The increase in nonmedical prescription opioid use in the United States does not appear to be strongly related to the concurrent increase in heroin use, according to a review by Dr. Wilson Compton of the National Institute on Drug Abuse, Bethesda, Md., and his associates.
While heroin users are 3.9 times more likely to have used nonmedical prescription opioids than are those who haven’t used heroin, heroin use only occurs in a small number of nonmedical prescription opioid users. The researchers cited studies showing that 3.6% of opioid users began using heroin within 5 years of beginning opioid use, and 4.2% of opioid users reported also using heroin in the past year.
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A more likely driver for the increased use of heroin and heroin death rate is decreased cost and increased availability, the investigators wrote. For every $100 decrease in price per gram of heroin, hospitalizations for heroin overdose increase by 2.9%. In addition, heroin use has grown significantly in areas of the United States that were not typically centers for heroin distribution, the researchers reported.
“Fundamentally, prescription opioids and heroin are each elements of a larger epidemic of opioid-related disorders and death. Viewing them from a unified perspective is essential to improving public health. The perniciousness of this epidemic requires a multipronged interventional approach that engages all sectors of society,” the investigators wrote.
Dr. Compton has ties with General Electric, 3M, and Pfizer. No other conflicts were reported. Find the study in the New England Journal of Medicine (doi: 10.1056/NEJMra1508490).