By Dr. Jarrod Sadulski
Faculty Member, Criminal Justice, American Military University
The dangerous and rapid increase of heroin use nationwide can be attributed to the widespread use of prescription opioids. The National Institute on Drug Abuse (NIDA) reported that about 80 percent of heroin users acknowledged taking prescription opioids before turning to heroin. Prescription opioids include legal drugs such as oxycodone, hydrocodone, codeine and morphine.
To emphasize the size of the problem, heroin overdoses increased five-fold from 2010 to 2017, according to the Centers for Disease Control and Prevention (CDC). In fact, the CDC has citied misuse of prescription opioids as the strongest risk factor for heroin use.
Prescription Opioids and Heroin Have Similar Properties and Physiological Effects
A NIDA comparison between prescription opioids and heroin revealed that they have similar chemical properties and physiological effects, whether the drugs are ingested or injected. This explains why prescription opioids are a potential gateway to heroin abuse: Those addicted to prescription opioids will experience the same high from heroin when they are unable to obtain prescription opioids.
The Spread of Heroin Addiction
Heroin addiction is widespread in many communities. Often, heroin users are recognizable. Track lines on an addict’s arms are a common indicator of heroin use, as are weight loss and the ravages of being homeless.
In one NIH study, 86 percent of heroin users had first used opioids, which were obtained through either family, friends, or prescriptions. So when opioids users are no longer able to obtain them, they are at risk of turning to heroin, which is plentiful and affordable on the street.
Heroin addiction is just one of the dangers that opioid use can trigger. NIDA reports that the upsurge in heroin use also has implications for HIV, hepatitis C (HCV) and other injection-related illnesses.
“Recent studies suggest that using opioid pain relievers before transitioning to heroin injection is a common trajectory for young injection drug users with HCV infection,” NIDA says. The Institute cited a study of “new HCV infections in Massachusetts which found that 95 percent of respondents used prescription opioids before initiating heroin.”
The increased regulatory restrictions placed on prescribing opioids can help explain such an increase in heroin use. Opioids can only be obtained with a doctor’s prescription. Doctors and the pharmaceutical industry associated with prescription opioids have come in for regulatory scrutiny because of the opioids’ adverse effects.
Some Healthcare Frauds Have Involved Opioid Prescriptions
In June 2018, the Justice Department announced “the largest healthcare fraud takedown in American history.” The fraud investigation involved by doctors, pharmacists and nurses who allegedly billed the federal government for 13 billion illegal opioid prescriptions worth more than $2 billion.
Similarly, the Department of Health and Human Services removed 587 medical providers from Medicare and Medicaid roles in 2017, due to their conduct associated with opioid abuse. In one investigation, a doctor was accused of defrauding Medicare of more than $112 million by writing 2.2 million unnecessary opioid prescriptions.
U.S. public health agencies and law enforcement need better educational programs to emphasize the dangers of prescription opioid abuse. There should also be more information available about the risk of potentially turning prescription drug users into heroin addicts once they are no longer able to legally obtain opioid prescriptions.
About the Author
Dr. Jarrod Sadulski has been a member of the Coast Guard since 1997. His expertise includes infrastructure security, maritime security, homeland security contraband interdiction and intelligence gathering. As a recognized subject matter expert in these areas, he frequently participates in international speaking engagements and presentations on these topics. He has received commendations from the Coast Guard and was the Officer of the Year for a municipal police agency that he served with in 2009. Currently, Jarrod is a supervisor in the Reserve Program and provides leadership to Reserve members who conduct homeland security, search and rescue, and law enforcement missions. In addition to the Coast Guard, Jarrod has experience in two local law enforcement agencies and is currently a sworn reserve deputy in Florida.