Increased use of heroin as an initiating opioid of abuse
Abstract
Introduction Given the relatively recent growth in access to heroin and a more permissive atmosphere surrounding its use, we hypothesized that an increasing number of persons with limited experience and tolerance to opioids would experiment with heroin as their first opioid rather than more common prescription opioid analgesics.Methods Individuals entering substance abuse treatment for an opioid use disorder in the period 2010-2016 (N=5885) were asked about the specific opioid they first regularly used to get high. To limit long-term recall and survival bias, analyses was restricted to opioid initiation that occurred in the past ten years (2005-2015).Results In 2005, only 8.7% of opioid initiators started with heroin, but this sharply increased to 33.3% (p<0.001) in 2015, with no evidence of stabilization. The use of commonly prescribed opioids, oxycodone and hydrocodone, dropped from 42.4% and 42.3% of opioid initiators, respectively, to 24.1% and 27.8% in 2015, such that heroin as an initiating opioid was now more frequently endorsed than prescription opioid analgesics.Conclusions Our data document that, as the most commonly prescribed opioids - hydrocodone and oxycodone - became less accessible due to supply-side interventions, the use of heroin as an initiating opioid has grown at an alarming rate. Given that opioid novices have limited tolerance to opioids, a slight imprecision in dosing inherent in heroin use is likely to be an important factor contributing to the growth in heroin-related over dose fatalities in recent years.
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Those already dependent on prescription opioids frequently transition to heroin when their supplies are cut off.
“However, evidence suggests that those already dependent on prescription opioids frequently transition to heroin when their supplies are cut off (31).”
From A Biopsychosocial Overview of the Opioid Crisis: Considering Nutrition and Gastrointestinal Health (2019) · cites this paper as [31]
A third of people in treatment for opioid use disorder in 2015 began with common prescribed opioids and progressed to heroin use.
“Data from 2015 shows that a third of people in treatment for OUD began with common prescribed opioids and progressed to heroin use (31).”
From A Biopsychosocial Overview of the Opioid Crisis: Considering Nutrition and Gastrointestinal Health (2019) · cites this paper as [31]
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- Authors
- Cicero, T. J., Ellis, M. S., & Kasper, Z. A.
- Affiliations
- Washington University in St. Louis (US)
- Corresponding author
- Cicero, Theodore J.
- Venue
- Addictive Behaviors
- Publisher
- Elsevier BV
- Published
- 2017-11
- Volume
- 74
- Pages
- 63-66
- ISSN
- 0306-4603 (ISSN-L)
- OpenAlex
- W2618137002
- Cited by
- 153
- References
- 14
- Citations by year
- 2026: 2 · 2025: 10 · 2024: 7 · 2023: 18 · 2022: 12 · 2021: 14 · 2020: 23 · 2019: 31 · 2018: 31 · 2017: 5
- FWCI
- 23.11
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Addictive Behaviors (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
- Keywords
- heroin, opioid initiation, prescription opioids, oxycodone, hydrocodone, opioid use disorder, addiction treatment, opioid overdose, opioid tolerance
- MeSH terms
- Adult, Analgesics, Opioid, Heroin, Female, Humans, Male, Opioid-Related Disorders, United States
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