When Prescription Opioid Abuse Escalates to Heroin Addiction

A growing number of people are graduating from prescription opioid addiction abuse to heroin use. For families of those struggling with addiction, understanding the progression to heroin addiction can help you contextualize your loved one’s disorder and gain important insight into what they are going through.

Many imagine the road to heroin addiction to be a gradual ascent with other illicit substances serving as stops along the way, priming you for the peak. But Sarah’s addiction wasn’t preceded by increasingly severe forms of substance use. Instead, it began with a relatively minor surgical procedure.

“I was introduced to opioids when I was 33 years old and got my tonsils out,” she remembers. “When you get your tonsils out as a child, it’s not such a big deal. But when you’re an adult, you usually have a long and painful recovery ahead of you. So I was sent home with a huge supply of painkillers.”

At first, she took the painkillers as prescribed. But when that didn’t relieve her pain, she took more and she took them more frequently. “I got high for the first time on maybe day 6 of my recovery and after that I tried to stay high as long as I could, both to dissolve the tremendous physical pain and because it stripped away any worry, any sadness, any anxiety.” But her prescription didn’t last forever. When it ran out, Sarah panicked. “My doctor wouldn’t give me more. Other doctors I went to realized I was drug-seeking. The only way for me to get more opioids was through a drug dealer. That’s when I was introduced to heroin.”

Sarah’s story is remarkable not because it is unique, but because it is increasingly common. People who have never imagined themselves to be candidates for addiction are graduating from prescription opioids to heroin in growing numbers, causing a surge in overdoses and leaving users and their loved ones to deal with the destructive force of what is perhaps the most infamous of drugs. In order to heal, it is critical for families to understand this ever more paved road to addiction and discover how to connect with the best heroin addiction treatment available.

Understanding the Progression to Heroin Addiction

In the past few years, the crisis of opioid addiction has received extraordinary public attention thanks to the work of activists, journalists, public health officials, and policymakers. Much of the discourse on the opioid epidemic has focused on the rise of prescription opioid abuse, which has increased dramatically since the 1990s. However, prescription opioids are only one part of the picture when it comes to overall opioid addiction. In fact, research shows that “from 2010 through 2013, there was a notable downturn in abuse of prescription opioids […] in the United States.” This is believed to be the result of increased awareness of the dangers of these drugs, more judicious prescription practices, better abuse-deterring technologies, greater regulation and oversight of prescription practices, and an increased focus on alternative methods of pain relief; even doctors who once routinely provided patients with opioid prescriptions are now reserving these medications for cases of true necessity and referring patients to less dangerous methods of relieving discomfort.

However, while the abuse of prescription opioids alone has decreased, there has been a rise in exclusive heroin use and combined prescription opioid and heroin use. Indeed, a study tracking 15,227 patients with opioid dependence between 2008 and 2014 found that “concurrent abuse of both heroin and prescription opioids in the previous month increased, with an average annual increase of 10.3%, from 23.6% in 2008 to 41.8% in 2014.” Meanwhile, exclusive heroin use more than doubled. As a review article published in the New England Journal of Medicine points out, “Some researchers suggest that the very policies and practices that have been designed to address inappropriate prescribing practices are now fueling the increases in rates of heroin use and deaths.” In other words, people who are unable to obtain opioids through legitimate or diverted prescriptions are turning to heroin to replace prescription options.

For some, heroin allows previous prescription opioid users to continue getting high, often more rapidly, reliably, and cheaply than is possible with prescription alternatives. In other cases, it allows users to continue staving off the legitimate physical pain that prescription opioids once held at bay. And sometimes, heroin is a way of avoiding the agony of withdrawal. Regardless of the reasons for heroin use, its risks are typically greater than those of exclusive prescription opioid abuse, largely due to IV administration. According to the National Institute on Drug Abuse, “Because heroin is often injected, the upsurge in use also has implications for HIV, hepatitis C (HCV), and other injection-related illnesses. ” Research suggests that having a history of prescription opioid use prior to heroin injection is “a common trajectory for young drug users with HCV infection,” with one study on new HCV infections in Massachusetts finding that “95 percent of interview respondents used prescription opioids before initiating heroin.” As such, recovery becomes more imperative than ever to protect both physical and emotional health.

