How Addiction Can Progress From Prescription Painkillers to Heroin
Opioid addiction is a public health crisis in America. Nearly 25% of Americans aged 12 or older with drug disorders are addicted to painkillers and/or heroin, and the most commonly reported overdose in poison control centers is misused prescription or illegal opioids. Deaths from opioid overdoses increased from 56,064 in April 2020 to 75,673 in 2021. There is also a painkiller-to-heroin pipeline as the abuse of prescription narcotics can lead to illegal opioid addiction and high-risk behaviors. Indeed, painkiller abuse is often a gateway to heroin use.
There are several prescription painkillers in use. Here is a list of some of the most common narcotics and their popular generic or brand names:
Hydrocodone is a semi-synthetic opioid derived from codeine and is used for moderate to severe pain. It is often combined with acetaminophen. Lorcet, Lortab, and Vicodin are a few examples of names it is sold under.
Oxycodone is a semi-synthetic opioid that is derived from thebaine. Like hydrocodone, it is used for moderate to severe pain and is combined with acetaminophen, but it is stronger and more difficult to obtain. Percodan and Percocet are examples of names it is sold under. Oxycontin is the extended-release form of oxycodone.
Methadone is a synthetic opioid used for chronic pain management and opioid addiction treatment. While not as addictive as morphine, it can itself be addictive. It is sold under the names Dolophine and Methadose.
Buprenorphine is a semi-synthetic opioid derived from thebaine that is used for opioid addiction treatment. Considered to have fewer effects than methadone and heroin, it is sold under the names Sixmo and Subutex.
Morphine is an opium derivative used for pain management during and after surgery. It is chemically similar to heroin. It is sold under the names Roxanol and Duramorph or as morphine sulfate under the name MS Contin.
Codeine is another opium derivative that exists in cough syrup and pain relief medications for oral use. It is used to treat mild to moderate pain.
Oxymorphone, or oxymorphone hydrochloride, is a semi-synthetic opioid analgesic used to treat severe pain. It is sold under the names Opana, Numorphone, and Numorphan.
Hydromorphone, also called dihydromorphinone, is a semi-synthetic opioid derived from morphine used to treat moderate to severe pain. It is commonly sold under the name Dilaudid.
Propoxyphene, also called dextropropoxyphene, is an opioid analgesic used to treat mild to moderate pain. It is sold under the name Darvon.
Meperidine, also called pethidine, is a synthetic opioid analgesic used to treat moderate to severe pain. It is sold under the name Demerol.
Fentanyl is a synthetic opioid. It is 50 to 100 times stronger than morphine and, hence, should only be used by people who are already tolerant to narcotics. It is sold under the names Actiq and Duragesic.
How Painkillers Are Made
As you can see, prescription painkillers are made up of synthetic and semi-synthetic opioids. Opium derivatives are from the poppy plant. Synthetic opioids are created in a chemical laboratory either starting with a poppy substance and synthesized with non-natural compounds to create a semi-synthetic opioid or by manufacturing the entire drug as a synthetic opioid.
The purpose of synthetic and semi-synthetic opioids is to mimic the analgesic properties of opium but with the additional benefits of being better, faster-acting, longer-acting, less addictive, or safer than illicit drugs. However, taking prescription painkillers for recreational use, such as when one is not in pain, or taking higher dosages than one needs, leads to substance abuse.
All prescription painkillers have the potential for overuse and abuse when not used properly under a doctor’s direction. Although painkillers are prescribed only for people who experience pain from injury, surgery, and other physical issues, patients can become addicted whether or not they are actively experiencing pain. Some people obtain painkillers through a friend or family member.
Painkillers have several tangible effects on users and affect the same receptors in the brain that heroin does. Not only do they mute physical and emotional pain and trauma, but they also cause feelings of euphoria and alter brain chemistry to slow down thoughts, responses, and movement. Addiction then occurs from becoming overly attached to the effects and an inability to control compulsive use whereas physical dependency results from the habit. Besides oral ingestion, painkiller abusers may also crush and snort pills for more immediate effects.
Most painkillers are not intended for long-term use. Depression is one effect. Impaired cognition from reduced brain matter and altered neurotransmitters that signal pain and pleasure are others, and addiction and physical dependency are considered to be two separate but related effects.
Shifting From Painkiller to Heroin Use
It is common to see many prescription painkillers, such as oxycodone, hydrocodone, and codeine, combined with acetaminophen. That’s because the FDA legally prohibits them from being sold unless they’re combined with another compound.
