How Bad Has the Opioid Epidemic Become?

Summary and Comment |
April 18, 2017

How Bad Has the Opioid Epidemic Become?

  1. Steven Dubovsky, MD

Significant increases in lifetime heroin use, heroin use disorder, and preceding nonmedical use of prescription opioids are seen in >10 years of epidemiological data.

  1. Steven Dubovsky, MD

To illuminate the nature of the increasing misuse of prescription and nonprescription narcotics, researchers examined data from two waves (2001–2002 and 2012–2013) of a nationally representative, household, interview survey involving 79,402 adults.

The prevalence of lifetime heroin use and heroin use disorder increased almost three- and fivefold, respectively, with the greatest increases seen in whites and men. Among white heroin users, the number who reported nonmedical use of prescription opioids before starting heroin use significantly increased (2001–2002, 36%; 2012–2013, 53%); the percentage decreased in nonwhites.

Comment

An editorialist points out that prescription opioid sales increased 300% over the study period, with more than half used for chronic noncancer pain. Even though most prescription-opioid users do not transition to heroin, other studies have found that 80% of heroin users previously misused prescription opioids. The transition from prescription opioid misuse appears to be the result of the greater availability of cheaper and increasingly potent preparations of heroin and related drugs. Meanwhile, obtaining prescriptions for narcotics has become more difficult for patients who became dependent on these drugs during treatment for benign pain, and heroin use has become more socially acceptable in middle–class, white populations. Factors behind the increase in narcotic prescriptions include the opinion that opioids, especially newer “abuse-deterring” versions, are effective and safe for chronic pain; a desire to satisfy the “customer”; and the belief, fueled by overly optimistic industry marketing, that complete relief of distress should be readily available in a pill. Clinicians should add behavioral techniques, physical therapy, and other nonpharmacologic modalities to non-narcotic medications before considering opioids for any form of chronic pain and, probably, for some kinds of acute pain.

Editor Disclosures at Time of Publication

  • Disclosures for Steven Dubovsky, MD at time of publication Grant / Research support Otsuka; Tower Foundation; Oshei Foundation; Patrick Lee Foundation; Wendt Foundation; Takeda; Lilly; Sumitomo; Hoffmann-La Roche; Pfizer, Neurim Pharmaceuticals; Neurocrine Biosciences Editorial boards Mind and Brain; Bulletin of the Menninger Clinic; Current Psychiatry; Journal of Psychosomatic Research

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