Researchers from the University of Philadelphia found that risk factors for using heroin and other opioids included a family history of substance abuse and a personal history of having a prescription for an opioid painkiller. Participants in the study were all injection drug users ages 16 to 25, and 75% had been prescribed an opioid drug.

"Participants in the study were commonly raised in households where misuse of prescription drugs, illegal drugs or alcohol was normalized," said researcher Dr. Stephen Lankenau. "Access to prescription medications – either from a participant’s own source, a family member or a friend – was a key feature of initiation into prescription drug misuse."

Well, move aside marijuana; there’s a new gateway drug in town. Researchers from Drexel University’s School of Public Health warn that people who misuse prescription drugs are one step closer to abusing heroin and other injected drugs.

From Pills to Needles

In a study published in the International Journal of Drug Policy, researchers polled 50 injection drug users ages 16 to 25 who had abused a prescription drug on at least three occasions in the past three months. They found that:

• Four of every five injection drug users abused an opiate drug, such as OxyContin or Vicodin, before injecting heroin.
• Nearly one in four youth who inject drugs first injected a prescription opiate before switching to injecting heroin.
• On average, it took two years for participants to make the switch from painkiller abuse to heroin abuse.

Risk Factors for Prescription Drug Abuse

In the study, access was a key factor in all instances of prescription drug abuse. Many study participants (nearly three-quarters) had been legitimately prescribed opiates after an injury or dental or medical procedure, and two-fifths of participants began by misusing their own medication. Most also had family members with a substance abuse problem so they could steal medication easily.

The following are common risk factors for prescription drug abuse:

• Family history of substance abuse
• History of getting prescriptions for opiates
• Mental health disorders such as depression or anxiety
• Being an adolescent or young adult
• Being addicted to alcohol or another drug
• Peer pressure
• Lack of knowledge about the dangers of prescription drug abuse
• Easy access to prescription drugs

Growing Problem, Hidden Danger

Most study participants began abusing prescription painkillers in their teens. According to a 2009 study by the Centers for Disease Control and Prevention, roughly one in five high school students reports having abused prescription drugs.

Even when prescribed for legitimate purposes, teenagers can build a tolerance to prescription painkillers and begin taking more than prescribed. Without realizing it, they may become physically dependent on the drug, leading some to use heroin – a sometimes cheaper and more readily available alternative.

Only a small percentage of teens who use prescription drugs will move on to abuse heroin or other injected drugs. But if you suspect that your teen is abusing prescription painkillers, don’t disregard their behavior as typical teen experimentation. Prescription drug abuse is a sign that larger problems may be close behind.

According to a new study conducted at the State University of New York at Buffalo (UB), many of those suffering from prescription painkiller addictions moved onto street drugs if their prescription became unavailable or too expensive. Researchers suggest that the switch also takes place because most individuals find that street drugs like heroin are more effective than prescription drugs because they go straight into the bloodstream.

According to some, heroin is less expensive than OxyContin. Robert Masone, president of the Ohio Society of Interventional Pain Physicians says that the cost of two to three OxyContin pills of 80 milligrams each can be as much as $200. And, if the doctor refuses to renew your OxyContin prescription, supplies of heroin are still readily available. In fact, in Ohio where heroin addictions are on the rise, some claim that heroin is easier to access than beer and that in Dayton, people are getting hooked because free samples are pitched into car windows.

Dayton methadone clinic, Project Cure, is relocating its facility because the neighborhood is so bad. It is hard for recovering addicts leaving the facility to stay sober because heroin dealers are waiting at the bus stop just around the corner from the clinic. Vie Ross who is a counselor at Project Cure says that many patients seek out illegal street drugs once they discover that heroin provides a comparable high for a lower price. Lt. Brian Johns, head of the narcotics unit in Dayton adds that the city has become a hub for cheap heroin that is drawing people from afar. Many, he claims, are even buying it in Dayton and reselling it in their hometown for a profit.

But Ohio isn’t the only state having problems with heroin. Between the four month period from December 2007 to April 2008, two university students studying in Oregon died from heroin overdoses. Each had been prescribed OxyContin by doctors for sports injuries. When the doctors would no longer renew the prescription, the students sought heroin.

Dwight Richard, clinical director of Project Cure claims that since 1994, prescriptions for painkillers have spiked by an incredible 900 percent. If we want to get this epidemic under control, prescribing doctors need to be more closely regulated and they need to be asking more questions about family history of drug addiction. The fact that many painkillers carry the risk of addiction as a potential side effect is not to be underestimated and begs the question – might not there be other, more viable alternatives?

Ron A., 57, a resident of the Easy Does It addictions treatment center in Bern Township, was a heroin addict for years. "Then one day I learned I could get the same high from prescription drugs and they were a lot easier to get," said Ron, who said he raided the medicine cabinets of friends and family and started going to doctors and dentists with made-up maladies, asking for pain medicine.

"They gave me Oxycontin and Dilaudid and other pain medications," he said. "It got to the point I was taking so many pills they didn’t even work anymore."

Dan Kelly of the Reading Eagle writes that Dr. Charles F. Barbera, chairman of the department of emergency medicine at Reading Hospital, said doctors are continually evaluating patients for pain in the emergency room.

"We have a system here that identifies people who we feel may have some dependence on prescription drugs, and we try to offer them ways through our social services department to regulate prescription drug usage," Barbera said. "That usually involves consultation with the family doctor and designating one person to authorize prescription drug usage in at-risk patients.”

