Increasing opioid prescription rates have escalated the number of people abusing the drug. And while the majority people taking the pills don’t abuse them, the epidemic and its implications are shaping the national drug abuse conversation.

Frighteningly, some measures intended to curb the disturbing trend have only turned the most vulnerable opioid abusers onto heroin.

Painkiller prescriptions jumped by 173% from 1991 to 2013, federal officials say.

The number of opioid prescriptions reached 207 million in 2013, up from 76 million in 1991, according to the National Institute on Drug Abuse (NIDA). About two million people in the U.S. live with an opioid addiction. Meanwhile, despite burgeoning efforts to save lives, the number of people dying from overdose has more than quadrupled since 1999.

As a result of these changing times, more U.S. adults now express greater concern over opioid abuse than over heroin use, according to a survey from Harvard School of Public Health. The poll found that 51% of those surveyed worried that opioids posed a threat to their communities while only 45% said the same of heroin.

Nearly 80% of those surveyed said the problem had stayed the same or grown worse over the past five years. Harvard professor Robert J. Blendon tells ScienceDaily:

“For much of the public, the issue of prescription painkiller abuse is not just a remote concern; it’s a problem they see in their personal lives.”

That’s because nearly 40% of those polled said they knew someone personally who has recently abused prescription pills. Some people blame rising opioid prescription rates for the problem, with excess supply often moving into the hands of drug abusers who never needed the pills for a medical purpose. Others blame the ease of buying the pills illegally.

Opioid abuse and heroin use are closely linked, worrying policymakers and concerned citizens.

Part of the problem with opioid abuse is not the high risks of the pills themselves, but their tendency to lead those who become addicted to harder drugs like heroin. In fact, many people now use the drugs simultaneously, according to research from the Washington University School of Medicine.

Although the drugs are linked, many people who become addicted to opioids convince themselves their situation is less dire than it is. Researcher Theodore J. Cicero tells ScienceDaily:

“People used to tell us quite often, ‘At least I’m not using heroin,’ when we asked about their drug abuse…But in many years, many have come to ignore that aversion because heroin is cheaper and accessible and because they’ve seen friends and neighbors use heroin.”

In fact, heroin use is on the rise, as is pain pill abuse, fueled in part by rising opioid prescription rates, researchers say. White men face the highest risk of abusing both drugs in combination, according to research from Penn State.

Penn State researcher Shannon Monnat attributes the rise to a “domino effect of addiction” that started in the 1980s and 90s when rising opioid prescription rates caused more people to become addicted, reports ScienceDaily.

And Monnat says the measures to prevent people from abusing the medications, such as making the pills difficult to crush, along with various prescription monitoring programs, haven’t slowed the rates of addiction. Instead, people turned to heroin, which is cheaper and easier to buy.

Efforts to make opioids more difficult to access and abuse have not lessened addiction rates, but turned people to heroin, experts say.

This problematic trend is not very common, but Monnat says the number of people addicted to both opioids and heroin or heroin only is increasing faster than the people who are addicted to painkillers only. She adds:

“You don’t eliminate the addiction simply by eliminating access to the drug…People who are addicted to the morphine substance will find a substitute.”

To stem this worrisome development, Brandeis University scholars recommend lowering the overall opioid prescription rates while increasing access for medical help overcoming addiction. Their research showed that recreational use of opioids was not the problem. Instead, an increasing number of people receiving the pills for medical use are succumbing to addiction, resulting in skyrocketing overdose rates.

Since 1997, the number of people in the U.S. who have entered treatment for painkiller addiction has soared by 900%, researchers say.

Those taking the pills for chronic pain have an especially high risk for addiction, the researchers said, because of the long-lasting nature of their health condition. Opioid painkiller manufacturers have encouraged this trend, even though medical research casts doubt on its efficacy. Study author Dr. Andrew Kolodny tells ScienceDaily:

“We need to prevent new cases of opioid addiction and we need to expand access to treatment for the millions of Americans who are already addicted…Without better access to addiction treatment, overdose deaths will remain high and heroin will keep flooding in.”

Prescription drug monitoring programs offer hope in the effort to prevent opioid overdose deaths.

States are largely responsible for implementing their own programs to combat this rising problem, and they’re looking to each other to see which ones work. In Florida, a prescription drug monitoring program resulted in a 25% drop in deaths related to oxycodone.

The success was likely due to the increased ability of health care providers to search a database and monitor patients’ access to prescriptions, according to researchers at the University of Florida. Study author Chris Delcher tells ScienceDaily:

“Forty-nine states have prescription drug monitoring programs of some kind, but this is the first study to demonstrate that one of these programs significantly reduced oxycodone-related deaths.”

Oxycodone is one of the most commonly abused painkillers, and exponentially rising rates had Florida officials worried. From 2007 to 2010, the rate of related deaths leapt by 118%. Starting in 2010, the number started to decline after implementing tamper-resistant pills, heightened law enforcement efforts, and the shut down of medical clinics that existed essentially to peddle opioids.

Despite all these efforts, the Florida researchers attribute about 25% of that decline to their prescription monitoring program that acts as a centralized database to track who is taking which pills, making it easy for health care providers to oversee their patients.

Do you think changing opioid prescription rates would affect the number of people dying from overdose or becoming addicted to heroin?

Image by David Goehring via Flickr

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