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The Role of Medication-Assisted Therapy

As families across the country struggle with the impact of heroin addiction, medication-assisted therapy has emerged as one of the most promising avenues toward recovery. Medication-assisted therapy involves the use of pharmacological opioid drugs that stave off withdrawal symptoms and quell cravings without the psychoactive effects of opioid drugs of abuse. Historically, this has meant methadone, which involves daily dosing at a specialized clinic. However, this administration method leaves a lot to be desired; methadone clinics are not available in all areas, participation requires a significant time commitment, and the public nature of such clinics can be highly stigmatizing. As such, more doctors are now turning to buprenorphine as an integral part heroin addiction detox and treatment. Unlike methadone, buprenorphine can be prescribed privately within the context of a medically assisted detox program, in a residential or outpatient treatment program, and for home use.

“Science says buprenorphine works,” writes Abby Goodnough in The New York Times. “A substantial body of research has found that people who take it are less likely to die and more likely to stay in treatment.” Indeed, many heroin users say that without buprenorphine, they wouldn’t have been able to participate in treatment at all. “I tried to go cold turkey I don’t even know how many times,” says Leon, whose addiction spanned 12 years. “The withdrawal process was horrific. I felt like I was dying and I couldn’t stand it. I always returned to using because I couldn’t get through detox. Buprenorphine changed that.” But the benefits of buprenorphine also go beyond buoying users through the withdrawal process; it can be used long-term in order to prevent relapse. “I don’t crave heroin the way I used to,” Leon explains. “I can go through my day without feeling a desperate urge to use. I don’t think I’d be here if it weren’t for buprenorphine.”

Despite both strong empirical and anecdotal evidence for the value of buprenorphine, access remains a significant barrier for many people struggling with heroin addiction, owing both to stigma and prescription restrictions. “Only about 5 percent of the nation’s doctors are licensed to prescribe it,” explains Goodnough. “A new study found that even among people who had overdosed, only 30 percent were provided with buprenorphine or one of the other medications approved for treating opioid addiction, methadone, and naltrexone in the year that followed.” Other studies have shown that only a third of addiction treatment programs in the United States offer long-term use of medication-assisted therapy. In fact, many programs labor under the erroneous belief that buprenorphine is simply replacing one addiction for another, actively preventing people from receiving the best possible care.

Connecting with a program that recognizes the value of buprenorphine is essential when seeking out the best heroin addiction treatment for your loved one. The availability of this life-saving medication means that your loved one is being treated within a medical model of addiction using every tool available to minimize trauma during withdrawal and create durable recovery.

The Best Heroin Addiction Treatment Goes Beyond Medication

While buprenorphine can play a critical role in your loved one’s healing process, it cannot address the full, complex picture of heroin addiction on its own. As such, the best heroin addiction treatment programs are comprehensive in nature, combining medication-assisted therapy with a complete range of therapeutic modalities to help your loved one gain the insight and skills necessary to break free from substance abuse. This includes individual and group therapies designed to help people understand the roots of their addictions, develop meaningful strategies to disrupt damaging patterns of thought and behavior, and help the brain heal from the ravages of addiction.

At the same time, many people who graduated from prescription opioid abuse to heroin addiction have very real physical pain and health conditions that must be attended to in order to prevent relapse. As such, it’s imperative that your loved one’s treatment team work closely with outside practitioners in order to provide effective pain relief without the use of harmful substances. Meanwhile, people struggling with pain can learn invaluable coping skills and receive targeted therapies within the treatment program itself, including mindfulness, cognitive behavioral techniques, yoga, acupuncture, and physical therapy. Addressing these unique needs of people whose heroin addictions were sparked by legitimate opioid painkiller use is vital to creating recovery.

Of course, for many, prescription opioid and heroin abuse arose not just out of the need to treat physical ailments, but out of a desire to address psychological needs. Heroin addiction, like other forms of addiction, often co-occurs with mental health disorders, including depression, bipolar disorder, anxiety, and PTSD. Properly diagnosing these conditions and implementing effective treatment plans are therefore essential components of the best heroin addiction treatment programs. By working closely with a highly trained psychiatrist and a team of therapists, your loved one can safely explore their psychological health while receiving the care they need to heal.

However, recovering from addiction is not just an individual pursuit. In fact, addiction is often said to be a disease of the family, involving each individual in unique ways. Family involvement is thus a critical part of the recovery process and it is important to choose an addiction treatment program that provides plentiful opportunities for such involvement. High-quality programs will offer specialized family programming to help you understand your loved one’s condition, identify any destructive relationship dynamics, and open up space for meaningful conversations, conflict resolution, and deeper bonding. Together, you can work toward a shared future free from addiction and with more stable, loving, healthy relationships.