Opioids and Heroin: A Deadly Combination On the Rise

You’ve read about the spike in abuse of narcotic painkillers. You’ve heard the news reports about the jump in heroin addiction and overdoses. Now there’s an even more frightening finding: More people — and particularly young, white men — are using a deadly combination of prescription painkillers and heroin, say researchers who analyzed data from the 2010-2013 National Survey on Drug Use and Health.

What’s driving the trend? “The crackdown on pill mills; public-health strategies to reduce doctor-shopping; and the development of a tamper-proof prescription painkiller that is difficult to crush and snort and difficult to liquefy and inject” have led opioid addicts to seek out a substitute, says Shannon Monnat, PhD, assistant professor of rural sociology and demography at Penn State University.

Heroin traffickers have quickly stepped in to provide that substitute. “In his book, Dreamland, Sam Quinones describes how an organized group of heroin dealers infiltrated small towns, selling heroin like pizza, with quick delivery, professional service and low prices,” says Monnat, referring to the recently published book by a former Los Angeles Times journalist that explores the rise of Oxycontin and heroin use in the U.S.

A Double Whammy

Many opiate addicts, though, aren’t giving up painkillers in favor of heroin — they are taking both, increasing their risk for overdose and other health dangers, such as contracting HIV through shared needles. In fact, the number of users who are addicted to both painkillers and heroin is increasing faster than the number of painkiller-only abusers, according to Monnat’s research. The trend is happening primarily among white people, especially among young, white men who are employed and living in rural areas and small towns.

Opioids work by blocking the sensation of pain, but they can also suppress breathing. Once a person is addicted to opioid painkillers trying to quit can cause a host of unpleasant symptoms: insomnia, diarrhea, bone and muscle pain, vomiting and coldness, according to the National Institute on Drug Abuse. “These withdrawals push users to do whatever it takes to make the discomfort stop,” says Monnat. Cheap and easily accessible heroin can seem attractive, but it’s equally dangerous. “There are many different types of heroin and some are more pure than others,” says Monnet. “This means that users often have no idea about the strength of the heroin they are using, putting them at high risk of overdose.”

When Painkiller Abuse Goes Unseen

Doctors need to be on the lookout for signs of heroin and opioid addiction, though painkiller addicts can often hide their addiction beneath a socially acceptable exterior. “[People who are addicted to pain pills] are more likely to have children living in the household, are more likely to attend religious services, are more highly educated, have higher incomes and are more likely to be employed than the groups of individuals who use heroin,” says Monnat. “The ease with which someone who is abusing prescription painkillers can simply pop a pill and go on with their business makes it difficult for friends and family to see when there is a problem.”

If there is any upside to those opioid addicts who are using heroin as well it’s that a dual addiction may be more difficult to hide — and so families, friends and doctors may be able to recognize that a loved one needs help before it’s too late.

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