Eric K. Mason
March 2, 2015
Prescription Painkillers to Heroin Addiction
Although death due to drug overdose from prescription painkillers, such as OxyContin and Vicodin, have decreased overall recently, the opposite is true regarding heroin overdose. Between 2012 and 2014 death due to heroin overdose doubled between 2010 and 2012. Nevertheless, overall, the number of deaths from legal painkillers remains about three times higher than the number of deaths from heroin.
These statistics represent a new reality amongst prescription drug users—heroin is often easier to get than prescription painkillers. Heroin, though illegal, which has the same painkilling properties as prescription painkillers, can be purchased without a prescription. Those addicted to painkillers may have difficulty at times obtaining their painkillers, as the medications are dispensed by doctors (unless purchased on the black market, of course). Doctors serve as gatekeepers for prescription drugs, while drug dealers typically will sell to anyone who has money. Furthermore, prescription painkillers are often more expensive than heroin. The going rate on the street for a fix of heroin is ten dollars, while OxyContin cost eight times that.
Recently regulations have made it more difficult for doctors to prescribe opioid painkillers, as well as more difficult for patients to doctor shop (visiting multiple doctors to obtain multiple prescriptions for painkillers). Other measures have included changing the formulation of prescription painkillers to make them more difficult to snort or inject. Although those who advocate for such regulations have good intentions, in that the goal was to reduce the likelihood that one may become addicted to prescription painkillers, such regulations may have inadvertently contributed to the steep rise that we are now seeing in heroin addiction.
Three quarters of those addicted to heroin used opioid painkillers as their gateway to the addiction. The demographics of the typical heroin users has begun to shift, perhaps, as a result. For example, in contrast to the heroin users of years before who were often young, of low-income status, and from urban areas, heroin users nowadays are often more affluent, older, and from the suburbs.
Although the use of prescription medications, such as methadone and buprenorphine, remains the standard for the treatment of opioid addiction, many programs are beginning to supplement such treatment with psychological interventions, such behavioral management training, counseling, etc. However, recent research suggest that adding psychological interventions may not necessarily improve treatment outcomes of pharmaceutical interventions for opioid addiction. One study found that adding individual counseling sessions “offered no additional benefit over and above the standard buprenorphine treatment. Other research has pointed out that adding individual counseling is helpful for those who are severely addicted, while less helpful for with less severely addictions. Researchers are trying to understand under what circumstances behavioral treatment is most effective. Apparently, the jury is still out regarding the usefulness of individual counseling.
Contingency management programs seem to be very promising for treating opioid addiction. Such programs involve offering rewards as incentives not to use drugs, such as some sort of prizes or even money. Although some regard these programs as too expensive, recent research has found that contingency management program that offered cheaper rewards were just as effective as those offering more expensive rewards. For example, a program offering $300 as a reward was just as effective as one offering $900. Although contingency management programs are promising, some specialist believe that adding opioid replacement therapy is still essential.
Indeed, addiction treatment if often very expensive. One study found that the cost of treatment for addiction was as high $32,000 annually. Trying to find cheaper modalities of treatment is an ongoing issue in the addiction treatment field. This has led some to attempt to develop computerized systems that may be capable of delivering some sort of interventions for addictions.
Clay, R. (2015, February). As deaths from heroin increase, psychologists are exploring
what kind of treatment works best. Monitor on Psychology.
(1). Retrieved from http://www.apa.org/monitor/