Are Heroin and Prescription Pain Killers Really the Same?

“Auto fatalities had been the leading cause of accidental death for decades, until this. Now most of the fatal overdoses were from opiates: prescription painkillers or heroin. If death were the measurement, this wave of opiate abuse was the worst drug scourge to ever hit the country.”

~ Sam Quinones, Dreamland: the True Tale of America’s Opiate Epidemic

When America’s drug problem is discussed, talk always turns to the Centers for Disease Control and Prevention has called the “opiate epidemic”. Prescription painkillers have been linked to thousands of overdose deaths every year in this country, and legislators, health care officials, and law enforcement agencies are all scrambling to make whatever policy changes are necessary to stem the tide of fatalities.

There is an unfortunate downside to their efforts, however. As new guidelines, patient databases, reporting procedures, and best practices are implemented and it gets harder and more expensive for abusers of prescription painkillers to obtain their drug of choice, many desperate addicts are switching to heroin as a cheaper, more readily-available substitute.

So are heroin and prescription opiates (like hydrocodone) really the same? Yes, they are very similar drugs (both opioids) that effect the brain in the same manner. Many individuals who become addicted to their prescribed pain medication, later go on to abuse heroin due to the cost and a few other reasons you can read about in this article.

Statistics Tell the Tale of the Twin Dangers of Prescription Pain Relievers and Heroin

In practical terms, this means that as deaths from prescription painkillers are going down, fatal heroin overdoses are skyrocketing. They are two sides of the same problematic coin.

Even the federal government realizes this. In late March 2016, President Barack Obama spoke at the National Prescription Drug Abuse and Heroin Summit, saying, “… They go to a doctor one time when the pain gets too bad, the doctor is prescribing painkillers, they run out, and it turns out it’s cheaper to get heroin on the street than it is to try to figure out how to refill a prescription, you got a problem.”

Take a look at the statistics:

  • In 2014, 9 million Americans had a Substance Abuse Disorder that involved prescription pain relievers.
  • There were 18,893 overdose deaths related to prescription pain relievers in 2014.
  • 586,000 had a SAD that involved heroin.
  • Heroin caused 10,574 fatal overdoses in 2014.
  • Almost 1 out of 4 individuals who even try heroin will develop an addiction.
  • 80% of new heroin users began by misusing prescription pain relievers.
  • A 2014 survey of people in treatment for opioids revealed that 94% used heroin because prescription medications were “far more expensive and harder to obtain”.
  • Between 2010 and 2013, the overdose rate for heroin increased 37% per year.

Are the Terms “Opioids” and “Opiate” Interchangeable?

Not quite.

Technically, “opiate” is an older term that only refers to those drugs and substances made from the opium poppy, such as:

  • Morphine –First distilled from opium in 1804. Over the last 20 years, the amount of morphine that was used directly for pain increased fourfold. 70% of that was used to make other pain relievers.
  • Codeine–discovered in 1832, codeine is the world’s most commonly-taken opiate. It is roughly one-tenth as strong as morphine, is often available without a prescription.

“Opioids”, on the other hand, is a broader term that refers to any substance that produces analgesic effects similar to morphine, which is regarded as regarded as the comparison point for potency. This includes all opiates, as well as semi-synthetic and synthetic drugs such as:

  • Hydrocodone –Most-commonly dispensed as a Vicodin, hydrocodone is equally strong as morphine. The United States consumes 99% of the world’s hydrocodone.
  • Oxycodone –Usually prescribed as OxyContin or Percocet, oxycodone is about one-and-a-half times as strong as morphine.
  • Methadone –Typically prescribed as maintenance therapy or a means to detoxify opioid-dependent people, methadone is up to five times as strong as morphine. In 2011, more than one-fourth of all opioid poisoning deaths involved methadone.
  • Fentanyl– This potent opioid is given for severe acute pain that cannot be controlled by a normal pain management routine. Fentanyl is up to 100 times stronger than morphine and up to 50 times more potent than 100% pure heroin. Between 2013 and 2014, fatal overdoses involving fentanyl increased by 79%.
  • Heroin –Also known as “smack”, “dope”, “horse”, or “black tar”, heroin is between four and five times as strong as morphine. When abused recreationally, it is usually injected (“slamming”), smoked (“chasing the dragon”), or snorted.

In What Ways Are All Opiates and Heroin Alike?

All opioids relieve pain by diminishing the intensity of pain signals that are able to reach the brain. In addition, all opioids also reduce the effects of painful stimuli, by affecting the area of the brain that controls emotion.

Because they also create euphoric feelings of confidence and well-being, all opioids also carry a risk of potential dependence, diversion, abuse, and addiction. Because opioids can suppress breathing, opioids abusers can be in danger of fatal overdose.

Prescription opioids are properly given only for acute (short-term) pain, although exceptions can be made for cancer patients or end-of-life palliative care. Unfortunately, many physicians dispense prescription opioids for chronic (long-term) pain, and that can be what initiates the development of a substance abuse problem.

In mid-March 2016, the Centers for Disease Control and Prevention released their first-ever guidelines for the dispensation of opioid medications. Among the 12 points were two specific recommendations:

  • Physicians should avoid prescribing opioid painkillers for chronic pain, and instead should look at alternative management methods – exercise, massage, meditation, weight loss, etc.
  • When opioids absolutely must be prescribed, they should be for the smallest dose possible and for the shortest duration possible.

The Executive Director of Physicians for Responsible Opioid Prescribing, Andrew Kolodny, said, “The CDC is making it perfectly clear that medical practice needs to change, because we’re harming pain patients and fueling a public health crisis.”

How Does Heroin Fit into the National Awareness of the Opioid Epidemic?

For starters, the very name of the event that the President attended –the National Prescription Drug Abuse and Heroin Summit–shows that the awareness is there, even at the highest levels.

What comes next is the action.

To that end, President Obama wants to include an extra $1.1 billion in the 2017 budget to address the crisis, specifically by expanding treatment options and availability, so that all Americans who want and need help can get it.

The lion’s share of that money – $920 million – will go directly to the states so they can increase accessibility to medication-assisted treatment programs for opioid use disorders. Individual states will be granted funds based upon the severity of their opioid problem locally and the strength of their response to that problem.

In April 2015, a report was generated showing that the “Top Four” states with the highest opioid abuse rates were in the Pacific and Mountain regions of the United States–

  • Oregon – 37%
  • Colorado – 00%
  • Washington –75%
  • Idaho –73%

These rates are all significantly higher than the national average of 4.6%.

If you live in any of the states, your best resource for the help you need is Northpoint Recovery – a nationally-recognized substance abuse rehab facility in Idaho that specializes in individualized, Evidence-Based Treatment for alcohol, illicit drug, and opioid addictive disorders.

If you are struggling with opioid dependence or addiction – whether it is due to prescription medications or heroin –making the call today to Northpoint Recovery can be your first, best step on your road to regaining your sobriety, serenity, and sanity.


Matrix Global Advisors, LLC, Healthcare Costs from Opioid Abuse: a State-by-State Analysis

American Society of Addiction Medicine, Opioid Addiction 2016 Facts & Figures


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By |2016-05-05T18:33:54+00:00May 30th, 2016|

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