The Connection Between Prescription Opioids and Heroin

SEPTEMBER 12, 2016
Prescription opioid pain medications like hydrocodone, oxycodone, and morphine can elicit similar effects to heroin when taken incorrectly and at higher doses than prescribed.

Currently, these opioid pain medications are the most commonly prescribed and abused drugs in the United States. According to the National Institute on Drug Abuse, the abuse of these drugs can lead to future heroin abuse and potentially increased overdose and death. In fact, half of heroin users reported using prescription opioids before starting heroin.

Throughout the United States, heroin use and related deaths have been increasing rapidly due to cheaper cost and greater accessibility. The United Nations Office on Drugs and Crime reported that between 26.4 million and 36 million individuals abuse opioids worldwide, with 467,000 of them being addicted to heroin.

What’s heroin?
It usually appears as either a white or brown powder. Synthesized from morphine, the opioid heroin can be used by injection, inhalation via snorting, or smoking. Each route delivers a rapid response, typically leading to chronic addiction characterized by relapses and further drug use regardless of negative consequences.

How does it affect the brain compared with prescription opioids?
Upon use, heroin enters the brain where it’s immediately converted back to morphine. Like prescription opioids, the molecules then bind to the opioid receptors located in several areas of the brain, including the ones involved with perceptions of both pain and rewards. Heroin rewards users with a feeling of euphoria accompanied by apprehensive mental functioning where they enter a very drowsy state.

Prescription opioids work by attaching to these same receptors found within the brain and reducing the perception of pain. They can also cause drowsiness and mental confusion, and the euphoric response is typically only seen when taken at higher doses.

How did we get here?
Several factors have contributed to increasing opioid abuse, the first being an increase in written and dispensed prescriptions. According to the American Society of Addiction Medicine, 259 million prescriptions were written for opioids in 2012 alone. Some physicians are very lenient about distributing opioids, prescribing them to patients for the smallest complaints. A more common scenario is the long-time opioid user who was originally prescribed opioids for a legitimate cause but is now dependent on them and the physician doesn’t know when to say enough is enough. This is always a tricky matter because pain is subjective and not something health care providers can precisely measure, but it’s important to try other pharmacological options such as nonsteroidal anti-inflammatory drugs (NSAIDs) if possible before jumping to opioids.

Another factor potentially contributing to opioid abuse is the greater social acceptability for using medications for different purposes. It seems like more than half of the population is participating in recreational drugs these days, whether its smoking marijuana, shooting up heroin, or popping prescription pills. Drug use overall is on the rise, and not everyone sees a problem with it.

The Substance Abuse and Mental Health Services Administration reports nearly 35 million Americans have used prescription pain relievers—including opioid-containing drugs such as hydrocodone (Vicodin), oxycodone (OxyContin, Percodan, Percocet), and fentanyl (Duragesic)—for nonmedical purposes at least once in their lives. These factors combined have contributed to the growing number of opioid abusers and led to the increased availability of drugs. Regardless, the majority of individuals are turning to heroin because of its cheaper price and availability on the street.

How can health care providers get involved?
Students, pharmacists, physicians, and other health care professionals can pay better attention to patients who come in on opioids. Ask questions like, “How is your pain level?” “How long have you been taking these medications?” ”Have you ever tried an NSAID for your pain, and if so, was the control of the pain while on it sufficient?” With our involvement, we could possibly reduce the number of individuals who become dependent on these medications and decrease the number of prescriptions being written for these drugs, which would lead to reduced availability overall.

There are also a number of treatments we could suggest to heroin abusers or individuals suspected of abuse, like behavioral therapies and local rehab centers that can help them develop stability and lead them one step closer to being back on track with their daily lives. Also, medications like buprenorphine and methadone both work similarly by binding to the same receptors as heroin but more weakly. This can help the individual wean off the drug and reduce further cravings. Another medication is naltrexone, which works by blocking opioid receptors and then preventing drugs like heroin from having an effect. Another drug called naloxone is sometimes used as an emergency treatment to counteract the effects of heroin overdose and can actually be obtained at many pharmacies without a prescription.

Research has proven a connection between opioid abuse and heroin use. Heroin overdoses are becoming an epidemic because heroin is cheaper and more accessible than opioids. Health care providers can help combat the issue by keeping an eye out for drug abuse and misuse, and by educating patients about the possible behavioral and pharmacological routes they can take in order to treat their addiction.


Shelby Leheny, Pharm D, B.S
Shelby Leheny, Pharm D, B.S
Shelby Leheny received her Doctor of Pharmacy Degree from Lake Erie College of Osteopathic Medicine (LECOM) and her Bachelor's of Science degree at the University of Pittsburgh. She is a pharmacist at CVS.
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