Report shows nonmedical use of pain relievers may increase risk of using heroin later

A new report by the Substance Abuse and Mental Health Services Administration (SAMHSA) shows that people aged 12 to 49 who had used prescription pain relievers nonmedically were 19 times more likely to have initiated heroin use recently (within the past 12 months of being interviewed) than others in that age group (0.39 percent versus 0.02 percent). The report also shows that four out of five recent heroin initiates (79.5 percent) had previously used prescription pain relievers nonmedically.

While the report shows that people using prescription pain relievers nonmedically were at greater risk of later starting heroin, it also shows that the vast majority of people using prescription pain relievers nonmedically did not start using heroin. In fact, only 3.6 percent of the people who initiated the nonmedical use of pain relievers went on to use heroin within five years.

"Prescription pain relievers when used properly for their intended purpose can be of enormous benefit to patients, but their nonmedical use can lead to addiction, serious physical harm and even death," said Dr. Peter Delany, director of SAMHSA's Center for Behavioral Health Statistics and Quality. "This report shows that it can also greatly increase an individual's risk of turning to heroin use - thus adding a new dimension of potential harm."

The report's examination of the association between the nonmedical use of prescription pain relievers and the initiation of heroin use is part of SAMHSA's efforts to identify some of the factors which may explain the rise in the rates of heroin use, dependence, and initiation that have occurred in the past few years.

The number of people reporting that they have used heroin in the past 12 months rose from 373,000 people in 2007 to 620,000 people in 2011. Similarly, the number of people dependent on heroin in the past 12 months climbed from 179,000 people in 2007 to 369,000 people in 2011. The number of people starting to use heroin the first time in the past 12 months also increased from 106,000 people to 178,000 people during the same period.

The report also found significant shift between 2008 and 2011 in heroin initiation levels and patterns. For example, although overall heroin initiation rose among all 12 to 49 year olds, these increases were only seen among adults aged 18 to 25 and 26 to 49, with no change in the rate among youths aged 12 to 17. Heroin initiation among people with annual incomes less than $20,000 or $20,000-$49,999 also increased during this time period.

Past-year heroin initiation rates went up sharply in all regions of the nation during this period except the South where the rate stayed lowest in country. Heroin initiation rates were also lower among Blacks than among other racial and ethnic groups.

SAMHSA funds projects which focus on preventing prescription drug misuse and abuse. For example, SAMHSA's Prevention of Prescription Drug Abuse in the Workplace provides work-based educational materials and other resources and supports to preventing drug misuse and abuse. SAMHSA also offers a number of web-based and print materials to educate patients, the public, and providers about prescription drug abuse, including the Not Worth the Risk, Even If It's Legal campaign and the Prescribers' Clinical Support System for Opioid Therapies, which provides support, training, and mentoring services to a variety of healthcare providers on the safe and appropriate prescribing of opioids.