14 Nov As Prescription Opioid Deaths Dip, Heroin Deaths Double
Prescription pain relievers are killing fewer people, but heroin deaths are more than making up for it. In fact, heroin deaths doubled from 2010-12, according to a study recently released by the Centers for Disease Control and Prevention.
The investigation was spurred by national death rates over 12 years ending in 2010 that saw prescription opioid pain reliever (OPR) overdoses quadruple while heroin overdoses increased by less than 50 percent.
The study had sought to determine if heroin death rates were related to the OPR death rates. Apparently, they are not, it concluded. At least, not directly. But heroin seems to be stealing some of the action from the prescription overdoses.
“When users of opioid painkillers become addicted and are no longer able to obtain or afford controlled opioid painkillers from the legitimate health care system, some turn to illicit sources to avoid withdrawal,” said Barbara Carreno, spokesperson for the Drug Enforcement Agency. “These opioid painkillers can cost $1 per milligram on the street — up to hundreds of dollars per day — which is financially unattainable for most addicts.” A dose of heroin, which is also an opioid and acts on the same brain receptors, can be purchased for $10, she explained. “That’s one reason for the increase in heroin use, which can be accompanied by an increase in the number of deaths.”
The CDC study, which covered 28 states and included 56 percent of the U.S. population, found that deaths attributed to heroin rose from 1 person per 100,000 people to 2.1 persons per 100,000 from 2010-12.
On the positive side, deaths related to overdoses of OPRs, which include such drugs as OxyContin and Vicodin, dropped from 6 persons per 100,000 to 5.6 per 100,000 over the same time period. Although the news is encouraging, there remain far more deaths attributed to OPRs than heroin.
Heroin deaths in the reporting geographic areas increased from 1,779 to 3,634. However, deaths from OPR overdoses decreased from 10,427 to 9,869.
Between the two totals, the 1,855 increase in heroin deaths more than offset the decrease of 558 from prescription painkillers.
Those ages 25-34 had the highest heroin overdose death rate in 2012, and those ages 45-54 had the highest OPR overdose death rate. The only decrease that occurred between the sexes was among males, whose opioid death rate declined 12.4 percent; female opioid deaths remained steady. Heroin overdose deaths doubled for both men and women.
“Efforts to address opioid abuse need to continue to further reduce overdose mortality and avoid further enlarging the number of OPR users who might use heroin when it is available,” says the study, which was authored by Len. J. Paulozzi of the CDC.
“The rapid rise in heroin mortality follows nearly two decades of increasing drug overdose deaths in the United States, primarily driven by OPR drug overdoses.”
Over the long term, 75 percent of a sampling of heroin users in a treatment program who began opioid abuse after 2000 reported their first regular opioid was a prescription, the study cited. But more than 80 percent of those who began abusing painkillers in the 1960s indicated they initiated their abuse with heroin.
Persons who initiated heroin use after 2000 reported heroin was more readily accessible, less expensive and offered a more potent high than the prescription opioids, supporting the analysis of the DEA’s Carreno.
The study found heroin was being used more widely by all demographic groups except American Indians and Alaska Natives. The bulk of heroin mortality came from the Northeast (an increase of 211.2 percent) and South (180.9 percent) while increasing more slowly in the West (90.7 percent) and Midwest (62.1 percent) during the study period.
However, one of at least five limitations in the study was its lack of participation by more states; the study population was over-represented by the Midwest but under-represented by the West. Additionally, death certificates from 22 percent of overdose deaths fail to specify the drugs involved, and heroin deaths may be misclassified as an OPR death if the heroin metabolite morphine is listed on the death certificate instead of heroin.
Fifteen of the 18 states that had statistically reliable heroin overdose death rates — at least 20 heroin deaths — reported increases from 2010 to 2012. None had a decline.
The study called for better access to treatment for those addicted to opioids, more intense prevention efforts that can help eliminate overprescribing of prescription opioids, and increased use of naloxone, a drug that can reverse opioid and heroin overdose if administered in time.
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