Analyzing The Connection Between Prescription Drug Use And Heroin Abuse

Introduction

The United States is currently crippled by the devastating effects of the opioid crisis. This may be largely accredited due to the over prescription of opioid painkillers. The Centers for Disease Control, otherwise known as the CDC, released a statement explaining that approximately every twelve minutes a person dies from overdosing on opioid related drugs (National, 2018). The ongoing opioid predicament is currently a public health crisis and should be addressed immediately. Within this literature review, the over prescription of opioid painkillers and its byproducts will be investigated.

Review of the Literature

In order to create connections between the over prescription of opioid painkillers and the current opioid crisis, a brief overlook must be provided. Prescription opioid painkillers were first commercially introduced into the marked in the early 1990’s. Purdue Pharma was the leading pharmaceutical company releasing new products meant for pain relief. Their first product, MS-Contin was a morphine-based medication that would gradually release its medication over a twelve-hour period. Due to the pre-existing stigma regarding morphine and its addicting properties, Purdue Pharma released their next analgesic, titled OxyContin, which was oxycodone-based as opposed to morphine based. Purdue Pharma conducted many conferences with thousands of attending medical professionals to pitch their products. Although OxyContin should have been marketed as a drug only appropriate to those with severe and chronic pain, it was advertised as being safe for those who had mild to moderate pain as well (Kerley, 2019). It can be seen that in 1991, approximately 76 million prescriptions were written for opioid painkillers. The amount of prescriptions written by 2013 had dramatically risen, up to 207 million prescriptions. Sen Claire McCaskill, a ranking Democrat on the Senate Homeland Security and Governmental Affairs Committee explains, “We are trying to get to the bottom of why all of a sudden opioid have been handed out like candy in this country. ” (Lyon, 2017). The United States quickly became the largest consumer of opioid related prescription medication, and, consequently the nation developed a widespread dependency on medications such as hydrocodone and oxycodone. Counterintuitively, the agency for Healthcare Research and Quality (AHRQ) found an absence of evidence supporting the notion that these opioid painkillers are effective and safe when treating long term chronic pain conditions. It was also discovered in a study that half of those who had been prescribed an opioid-related prescription for three months continue to take these medications as late as five years later (Compton, Boyle, Wargo, 2015). With opioid prescriptions on the rise, the government began to take initiative to reduce unauthorized consumption. The FDA required that any and all pharmaceutical companies begin to develop post-marketing plans to track whether their products are being reallocated or abused. The FDA also required these companies to produce tamper-resistant medications so that users could not crush the pills to bypass the time-release mechanisms (Kerley, 2019).

With prescriptions for opioid related medications rising, the number of heroin-related overdoses rose synonymously. By 2013, the amount of those overdosing on heroin had quadrupled since 2002. Heroin can be defined as an opioid retrieved from the various poppy seed plants originating from Asia, Mexico and Columbia. Heroin can be used in many different ways, most commonly via intravenous injection. Many users explain the high from heroin as being a “rush” or a strong sense of euphoria once administered. Heroin is a highly potent drug that is also exceptionally addictive in nature. Common side effects of heroin include (but are not limited to) collapsed veins, nausea, vomiting, dry mouth and clouded mental functioning. Persistent heroin use may lead to liver and kidney disease, abscesses, and death (NIDA, 2019). In 2017 alone, over fifteen thousand people died from drug overdoses involving heroin in the United States. Similarly, in 2017, approximately 494,000 Americans reported using heroin in the past year. The CDC released a PSA explaining that from 2010 to 2017, heroin related overdoses deaths increased more than five times (CDC, 2019). There have been several different methods to combat heroin use specifically, and this may include treatments such as Naloxone. Naloxone is an overdose reversal drug that can be administered via needle or in a nasal spray. This drug blocks the effects of heroin on the opioid receptors which then helps the user breathe again (NIDA, 2019).

Research Question

Is the over-prescription of opioid-related medications preemptively causing a spike in heroin use and heroin-related deaths?

