ABUSE OF PRESCRIPTION PAIN MEDICATIONS RISKS HEROIN USE

The increase in prescription drug abuse, in particular pain relievers, has been recognized as an alarming trend for some time. We believe the public possesses some awareness of the issues, but we fear there may be fatigue. By highlighting the unexpected (to the lay person) association of prescription pain reliever abuse and heroin we hope to inject new vigor into the public discussion of prescription drug abuse. While the research literature to date does not allow one to claim a causal association (and we are careful not to do so in our infographic), anecdotal evidence and descriptive statistics suggest that abuse of prescription pain relievers may be a gateway to heroin use. In a recent working paper we examined this issue and were surprised by the strength of the associations. The descriptive statistics from that paper form the backbone of this infographic. We believe the data points in this infographic represent original and creative examination of the NSDUH that have not previously been publicly disseminated.

In our infographic we hope to (perhaps subliminally) take the reader through the possible transition of experimenting with non-medical prescription pain relievers through serious heroin-related health consequences. In doing so, we hope to emphasize the integration of prescription drug abuse with use of more traditional, and perhaps better understood, drugs of abuse.

• In the introductory text we define non-medical prescription pain reliever use and describe how shockingly common it is in the U.S.(1) We briefly note the transition some individuals experience from prescription pain medication use to abuse/dependence and to heroin use. This foreshadows the more detailed data that follow.

• The first data point notes that, for some individuals (approximately 7 percent), even trying non medical prescription pain relievers is associated with eventual heroin use (2). We highlight this because we believe the transition is more common than people expect (1 in 15).

• We next examine heroin use among individuals with current prescription pain medication abuse and dependence. What is surprising is the large increase in heroin use between 2004 and 2010 (3). As the increasing size of the circle and slice indicate, this increase in heroin use is associated with both more prescription pain medication abuse/dependent individuals, and a higher share of these individuals using heroin.

• Although we imagine people already perceive pain relief medication to be less addictive than heroin, we explicitly show this by noting the proportion of users that are dependent (4). We expect this to suggest to the reader that trying heroin, even once, puts individuals at risk for dependence.

• Finally, we reiterate that the use of heroin is not without consequences. We choose emergency room admissions to suggest these consequences are broader than the individual, extending to the health care system and society (5).

References:

1. United States Department of Health and Human Services. Substance Abuse and Mental Health Services Administration. Center for Behavioral Health Statistics and Quality. National Survey on Drug Use and Health, 2010.
   1. United States Department of Health and Human Services. Substance Abuse and Mental Health Services Administration. Center for Behavioral Health Statistics and Quality. National Survey on Drug Use and Health, 2004 - 2010.
   2. United States Department of Health and Human Services. Substance Abuse and Mental Health Services Administration. Center for Behavioral Health Statistics and Quality. National Survey on Drug Use and Health, 2004, 2010.
   3. United States Department of Health and Human Services. Substance Abuse and Mental Health Services Administration. Center for Behavioral Health Statistics and Quality. National Survey on Drug Use and Health, 2004 - 2010.
   4. Substance Abuse and Mental Health Services Administration, Drug Abuse Warning Network, 2011: National Estimates of Drug-Related Emergency Department Visits. HHS Publication No. (SMA) 13-4760, DAWN Series D-39. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013.