. Addicts are not being charged or going to jail. And unfortunately the hold is on the painkillers…I have gone into doctors offices and they have a big sign in the waiting room stating they do not prescribe narcotics AT ALL. And the average GP does not understand severe pain at all…I worked in a hospital and the Pain Clinic was so concerned because they didn’t think they were getting patients with severe pain soon enough to really help them, they went to a lot of trouble to hold a big chronic severe pain conference….they sent out invitations to all the doctors in the province and only about 20 doctors came. It’s really bad for patients with severe pain. An example here is these pain experts believe they can cure patients with RSD if they get them within a few months of onset…but they aren’t getting them until it is too late. Then all they can do is help the person cope.

  • OnyxE

    I took Oxycontin for about 4 years for severe pain, the max dose. I didn’t get high, I felt perfectly normal other than the pain relief it gave. I worked, was totally normal. I have no idea what these drug abusers do with this. When my RSD remitted I was able to stop this drug with absolutely no problem.

    It is also very sad that people with severe pain are now having a trouble getting opiates for pain relief drug and maybe the media should look at that aspect rather than always portraying the abuse side of it. Some people just want drugs..they will take anything they can inject, suck, or **k.

    And I still believe THE gateway drug most addicts take is alcohol. Cory Monteith died of a heroin and alcohol overdose, Amy Winehouse died of an alcohol overdose, Philip Hoffman apparently had one drink of alcohol and it put him back on his life of addiction, including heroin.

    Philip Seymour Hoffman’s recent and fatal path down the road of addiction was triggered by an innocent drink … sources close to the actor tell TMZ.

    Hoffman had been sober for 23 years prior to shooting “The Master” — but during a wrap party in 2012, the actor succumbed to temptation … and celebrated the movie with a drink … which quickly became a couple of drinks.

    Hoffman acknowledged to confidants … the drinks opened the floodgates. Addictions experts all say one drink can destroy an addict’s life … and that seems to be what happened here.

    Read more:

    Experts: Alcohol More Harmful Than Crack or Heroin
    Substance Abuse Ranked According to Harm to User and Society

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