Theoretical Framework

There have been several connections drawn between the over-prescription of opioid painkillers and the dramatic rise in heroin abuse. There may be several reasons for this increase in heroin usage. For instance, stricter requirements passed by the FDA creates a stronger lock down on these prescription opioid painkillers. Due to the lack of availability of these medications, users may opt in for an alternative solution to feed their dependency: heroin. As explained by Kent. R Kerley in his article titled “Examining the Nexus Between Prescription Opioids and Heroin Use”, 80% of all heroin users reported using prescription opioids before they began using heroin (2019). We can also see a major increase demographically as to who is using heroin and opioid prescriptions. Before the spike in sales of opioid related prescriptions, analysts examined a low variation in minorities, age and gender in regard to heroin abuse. This is no longer the case, as heroin use and addiction are now being seen in an older, more variating population (including sex and ethnicity) as well as less urban populations (Compton, Boyle, Wargo, 2015). This may be explained by the increase of opioid prescriptions, which is not discriminatory to age, sex, and ethnicity. The amount of opioid-related prescriptions sold per capita has shown to be directly related to the state’s number of drug-related overdoses (Compton, Boyle, Wargo, 2015). The CDC also claims that three out of four new heroin users between the years 2000 and 2013 reported misusing prescription opioids before venturing into heroin use (CDC, 2019).

In interviews conducted by Kent R. Kerley, he inquires whether the user initially began taking opioid pain killers recreationally or whether it was prescribed to them for medical ailments. Many of these women claimed they have never used drugs prior to their prescription written by their doctor. It can also be noted that most of the women were unaware of their growing addiction until they began depleting their source of medications. They then turned to illicitly obtaining their “fix” from heroin dealers in the towns they lived in (Kerley, 2019). OxyContin and Purdue Pharma are large role-players in the sharp increase of opioid addiction. This may be due to the lucrative marketing and advertisement produced by Purdue Pharma to effectively sell their product. Barry Meier, author of Painkiller, states, “There is no question that the marketing of OxyContin was the most aggressive marketing of a narcotic drug ever undertaken by a pharmaceutical producer” (Taddonio, 2019). For instance, Purdue Pharma enacted a bonus system to their sales representatives. The average annual bonus to sales representatives who regularly visit physicians to sell OxyContin calculated out to be approximately $71,500. In 2001 alone Purdue Pharma spend around $40 million in incentive bonuses to sales representatives. Although OxyContin was intended to be appropriate for those who were in severe, chronic pain, such as cancer, 86% of their business had been allocated to non-cancer related pain. Purdue also claimed that the risk of OxyContin addiction was extremely small. In 2004 it was examined that OxyContin was the most commonly abused opioid in the United States (Van Zee, 2009). This may be correlated to the increase in heroin usage as many Americans have been predisposed to the effects of opioid-related drugs.

Hypothesis

Due to the over-prescription of opioid-related painkillers such as OxyContin, Americans are becoming dependent on opioids, thus increasing the illicit usage and abuse of heroin.

References

1. CDC. Heroin Overdose Data. https://www. cdc. gov/drugoverdose/data/heroin. html. June 20, 2019.
2. Compton, Wilson M. , Boyle, Maureen, and Wargo, Eric. “Prescription Opioid Abuse: Problems and Responses. ” Preventive Medicine 80 (2015): 5–9. Web.
3. Kent R. Kerley, Megan Webb & O. Hayden Griffin (2019) Examining the Nexus between Prescription Opioid and Heroin Abuse, Deviant Behavior, 40:9, 1132-1143, DOI: 10. 1080/01639625. 2018. 1461787
4. Lyon J. Investigation Into Opioid Crisis Targets Drug Companies. JAMA. 2017;317(18):1826. doi:https://doi-org. mutex. gmu. edu/10. 1001/jama. 2017. 5130
5. National, A. O. S. E. A. , Health, A. M. D. , & Board, O. P. H. A. P. (2018). Integrating responses at the intersection of opioid use disorder and infectious disease epidemics: Proceedings of a workshop. Retrieved from https://ebookcentral-proquest-com. mutex. gmu. edu
6. Taddonio, P. (2019, September 12). Revisit Purdue Pharma's Role in the Opioid Crisis. Retrieved from https://www. pbs. org/wgbh/frontline/article/revisit-purdue-pharmas-role-in-the-opioid-crisis/.
7. Van Zee A. (2009). The promotion and marketing of oxycontin: commercial triumph, public health tragedy. American journal of public health, 99(2), 221–227. doi:10. 2105/AJPH. 2007. 131714