A preliminary analysis has concluded that over 75 percent of high school students who use heroin previously used prescription painkillers. The study’s authors implicated not only pharmaceutical opioids, but the nature of drug education in the United States, suggesting students do not trust institutional calls to refrain from drug use. Though the findings come with limitations, they further highlight the nation’s persistent, growing struggle with opiate addiction.
The study, called “Nonmedical Opioid Use and Heroin Use in a Nationally Representative Sample of US High School Seniors,” was published in Drug and Alcohol Dependence and analyzed data from 130 public and private schools across 48 states. The information is collected by researchers at the University of Michigan’s Institute for Social Research Monitoring the Future (MTF), whose database serves as “an ongoing annual study of behaviors, attitudes and values of high school students in the country.”
Researchers from New York University’s Langone Medical Center and the NYU Nursing School’s Center for Drug Use and HIV Research“examined associations between frequency and recency of nonmedical use of opioids and heroin.” They foundthat over three-quarters of high school seniors who use heroin reported prior use of opioids.
“12.4% of students reported lifetime nonmedical opioid use and 1.2% reported lifetime heroin use,” the authors explained. “As frequency of lifetime nonmedical opioid use increased, so too did the odds for reporting heroin use, with over three-quarters (77.3%) of heroin users reporting lifetime nonmedical opioid use.”
The study also found that recentopioid use “was a robust risk factor for heroin use and almost a quarter (23.2%) of students who reported using opioids ≥40 times reported lifetime heroin use.”
Though the researchers cautioned that more research is needed, their conclusions are consistent with other findings. In 2013, the Center for Behavioral Health Statistics and Quality reported that four out of five new heroin users had previously been addicted to painkillers. A 2012 study in the International Journal of Drug Police found “prescription opioid misuse was a key feature of trajectories into injection drug use and/or heroin use amongst this sample of young IDUs [injection drug users],” cautioning that a “new pattern of drug use may be emerging whereby IDUs initiate prescription opioid misuse before using heroin.”
Dr. Joseph J. Palamar, lead author the newly-released study of high school seniors, offered several explanations for his findings. He suggested the false demonization of marijuana that anti-drug education programs often perpetuate may lead young people to believe other drugs are also incorrectly vilified.
“Teens are commonly taught that marijuana is as dangerous as heroin and then when they’re exposed to marijuana they may develop a distrust regarding all other drug information,” he said. “Teens are generally only taught how drugs are bad and there is little focus on why some people use.”
Palama also noted that because prescription painkillers are legal, young users do not see them as harmful. “Opioids are an even more complicated situation because most other drugs are illegal in all contexts, yet opioids — the most dangerous drugs — are prescribed by doctors and are often sitting there in parents’ medicine cabinets,” he said. “If teens don’t believe warnings about street drugs then why would they be afraid to use government-approved, pharmaceutical-grade pills?”
He cautioned that “Dependence can really sneak up on you,” noting that “[t]eens who are hooked on opioids almost always say they’ll never use heroin.”
“Months later after they’ve moved on to heroin because they could not longer find or afford their pills, they say they’ll only sniff heroin but never inject. Next thing they know they’re injecting.”
Prescription painkiller abuse has skyrocketed in recent years. According to the CDC, 44 people overdose on pharmaceutical opiates per day. In 2013,16,235 people died from opioid painkillers — a 303% increase from 1999. Heroin use has similarly exploded. Since 2002, use increased by 63%, and overdose deaths quadrupled.
In spite of the increasingly publicized epidemic, Palamar was careful to express the limits of his team’s findings. “Longitudinal research is needed to more closely examine which pill users are moving on to heroin,” he warned. “We’re even lacking basic longitudinal research showing that opioid use usually precedes heroin use. While we believe that pill use preceded heroin use in most cases in our study, we were unable to detect whether heroin was actually used first by some teens.”
Regardless, opiate addiction — whether to legal painkillers or illegal heroin — continues to plague the United States.