Can Prescription Pills be “Gateway Drugs” to Heroin Use?

The easy answer is, “yes.” But we all know there are no easy answers.

To examine the problem, we need to walk backward from the gateway along the path that leads to heroin addiction driven by prescription pills. That path takes us back to 1984 when the Food and Drug Administration approved the synthetic opiate Vicodin, followed by OxyContin in 1995 and Percocet in 1999. That was 15 years ago. But heroin, which is processed from morphine which is a naturally occurring opiate, has been around since 1874.

Heroin use in the United States has spiked in the last ten years. Nationally, heroin overdose deaths increased by 45 percent from 2006 to 2010.

According to most sources, there are two primary reasons for the increase in heroin deaths.

1. A growing market in this country driven by prescription drug abusers who can no longer find or afford their pills because of the government crackdown on “pill mills.”

Florida, an actual physical gateway to the East Coast, was known for its “pill mills” before legislation was signed by Gov. Rick Scott in 2011. Prior to that initiative, Interstate 75 was known as the Oxy Express and Interstate 95 was dubbed Oxy Alley. The tentacles of the diverted pharmaceutical business reached all the way up the East Coast. When the Strike Force began shutting down corrupt wholesalers, rogue pharmacies and unscrupulous doctors, the supply of prescription pills for users began to dwindle.

National figures show that in Florida in 2010, 98 of the top 100 oxycodone pill dispensing doctors lived in Florida. By the end of 2012, no Florida doctors made the top 100 list. A positive effect of the crackdown was a 52 percent decline in the number of oxycodone overdose deaths.

During that same time period, statistics for Miami-Date County show an increase of 120 percent in heroin deaths. They tripled in Broward County. State-wide, deaths from the more potent and readily available heroin rose 89 percent from 2011 to 2012.


2. A larger amount of heroin is being imported by Latin American cartels.

Not an operation to miss an opportunity for a new market, the Latin American cartels filled the void left by the diminished supply of prescription drugs. They flooded the market with cheaper, more potent heroin that could produce a similar high at a fraction of the cost. Because of the volume of heroin on the streets today, it’s cheaper and purer than it’s ever been. The purity enables users to take the drug without using a needle. They can snort it or smoke it. For many users, not using a needle makes snorting or smoking it more acceptable.

Who are the abusers of painkillers?

  • People who have been prescribed painkillers after surgery and for other chronic pain and who find they eventually can’t function without them. This group includes many older Americans dealing with chronic pain. Even so, not all people prescribed painkillers become addicted.
  • Teens. In a recent survey, 50 percent of teens believe prescription drugs are safer than street drugs. They often start with their own family medicine cabinet. One in ten high school seniors admits to abusing prescription painkillers.

Who uses heroin?

  • Many of the same people, with the possible exception of older Americans.
  • In three recent studies, nearly half of young people surveyed who inject heroin reported abusing prescription opioids before moving on to heroin.
  • Some of those surveyed indicated they started using heroin because it is easier to get and cheaper than prescription pills.
  • Surprisingly, many college-educated suburbanites who would never go near a needle have no qualms about crushing heroin and either snorting or smoking it. The high is similar to prescription painkillers, the delivery system is the same, and they feel as if they haven’t crossed the line to the needle. Once considered an urban drug, heroin is now at home in the suburbs and in rural America.

The unintended consequence of the successful crackdown on the pill mills in Florida and elsewhere and the confiscation of so many illegal prescription drugs seems to have displaced one drug with the other.

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