Why Are Middle-Class Heroin Overdoses Skyrocketing?

By Dr. Mercola

A joint report1,2,3,4 by the US Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) reveals lethal heroin overdoses nearly quadrupled between 2000 and 2013.

Between 2000 and 2010, heroin-related deaths rose at an average rate of 6 percent per year. Then, from 2010 to 2013, the average annual increase suddenly jumped to 37 percent.

What might account for such a radical increase in heroin overdoses?

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Prescription Painkillers Pave Way for Heroin Addiction

According to CDC Director Dr. Thomas Frieden, opioid painkillers like Vicodin, OxyContin, and Percocet increase your susceptibility to heroin addiction, and the report found that the vast majority — 75 percent — of heroin users started out on prescription painkillers.

Those who abuse prescription opiates have a 40 times greater risk of abusing heroin, and the widespread misuse of prescription painkillers is thought to be at the heart of rising heroin addiction and related deaths.

As reported by Reuters:5

“Frieden said… doctors are prescribing ‘way too much of these medications, and the result of it is large numbers of people who are addicted.’”

Indeed, prescriptions for opioid painkillers have risen by a staggering 300 percent over the past decade.6 As of 2012, 259 million prescriptions for opioids and other narcotic painkillers were written7 in the US.

The trend of painkiller abuse can also be seen in death rates linked to overdoses from prescription painkillers, which rose by 350 percent among men and 500 percent among women in the decade between 1999 and 2010.

Notably, there were four times more deaths from prescription painkillers among women than for cocaine and heroin combined in 2010.8

Heroin Use Surging Among Women and Middle-Class

While heroin use has increased across the board, among both sexes, virtually all age groups, and all income levels, some of the largest increases are seen in groups that have had historically low rates of heroin use, namely women, the privately insured, and those in higher income brackets.

These demographic groups do correlate with higher rates of prescription opioid abuse, however — another indication that prescription painkillers have become a primary gateway drug.

Among women, heroin use has doubled in the past decade. Heroin use also rose by 60 percent among those with an annual income of at least $50,000, and by 62.5 percent among people with private insurance.

Multiple-drug addiction is also common. Ninety-six percent of heroin users use at least one other drug, including prescription painkillers, cocaine, marijuana, and alcohol.

In all, an estimated 517,000 Americans used heroin in 2013 — a 150 percent increase since 2007. Price is one major incentive for switching. According to the Drug Enforcement Administration (DEA), one day’s supply of OxyContin on the street can cost as much as $160, while a day’s worth of heroin costs about $40.

People also turn to heroin when they can no longer get their prescriptions refilled, or when their tolerance level surpasses their allotted prescription dosage.

Gender Differences Place Female Addicts at Increased Risk for Death

The Atlantic9 recently discussed the phenomena of rising heroin use among women, noting that gender differences can make getting hooked on painkillers a riskier proposition for women than for men.

“Women tend to become dependent on drugs more quickly than men, according to the most recent data10 from the Substance Abuse Mental-Health Services Administration.

This is especially the case among those who abuse alcohol, marijuana, and opioids like heroin. Women also find it harder to quit and can be more susceptible than men to relapse, according to Harvard Medical School.”11

A 2013 study12 identified three factors that are predictive of an increased risk of painkiller dependence:

  • Frequency of painkiller use
  • History of substance abuse (often unrelated to pain relief)
  • Reduced ability to cope with pain

According to the authors:

“Based on these findings, a preliminary model is presented with three types of influence on the development of painkiller dependence:

1) Pain leading to painkiller use

2) Risk factors for substance-related problems irrespective of pain, and

3) Psychological factors related to pain.”

The second and third items may reveal some of the underlying mechanisms that place women at increased risk of painkiller and heroin abuse.

As discussed in my recent interview with Dr. Pamela Peeke, food addiction is very common, especially among women. And those who have suffered emotional trauma or abuse during childhood or adolescence are particularly predisposed to addiction of all kinds — not just food.

How Addiction Works

Groundbreaking research into food addiction reveals that the mechanisms of addiction are identical no matter what you’re addicted to, be it food or drugs. A critical player in all forms of addiction is the neurotransmitter dopamine.

Your brain can secrete dopamine simply by looking at a picture of a loved one or a beautiful sunset. But you will not feel pleasure or reward unless dopamine binds with its receptor (D2 receptors), which are located all throughout the reward center in your brain.

When dopamine links to the D2 receptor, immediate changes take place in your brain cells, producing the experience a “hit” of pleasure and reward. However, when the stimulation becomes too high, your brain’s reward center will begin to downregulate your D2 receptors, basically eliminating some of them.

This is a built-in survival strategy to prevent you from becoming hyperstimulated, but as a result you no longer feel anywhere near the pleasure and reward you felt initially. As a result, you build tolerance, which means you need greater amounts of the substance to achieve the same result you got initially.

Addictive cravings also grow stronger, and this is where it can get really dangerous when you’re using painkillers or heroin, as opioids can slow your breathing to the point of death if you take too much. Such risks are compounded if you add alcohol or other drugs to the equation. As previously reported by CNN’s chief medical correspondent, Dr. Sanjay Gupta:13

“…after just a few months of taking the pills… [t]he effectiveness wears off, and patients typically report getting only about 30 percent pain relief, compared with when they started. Even more concerning, a subgroup of these patients develop a condition known as hyperalgesia, an increased sensitivity to pain.

As you might guess, all of this creates a situation where the person starts to take more and more pills. And even though they are no longer providing much pain relief, they can still diminish the body’s drive to breathe. If you are awake you may not notice it, but if you fall asleep with too many of these pills in your system, you never wake up.”

Weighing the Risks Versus Benefits of Painkillers

As noted by CDC Director, Dr. Thomas Frieden:14“Before they prescribe an opioid for the first time, doctors really need to look at the risks and the benefits, particularly for chronic pain like back pain, neck pain, headaches.  Really, does it make sense to give a prescription opiate for these conditions? What are the risks and what are the benefits? Well, we know the risks – someone can get addicted for life and if they take a few too many pills, they can die. The benefits are really unproven for chronic, non-cancer pain management.”

Indeed, despite dramatic increases in prescriptions, two papers,15,16 published in the Annals of Internal Medicine earlier this year found NO evidence in the medical literature supporting the long-term safety and effectiveness of narcotic painkillers. Most trials do not go past six weeks, and there are no studies longer than one year on record. There’s also a lack of standardized trials evaluating the side effects of opioid use, which is the “golden standard” of medical science-based evidence.

Clearly, there are instances where a narcotic painkiller may be warranted, but it’s really important to use the lowest effective dose for as short a period of time as possible.  For people suffering from chronic pain, neither of these warnings is going to be popular, and many may argue that they can’t function without some form of pain relief. This is understandable, but if you’re struggling with chronic aches and pains, I urge you to take the time to investigate your options, and to really try to address the root of your pain rather than cover it up with a narcotic that can lead to debilitating addiction and death.

Non-Drug Alternatives for Pain Relief

Following are some of the most effective non-drug alternatives for the treatment of various types of pain that I know of. If you’re in pain, I recommend trying these first, before even thinking about prescription painkillers of any kind.

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Sources and References

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