The nonmedical use of prescription opioids has become a significant public health issue throughout the country. Not only because of the numbers of people using and abusing prescription opiates but also because of the increase rise of deaths from overdoses and related traumatic events. In a relatively recent article in The New England Journal of Medicine “Relationship between Nonmedical Prescription-Opioid Use and Heroin Use” researchers found that heroin users were 3.9 times as likely to report nonmedical use of opioids in the previous year, and 2.9 times as likely to meet the criteria for abuse or dependence on opioids, as persons who did not use heroin. Other studies noted that nonmedical use of multiple opioids was associated with transitioning to heroin. Similarly, another study found that the incidence of heroin use among people who reported prior nonmedical use of prescription opioids was 19 times as high as the incidence among persons who reported no previous nonmedical use. Additional studies involving persons from various geographic, economic, and drug-using backgrounds have shown similar patterns.
In 2003, early researchers found that in Ohio, 50% of persons 18 to 33 years of age who had recently begun using heroin reported having abused opioids, primarily OxyContin, before initiating heroin use. A larger study involving young urban people who used injected heroin in New York and Los Angeles in 2008 and 2009 showed that 86% had used opioids non-medically before using heroin. Similar studies conducted in San Diego, Seattle, and New York showed that 40%, 39%, and 70% of heroin users, respectively, reported that they had used prescription opioids non-medically before initiating heroin use
Sadly, it appears that the analysis of patterns of nonmedical use of prescription opioids suggests that persons most often start with medical use of opioids. Once they develop tolerance or access becomes harder, they move to more “efficient” routes of administration, such as smoking, injection or inhaling. By the time these individuals start heroin use, they find heroin to be more easily available, more potent, and more cost-effective than prescription opioids.
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