"We see people misuse prescription drugs that they have for valid medical reasons, and we also see people that utilize prescription drugs and maybe come to us and several other hospitals seeking prescription drugs,” he continued.

In addition to doctor shopping, addicts now can order prescription painkillers on the Internet without a prescription.

"It’s an ongoing battle: prescription drug abuse and what we call prescription drug diversion, which is when people get legal prescription drugs and divert them for illegal purposes," Frederiksen said, adding that prescription fraud, or forgery, sometimes involves medical professionals diverting the drugs for themselves or others.

In addition, the state attorney general obtained a $5 million civil judgment against Purdue Pharma, the maker of OxyContin, saying the company downplayed the addictive nature of the drug and marketed it to physicians as a replacement for other nonaddictive painkillers.

"That was a recipe for addiction," Frederiksen said. "There have been changes, but we continue to work with other attorneys general because the problem with OxyContin started up and down the Appalachian Mountains," he said. "In some states it was referred to as ‘hillbilly heroin.’"

The federal Centers for Disease Control and Prevention and the U.S. Food and Drug Administration said a study of patient deaths between 1999 and 2007 showed an 83 percent increase in accidental overdose deaths due to prescription painkillers.

A companion study by the Canadian Medical Association found that the numbers of accidental prescription drug deaths in Canada increased by 500 percent since 1991.

In nearly every case, the teens started by popping prescription pain pills, KMBC’s Martin Augustine reported.

Brett Hayes was one of the teens who died from a heroin overdose. Brett’s father, Dorman Hayes, said that Brett was a talented wrestler, a loyal friend, and a loving son. He began abusing prescription pain pills after graduating from Blue Valley Northwest High School.

"He cared, I think, more about other people than maybe he cared about himself," mother Debbie Hayes said.

Brett’s parents said they aren’t sure how his drug habit started, but they got him into a drug rehabilitation program that temporarily cleaned him up. Then, on Nov. 6, 2008, Brett bought a $10 hit of heroin. His parents were at work and couldn’t get in touch with Brett all day.

"I felt like something was wrong," Debbie Hayes said, as it was unusual for Brett to not return their phone calls.

Later that day, Brett’s parents found his body in his room—he had been injecting heroin while sitting in a chair against his bathroom sink.

"You know, there was the syringe, the stuff," Dorman Hayes said. "He was just kind of leaned over, like he’d (gone) to sleep…We’ll never know what triggered him to do it.”

Police said that heroin was long thought to be a big city problem, but now it’s become a problem in the suburbs. Narcotics officers said many teens start turning to heroin because pills are expensive but heroin isn’t.

Brett’s parents said they hope their son’s heroin overdose can be an example to warn other families.
"There has to be something good out of Brett’s death." Debbie Hayes said. "If we can help other parents, if we can help another kid not lose his life, then that’s what we’re going to do."

Debbie Hayes said parents should ask a lot of direct questions of their children, especially if they’re good students and their grades suddenly go bad, or if their old friends aren’t around anymore. Find out what’s going on, even if it’s embarrassing.

"If you could figure out where everything went wrong, then we wouldn’t be sitting here right now. And other parents wouldn’t be in the situation that our family’s in right now," Debbie Hayes said.

Johnson County authorities are developing an education program to fight the heroin problem. Last month, they unveiled a presentation available to every police department in Johnson County.

One of the messages is for parents to lock up their prescription pills, since they are a gateway drug to heroin.

“The driving factor in kids using prescription drugs and then heroin is that they get sick when they stop,” said Dr. Alex Stalcup. “This is the new epidemic.” He also said that within two years of using heroin, people begin to inject the drug for quicker relief, which can lead to death, increases in crime rates, and occurrences of HIV and hepatitis.

Members of Nevada’s Meth Alliance were concerned by Dr. Stalcup’s words, as police and treatment providers are reporting a rise in heroin use.

Dr. Stalcup was asked to speak by members of Join Together Northern Nevada members, part of the meth task force, so they could get help in figuring out how to address the rise in youth prescription drug abuse before it becomes an epidemic. No statistics exist, but officials say they are seeing a rise.

Sgt. Mac Venzon of the regional Street Enforcement Team said heroin arrests have risen from about 1 to 2 percent of the caseload to about 15 percent. Most of the users are young, he said, with the sellers being organized and from Mexico.

The January death of a 15-year-old Reno boy who overdosed on two methadone pills prompted the alliance to investigate the issue. Austin Riley Jones’ parents said he took the pills at a party and likely had no idea of the drug’s fatal consequences.

The group’s public campaigning has been credited with helping reduce local meth use and associated problems.

Stalcup, a pediatrician and medical director of the New Leaf Treatment Center in Lafayette, California, said the Internet is fueling youth prescription drug abuse. He said the age-range of prescription drug addicts are between 15 and 24, many of whom had no previous risk to become addicted.

Increases in heroin users, Stalcup said, means there was a failure to intervene when they were abusing prescription medications. He said treating addicts when they are in jail with a highly effective drug called buprenorphine can help them get clean. He suggested rehab stints longer than 28 days, along with outpatient therapy and sober living.

“Absent intervention, there is no choice but the needle,” Stalcup aid. “Because there is no treatment for them to get off the prescriptions, their disease perpetuates. They need medical management to get through withdrawals, which is a horrible experience.”

“They say this happens to other people, not us. But this is us, and these are our kids,” Stalcup said, encouraging the meth alliance to tap into emergency rooms, health departments, and schools to gather data on youth drug abuse.