How to Predict the Transition from Prescription Opioids to Heroin

By John Lavitt 02/29/16

A NIDA-funded study tracked young adult users of illicit opioids for three years.

Can Certain Factors Help Predict The Transition From Prescription Opioids To Heroin?
Photo via Shutterstock

As the opioid abuse epidemic continues unabated across the nation, the ongoing narrative seems to be focused on how people make the transition from prescription drugs to heroin. Once someone becomes hooked on prescription painkillers, heroin suddenly becomes a viable option, particularly when the prescriptions run out. In an NIDA-funded study, researchers at Wright State University tracked a cohort of young adult illicit prescription opioid users (ages 18 to 23) in Columbus, Ohio, for three years. At the start of the study, the participants were not dependent on opioids, and had never used heroin or injected any illicit drug.

The goal of the study was to understand the key factors that cause people who misuse pain medications to transition to heroin use. If the factors were understood, could such a transition be predicted?

In this high-risk demographic, the study found that 2.8% of illicit opioid users initiated heroin use every year of the study (7.5% total over three years). Overall, the results were lower than expected, particularly in light of the media's wide coverage of prescription opioid users dramatically morphing into heroin addicts.

Perhaps the most intriguing outcome of the study was the ethnic makeup of those who made the transition. Although only half of the recruited subjects was white, every single person who initiated heroin use in the study was white. Such a finding undermines negative racial stereotypes about drug use propagated by the mainstream media.

The strongest predictor of initiating heroin use was non-oral use of prescription opioids, particularly sniffing and snorting crushed-up pills. Such actions indicate an intensifying relationship with the drug and its associated high. The length of opioid use was also a determining factor. Longer periods of use, along with a higher frequency of consistent use, led to the development of DSM-IV dependence.

There was also a relationship of such transitioning patients developing a focus on using prescription opioids to get high, as opposed to self-treating for pain. When the high replaced pain management, opioid dependence quickly followed, leaving the door to heroin experimentation wide open.

"This is one of the first prospective studies … on the relationship between illicit PO use and heroin initiation among young, initially non-opioid dependent PO users," writes the study authors. "The results provide insights into targets for the design of urgently needed prevention interventions."

The early onset of illicit prescription opioid use turns out to be a key predictor of heroin initiation. If illicit prescription opioid use is caught and stopped at the first stages, it is much more likely that heroin initiation would not occur. Such findings point to prevention efforts aimed at individuals who are currently misusing prescription opioids, who may or may not make the transition to heroin.

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Growing up in Manhattan as a stutterer, John Lavitt discovered that writing was the best way to express himself when the words would not come. After graduating with honors from Brown University, he lived on the Greek island of Patmos, studying with his mentor, the late American poet Robert Lax. As a writer, John’s published work includes three articles in Chicken Soup For The Soul volumes and poems in multiple poetry journals and compilations. Active in recovery, John has been the Treatment Professional News Editor for The Fix. Since 2015, he has published over 500 articles on the addiction and recovery news website. Today, he lives in Los Angeles, trying his best to be happy and creative. Find John on Facebook, Twitter, and LinkedIn.