Peter R. Coleman, M.D.
It is a case of good news – bad news. A medical journal article published this month reports what appears to be the beginning of the decline in the abuse of painkillers. This is great news but, and there is a but, the evidence is very strong that the major reason for this drop in pain killer abuse is that many people are simply switching to Heroin. That is certainly what we have been hearing from our patients.
Until recently, there has been strong evidence that narcotic painkiller abuse has been steadily increasing for the last 10 years or so. U.S. sales of painkillers tripled from 1999 until 2008. Deaths from prescription overdoses have also increased three fold during this period.
The situation got so bad that by 2010 more than 12 million Americans were abusing narcotic painkillers and, in 2010, over 16,000 Americans died from an overdose.
The new study found that this may be changing. The study was published in the January edition of the New England Journal of Medicine. The researchers looked at five different data bases to evaluate the amounts of painkiller abuse. In four out of the five databases, there was good evidence that showed the beginnings of a decrease of painkiller abuse.
They found that overdose deaths from painkillers have started to dip slightly since 2009. They also found that the number of people who enter treatment and reported abusing opiate painkillers has decreased about 26%.
The surge in painkiller abuse that started in the late 1990's, has many causes. One of the biggest causes, was simple unawareness. Physicians were not fully aware of just how easy it was for their patients to become hooked on narcotic painkillers, and patients were also uneducated on how quickly and easily these medicines caused physical dependence.
There was a lot of pressure on doctors to “adequately treat pain” and not make patients suffer. Many of these messages to physicians were strongly promoted by the drug companies, like Purdue Pharma, who were making billions of dollars from drugs, like OxyContin.
Physicians were also not aware of how much diversion was going on. As more people became addicted, painkillers became very valuable and a lot of people started faking pain and visiting doctors in order to get prescriptions for painkillers, then, sell them on the street. Some people were making thousands of dollars every month.
It is not very easy for doctors to distinguish between real pain and exaggerated pain, so, a lot of time, the doctors got fooled into writing prescriptions. Added to this, there was outright criminal behavior. Some unscrupulous doctors had “pill mills” where they would see patients for cash, prescribe very high doses of painkillers, and then, sell them the drugs, all on the same visit. There was a lot of money being made – on both sides of the transaction.
Now the tide is turning. The DEA and other regulators are much more aggressively looking at physicians who over-prescribe. Most states have shut down the pill mills and have set up a database where physicians can check online and see all of the recent prescriptions that any patient has filled. It is very easy to see if a patient is “doctor shopping”. Perhaps, most importantly, physicians and patients and are starting to understand that narcotic painkillers are powerful drugs and should only be prescribed for severe pain. Narcotic painkillers are, in reality, not a very effective treatment for chronic pain.
That is the good news – the tide is turning on painkiller abuse. But, the bad news is the number of Heroin overdoses has more than doubled in the last 3 years.
Many people have simply switched to Heroin. We hear this from our patients over and over again. As the supply of painkillers goes down, the cost and lack of availability goes up. Heroin, then, becomes much more attractive. Most patients tell us that Heroin is so cheap that switching to it can reduce the cost of their drug habit by 75%. That is such a huge temptation that we are seeing people from all walks of life using street Heroin.
It is a horribly dangerous situation. Heroin is unregulated and much more dangerous. People have no idea what other drugs may be mixed into it and, they have no idea of what is the strength. It makes the chance of overdosing so much more likely. And, even worse, once people start using Heroin, it is a very short and slippery slope to begin injecting it. We are seeing it every day.
When it comes to Heroin and its impact, I fear we are in for even worse statistics down the road.