Codeine is available both as a single-ingredient drug and in combined medications. Acetaminophen, or sometimes aspirin or ibuprofen, is present to provide greater pain relief as well as to discourage excessive self-dosing and abuse. Instead of being able to take a handful of pills and not get physically sick, users experience nausea and other symptoms. Too much acetaminophen causes unwanted side effects, including upset stomach, liver damage and failure, and death. Even chronic pain patients who take high dosages experience these negative effects and are unable to properly manage their pain.
Some of the reasons why people who use or are addicted to painkillers change to heroin is because of the difficulty in obtaining single-ingredient drugs, often in addition to another factor, such as a high tolerance for painkillers, prescription guideline restrictions, difficulty in street access, and a high street price tag. One of the most dangerous, addictive, and illicit narcotics, heroin is a semi-synthetic opioid derived from morphine. It was once falsely believed to be safer than morphine and to be non-addictive, but the two drugs are chemically very similar. And because prescription painkillers affect the same receptors of the brain that heroin does, the change is not difficult.
Heroin is a depressant. It affects the central nervous system to slow down breathing, heart rate, and blood pressure, and it creates changes in mood and behavior. Worse than addiction to prescription painkillers, it causes loss of white brain matter, which leads to difficulties in making good decisions, controlling behavior, and having appropriate responses to stressful situations. Long-term heroin use changes the physical structure and chemistry of the brain and leads to long-term imbalances in neurotransmitters and hormones, such as the stress hormone cortisol.
Chronic heroin users experience the following physical effects:
• Chronic constipation
• Collapsed veins
• Pulmonary infections
• Liver disease
• Kidney disease
• Heart disease
• Skin infections
• Infertility, miscarriage, or birth defects
• Transgenerational effects on offspring from paternal addiction
• Low sex drive
Heroin users can snort, smoke, or inject the drug. They risk diseases from shared IV drug use, such as hepatitis or HIV, and permanent damage to nasal and sinus passages from snorting. The lowest quality and cheapest form of heroin is black tar whereas brown tar heroin is more refined but still impure. Both are cut with brown sugar and other agents, including toxic substances. Hence, heroin users are also at risk from effects that result from cutting agents.
Opioid Abuse Trends
A small sample of heroin users aged 18 to 33 years old in Ohio investigated by the OSAM Network reported that they would have never tried heroin if they hadn’t become addicted to Oxycontin. This same pattern has repeated itself throughout Ohio and in other parts of the United States because heroin is more easily accessible and lower in price than Oxycontin on the street.
In the past, heroin users would resort to painkillers when heroin wasn’t available. Today, the pattern is the opposite. According to one study, 80% of heroin users abused prescription opioids first before turning to heroin. While some opioid addicts use just heroin, many others use both heroin and painkillers. It is a contrast from people who are addicted to painkillers but do not use heroin. In fact, the number of people who use both heroin and painkillers exceeds the number of people who abuse painkillers alone. Also, with the inconsistent quality of heroin, heroin users tend to inject the drug rather than snort or smoke it. The injection of the drug leads to unique physical effects, especially from long-term or shared use.
Recovery From Opioid Addiction
There are a number of reasons why doctors are hesitant to prescribe sufficient pain medication for their patients. They may believe that patients are exaggerating or making up their pain in order to obtain prescriptions. A very real concern is that the DEA will remove their right to prescribe controlled substances and that the state will suspend or revoke their licenses to practice. This is especially the case with the treatment of terminally ill patients because doctors are worried about being accused of hastening their deaths or about engaging in assisted suicide.
Another issue is that some painkillers are Schedule II and others are Schedule III. Schedule III drugs are not as strictly controlled as Schedule II drugs, such as oxycodone, and many patients don’t know how to talk to their doctors about switching painkillers from strong to moderate strength. Sometimes a lack of familiarity with a doctor while displaying too much knowledge about drugs can lead that unknown doctor to assume addiction.
Unfortunately, these issues leave many people unable to properly manage their chronic pain issues. It also leaves people who are addicted to prescription painkillers with no way of properly dealing with their addictions. Both then often resort to illicit street drugs such as heroin.
Granite Recovery Centers has several drug rehab options available, including:
• Drug detox
• Medication-assisted treatment
• Partial hospitalization program
• Inpatient treatment program
• Outpatient treatment program
• Intensive outpatient program
• Residential treatment program
• Sober living options
At Granite Recovery Centers, we offer a variety of treatment options for opioid addiction at any stage and for any preference. We understand the many challenges clients face, so our assistance comes with the level of support that clients need to get and stay sober. Contact us to find out more about our treatment programs and approaches for opioid addiction.