Based on the testimony of recovering addicts and the professionals who treat them, it’s well-known that using prescription pain medications is one of the most common pathways to developing a heroin addiction. A new study of how young people first use heroin has provided some empirical data to support that anecdotal belief.
For three years, researchers at Wright State University tracked nearly 400 18- to 23-year-olds in Columbus, Ohio, who used illicit prescription opioids but were not opioid-dependent. Of the 362 participants, 27 eventually transitioned to heroin, a rate of 7.5 percent.
“We were surprised at the number of people who transitioned to heroin,” says Dr. Robert Carlson, the study’s lead researcher. “We had really no idea of what exactly we’d be able to predict.”
Researchers found several predictors of increased risk of heroin use, starting with the ways in which the opioids were being used. Those who crushed or snorted the prescription drugs were far more likely to transition to heroin.
“It increases the speed at which the drug is hitting the system and makes people much more liable to becoming dependent,” Dr. Carlson says. “If people can become aware that if they even think about starting to use via a non-oral route, they are heading off on a very dangerous path.”
The study also revealed a difference in race among those who eventually turned to heroin. Despite roughly half the participants being African-American or Hispanic, all of the individuals who ultimately used heroin were white.
Although the study could not determine the reasons behind such a strong racial divide, Dr. Carlson suggests that social networks, generational use and other circumstances could be significant factors.
National data shows the heroin epidemic has increasingly hit white males the hardest. The Centers for Disease Control estimates that between 2002 and 2013, heroin use among non-Hispanic whites increased 114 percent.
The new NIDA-funded study targeted 18- to 23-year-olds because they are arguably at the highest risk for substance abuse. In fact, men ages 25 to 44 accounted for the highest heroin-related death rate (13.2 per 100,000) in 2015 — a 22 percent rise from the previous year, according to the Centers for Disease Control and Prevention.
The study did not look at other age groups. But when considering the factors that may move a person from prescription opioids to heroin, Dr. Carlson believes age is just a number. “I wouldn’t think the risk factors for transition to heroin would be much different regardless of age group,” Dr. Carlson says.
While the risk factors may be the same across age groups, the most deadly effects of heroin use are not. Research has shown that those most at risk of a heroin-related overdose fall in the 25 to 44 age range.
It’s important to keep in mind that the vast majority of prescription opioid users will not move on to heroin. And significant research is still needed to determine the social, environmental and biological factors that contribute to a person transitioning to heroin.
But Dr. Carlson says he’s encouraged by the progress being made and believes the groundwork has been laid to develop effective treatment and intervention programs.
“The really exciting thing to come out of this is it gives us a firm foundation of some variables that could be targeted to prevent transition to heroin and transition to dependence,” Dr. Carlson says.
The study was published in the journal Drug and Alcohol Dependence.