Heroin Is Increasingly the Initial Opioid Used by Individuals Who Develop Opioid Use Disorder

The past few decades have seen an increase in opioid use disorder and overdose in the US. This epidemic was initially fueled by a rise in opioid prescribing and non-medical use of prescription opioids, resulting in efforts to limit prescribing. Many people with non-medical use of prescription opioids have transitioned to heroin because of easier access and lower cost. Researchers used reports of the specific opioid first regularly used from interviews of individuals entering substance use disorder treatment as part of the nationwide Survey of Key Informants’ Patients (SKIP) program to analyze changes over time.

• In 2005, 8.7% of opioid initiates began with heroin; this rose to 33.3% in 2015.
• In 2005, 42.4% of initiates began with hydrocodone and 42.3% with oxycodone; this fell to 24.1% and 27.8%, respectively, in 2015.
• Individuals who initiated with heroin were younger and less likely to have a college education, be white, or reside in non-urban areas, but the differences were relatively small.

Comments: This study is limited by its focus on individuals seeking treatment and may not be representative of others with opioid use. Nonetheless, it suggests that heroin (or what is being distributed as heroin) is increasingly becoming the opioid with which people initiate use. This is likely a spillover effect of the increasing use of heroin in general and the decreased availability of prescription opioids. The increase in relatively inexperienced individuals using substances with variable and unpredictable potency is likely contributing to the alarming increase in the rates of overdose.

Darius A. Rastegar, MD

Reference: Cicero TJ, Ellis MS, Kasper ZA. Increased use of heroin as an initiating opioid of abuse. Addict Behav. 2017;74:63–66.