MATTOON — Switching from a strong painkiller like hydrocodone or oxycodone to heroin is a large step, but it is not an uncommon one, and it is a step being taken by many who have been and are addicted to intense pain medications.
According to the Centers for Disease Control and Prevention (CDC), among new heroin users, approximately three out of four report abusing prescription opioids prior to using heroin.
John Lauer, medical director of inpatient psychiatry at Sarah Bush Lincoln Health Center, said specifically for opiate addicts who are making the move to heroin, the notion of doing so is not extreme or unbelievable especially given the similarities of painkillers and heroin.
At a biological level, the differences between heroin and strong painkillers are not vast. Lauer explained strong painkillers like oxycodone, along with heroin, are opiates, and they both work on the same opioid receptors in the brain in similar ways. The only major difference between the two drugs is their strength in comparison to each other, Lauer said, with heroin producing larger highs for the users.
“Heroin is an opiate, a pain medicine, that works on the same receptors, so when you can’t get painkillers, the heroin works just as good,” Lauer said. “(Theoretically) you can use heroin for pain control if you wanted to.”
For many who get addicted to painkillers and potentially go over to heroin, that is all they are looking for: a pain reliever, at least initially, he said. But after continuously taking the opioid painkiller, they can grow an addiction and eventual tolerance, requiring higher, more dangerous doses for the same effect.
However, their growing wants for these painkillers are conflicting with a growing shift for doctors to not prescribe opioid pain medicine.
Recently, those in the medical field have pushed against using opioids so frequently. In March, the CDC released guidelines on prescribing opioids explaining in detail that there are too many opiates prescribed as an approach for dealing with pain. This push was developed on the heels of a notable issue facing medicine: a large number of prescription opioid overdoses and addicts.
“The United States is in the midst of an opioid overdose epidemic,” according to the CDC. “Opioids (including prescription opioid pain relievers and heroin) killed more than 28,000 people in 2014, more than any year on record. At least half of all opioid overdose deaths involve a prescription opioid.”
Lauer said at this point, the pendulum is swinging against prescribing these drugs, but not too long ago, in the late ’90s and early 2000s, governmental bodies thought doctors were not active enough in treating pain, and they pushed for these pain pills to be prescribed much more frequently.
Even though doctors knew of the addictive nature of these drugs, governmental and patient pressure, in essence, forced them to give out these medications, Lauer said.
Jim Hildebrandt, vice president of medical affairs at Sarah Bush, said before this push, doctors would almost never prescribe these drugs. Now, after seeing the negative effects of prescribing these addictive drugs so frequently, Hildebrandt said doctors are dealing with preventing further addiction and keeping those addicted off of the medicine to avoid eventual overdoses.
It comes at a price, though.
This growing lack of medically prescribed drugs has led addicts to search for other avenues to satiate their habit and avoid withdrawal. Rachel Duhamell, alcohol and drug counselor at Sarah Bush Lincoln, said availability of opioids or lack thereof increases the odds of a switch to heroin. There is a “high likelihood” they will go to heroin, she said.
“The withdraw is unbearable,” Lauer said. “You are either going to go through opiate withdraw, or you are going to look elsewhere for the same stuff.”
But, the more the medical field cracks down on opioid painkillers, the less is seen on the streets, causing more demand and higher prices for painkillers. This, too, has helped heroin to develop a demand beyond recreational drug use. Now, heroin is becoming a cheap alternative to painkillers, said Brandon Spindler, officer with the East Central Illinois Task Force drug investigation unit.
Prices fluctuate regularly, but law enforcement is now seeing street prices for pills like hydrocodone go from $5 to $10 a pill and a tenth of a gram of heroin, a common amount used a day, go from $20 to $40, Spindler said.
He said while each pill might be cheaper, addicts and those chronically taking painkillers often take five to 10 pills a day to get the same highs that a tenth of a gram of heroin will provide.
Hildebrandt said this transition to heroin is a complex one because there are correlations to the medical field’s move away from opioid drugs for some pains, but doing so might lead those addicted to those medicines to different drugs. The medical field is still striving to stay tough on painkillers, he said.
At Sarah Bush Lincoln Health Center, Hildebrandt said other forms of medicine like meditation therapy, physical therapy and massage therapies are being encouraged. Also, doctors are being encouraged to use less potent opioids or use other small scale pain relievers to treat pain.
Pain is a challenge when treating it properly, though, he said.
“Pain is difficult. Chronic pain is really difficult,” Hildebrandt said. “There are no other great answers for it. So you get tempted to use opioids in it because you want to do something for this poor soul.”
Ultimately, it is an individualized issue, highly dependent on the patient, he said, and it is up to the judgment of each individual doctor on how to best treat the patient.
Hildebrandt said it is still crucial to stay strong on limiting prescription opioid use as much as possible, even if current addicts move to heroin.
“We as a nation have to go through a period of withdrawal, essentially where people are going to turn to heroin for a while,” he said. “But once we don’t have this large number of people out there that have tasted opioids and acquired an affinity for them, then they are not going to be going to heroin anymore. We can’t perpetuate this.”