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Most Heroin Addicts Didn't Start By Being Prescribed Pain Pills, Despite Drug Czar's Claims [FEATURE]

Submitted by Phillip Smith on (Issue #1071)
Politics & Advocacy

As part of its campaign to stem opioid addiction and overdoses, the White House Office of National Drug Control Policy (ONDCP -- the drug czar's office) has launched an education campaign called The Truth About Opioids, but some of the material it is presenting has more than a whiff of spin to it -- and could imperil the ability of pain patients to get the relief they need.

Most addicts didn't go from the doctor's office to the needle and spoon, a new study reports. (Wikimedia)
The web site declares in big, bold letters that "80% of heroin users started with a prescription painkiller," and highlights the words "80%," "heroin," "started," and "prescription" in lurid purple. The graphic suggests that heroin users were prescribed opioids, developed a habit, and then went on to junk, with the further implication that a way to reduce heroin addiction is to tighten and reduce the prescribing of opioids.

The web site then asks readers if they are "shocked," "ah-ha," "outraged," or "fired up" by the information. It is only if readers scroll down the page that they are informed that the basis for the statistic is a 2013 study of "Heroin use and heroin use risk behaviors among nonmedical users of prescription opioid pain relievers." (Emphasis added.)

That's right, even though the graphic shouts out that people prescribed opioids then went on to become heroin addicts, the science it uses to back its claim is about recreational pain pill users. That's deceptive.

Misleading claims about prescribing opioids and the potential for opioid addiction are, of course, nothing new. Twenty years ago, PurduePharma infamously claimed that the risk of addiction from OxyContin was so low as to be negligible, a marketing tactic that helped kick into overdrive the pain pill phase of the current wave of opioid use.

But the drug czar's office, with its misleading suggestion that being prescribed opioids leads to heroin addiction, tips the pendulum too far in the other direction. There are real world consequences to using such faulty information. The Drug Enforcement Administration cited that 80% figure last year when it ordered steep decreases in the supply of prescription opioids, and it claimed in the Federal Register that patients got addicted "after first obtaining these drugs from their health care providers."

"The 80% statistic is misleading and encourages faulty assumptions about the overdose crisis and medical care," Pain News Network columnist Roger Chriss argued in a column last year.

And now, a new study from researchers at Penn State University published in the Journal of Addictive Studies bolsters that claim. Concentrating on southwestern Pennsylvania, an area with high levels of addiction, the researchers conducted surveys and in-depth interviews with drug users to determine their drug using histories. The sample size was small, with 125 people surveyed and 30 interviewed, but the results were illuminating.

The researchers found that two out of three of those interviewed got their first prescription opioids not from a doctor's prescription, but either bought or stole it from a family member or friend. Another 7 percent bought their drugs from a stranger or a dealer. And only one out of four (26 percent) began with opioid medications prescribed by a doctor.

"What emerged from our study -- and really emerged because we decided to do these qualitative interviews in addition to a survey component -- was a pretty different narrative than the national one. There's a lot about that narrative that I think is an overly simplistic way of thinking about this," said lead author Ashton Verdery, PhD, an assistant professor of sociology, demography and social data analytics at Penn State.

"We found that most people initiated through a pattern of recreational use because of people around them. They got them from either siblings, friends or romantic partners," he continued. "Participants repeatedly reported having a peer or caregiver in their childhood who had a substance use problem. Stories from childhood of witnessing one of these people selling, preparing, or using drugs were very common. Being exposed to others' substance use at an early age was often cited as a turning point for OMI (opioid misuse) and of drug use in general."

Among study participants, recreational drug use -- or polysubstance abuse, in public health speak -- was common, Verdery noted, and usually began not with prescription opioids but with drugs such as alcohol, marijuana, cocaine, methamphetamine, and prescription sedatives and stimulants.

"It is important to note that interviewees universally reported initiating OMI only after previously starting their substance use career with another drug (e.g., alcohol, marijuana, cocaine). Opioids were never the first drug used, suggesting that OMI is likely associated with being further along in one's drug using career," he added.

Researchers studying opioid addiction need to be aware of the role other substances play in the process, Verdery said. Understanding how opioid addiction is intertwined with other drug use is necessary to figure out the correct steps to take to prevent addiction before it takes hold.

