Research Review

National Data Reveal Intertwined Opium-Related Epidemics

Several studies have documented an enormous increase in the availability of prescription opiates that has fueled rising addiction, drawing new users and changing populations at risk for opiate overdose. Recent efforts to reduce the supply of prescription opiates may reduce consumption overall but may prompt opiate-dependent individuals to switch to other opiates such as heroin. As demographics shift, those ensnared are as likely to be women as men and as likely to be rural and suburban residents as city dwellers.

“Intertwined Epidemics: National Demographic Trends in Hospitalizations for Heroin- and Opioid-Related Overdoses 1993-2009,” published Feb. 6 in the journal PLOS ONE, finds a strong correlation between increases in prescription opiate overdoses and heroin overdoses. This study is based on the first nationally representative sample of hospitalizations for opiate pill-related and heroin-related overdoses.

Examining the relationship between the two, author George Jay Unick, MSW, PhD, assistant professor at the University of Maryland School of Social Work; principal investigator Daniel Ciccarone, MD, MPH, professor at the University of California San Francisco; and colleagues used data from the Nationwide Inpatient Sample Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality.

“We are concerned that the rapid and forceful ‘turning of the tide’ regarding the over-supply of prescription opiates is driving a new heroin use epidemic nationwide,” says Ciccarone.

The study finds striking changes in the demographics of individuals admitted for treatment of prescription opiate and heroin-related overdoses during this period. “The current opiate epidemics are more white, female, wealthy, and rural than their immediate predecessors, in large part based on the matter of legal pills vs. illegal injectables” observes Unick.

The findings show women are at greater risk than are men for opiate overdose hospital admissions. The rates for females have soared, from fewer than 3 per 100,000 individuals in 1993 to greater than 15 per 100,000 in 2009 for prescription opiate overdoses. The rate of heroin overdose admissions grew from slightly more than 2 per 100,000 in 1993 to nearly 3 in 2009. For both types of drugs, the rates for women hospitalized due to overdoses have risen more steeply than the rates for men.

The study documents a recent surge in heroin overdoses among young adults, in the 20-34 age groups. “For a variety of reasons, young people are very susceptible to making a shift. They are more willing to risk substituting drugs, and more likely to associate with others willing to experiment,” Unick says.

Furthermore, the intertwined nature of the epidemics arises from “spillover due to opiates’ interchangeable function,” Unick says. Pressures to limit availability of prescription opiates causes some addicted individuals, attempting to avoid the severe pain of withdrawal, to obtain heroin instead.

The findings suggest that relying on supply-based interventions may simply lead opiate users to shift to heroin. “And the stigma surrounding heroin use prevents many new users from seeking treatment—getting help,” suggests Ciccarone. As an alternative, a broader approach that also aims to expand demand-side interventions, as well as risk reduction, e.g., overdose prevention campaigns, is likely to be more productive. Such an approach would offer evidence-based pharmaceutical and therapy-based treatments that can prevent and reduce the harms associated with opiate misuse and abuse.

— Source: University of Maryland