"We think that understanding this mechanism as a potential pathway is worth further consideration," said Verdery. "It's not just that people were prescribed painkillers from a doctor for a legitimate reason and, if we just crack down on the doctors who are prescribing in these borderline cases, we can reduce the epidemic."

It's not nice for the drug czar's office to promulgate deceptive and misleading information about why people are getting strung out on heroin. It results both in limitation on access to opioid pain medications for those who need them and in obfuscating the realities of how heroin addiction happens -- and how best to deal with it.

Permission to Reprint: This content is licensed under a modified Creative Commons Attribution license. Content of a purely educational nature in Drug War Chronicle appear courtesy of DRCNet Foundation, unless otherwise noted.


Dain Bramage (not verified)

We can begin to sort this out by looking at first principles.

One thing we know, for example, is that the so-called "war on drugs" is just a really, really bad idea, at best.  If we, as a society, were to treat drug use and abuse as a health issue rather than a criminal justice issue, that would get us started off on the right track.

Another thing we already know is that profit motive, that is to say, free market capitalism, has no conscience. 

What does corporate America do, besides take the all the money they can?  Answer: offload all the responsibility and liability they can.  

So, it does fit a pattern of behaviour if Big Pharma, after bribing doctors to promote and over-prescribe its pain-killers, and now facing heat for the opioid epidemic, would use the "drug czar" propaganda machine to then double-cross the doctors by pointing the finger at them for over-prescribing the pain-killers, even as chronic pain remains severely under-treated in America, which is inhumane.

Harm reduction principles dictate mitigating these two malicious forces -- drug war ideology, and corporate greed -- as best as possible.  

This is best done through science-based education, and strict corporate regulations.

At the same time, harm reduction principles would dictate mitigating the risks associated with various kinds of drug use.  This is best done by replacing dogma and judgementalism with legalization, regulation, and fact-based education.

What would that all look like, taken together?  Not sure.  That requires the imagination of John Lennon; at the moment we're caught up in the sick-fuck dreams of Putin and Trump.   But, probably it would be a real democracy, where people voted against evil politicians like Trump and Pence and McConnell, not for them.  It would be a society where corporate America served America, instead of bleeding it to death like an alien parasite.

We can start by destroying Trump and the ass-clown Republicans in every election to come forever, until they are vanquished, would be my strong suggestion.

Fri, 06/21/2019 - 8:12am Permalink
Hypercube (not verified)

In reply to by Dain Bramage (not verified)

Yeah, the ONDCP was so enlightened under the last regime... Your grievance-mongering, hateful, disingenuous, extremely boring, predictable agenda could not be more transparent or obvious. Do you even care about prohibition, except as a hook upon which to hang your agenda against those whom you despise, and are determined to blame, against the evidence, for all your (plural) problems? Why does Trump get no credit from you for the pardons he has issued? Because no matter how much he helps the "right" people, he doesn't hate the "wrong" people enough, and the latter is what really motivates you, is it not? The ONDCP's deceit here is inexcusable. But you, as ever, are clouding the issue by bringing your usual obsessions into it. Pain patients of all shapes and sizes suffer from underprescription; working with people across the board, like grown-ups, to solve this particular problem is more likely to produce success than alienating potential allies against prohibition with your divisive rhetoric. Others here have long since given up replying to your repetitive, mean-spirited walls of text. Why do you think that is? Oh, let me guess...
Fri, 06/21/2019 - 8:22pm Permalink
Dain Bramage (not verified)

In reply to by Hypercube (not verified)

You don't know what the fuck you are talking about, Hypercube.

But you are definitely "hyper!"   Might I suggest Thorazine?

Fri, 06/21/2019 - 8:38pm Permalink
Seth Tyrssen (not verified)

Different tune, same song; it used to be that cannabis ("marijuana") was the sure-fire gateway drug that led to heroin.  So this statement from the "drug czar" (what an unfortunate term) is about as believable as anything else we hear from government.  Oh, by the way, at one point heroin was touted as the "safe substitute" for morphine.

Fri, 06/21/2019 - 12:08pm Permalink
Rita Shryock (not verified)

"As part of its campaign to stem opioid addiction and overdoses"?  And here I thought this was going to be a serious article by people seriously committed to telling the truth about the so-called "war on drugs."  Didn't bother to read any further, as the first line is obviously a falsehood.  

Fri, 06/21/2019 - 12:23pm Permalink

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