Ameritox, a provider of pain medication monitoring, is focused on reversing the rampant misuse, abuse, and diversion of prescription painkillers that has proliferated in the US over the last decade. An old epidemic that many experts say grew from the abundance and abuse of prescription opioids is seeing a resurgence: Heroin abuse.

At PAINWeek 2014, Rick Tucker, an Ameritox compliance education consultant and former assistant special agent in charge of the DEA, and Mike DeGeorge, PharmD, Director of Medical Affairs at Ameritox, discussed in an interview the roots of the current heroin epidemic facing the US, and how chronic pain patients prescribed opioids are affected by it.

How has heroin abuse changed over the last few decades?

Rick Tucker: Heroin in the last decade has attained a degree of social acceptability that it didn’t have before. Persons across all social and economic positions are now using heroin. The proliferation of the abuse of prescription pain medications led to abusers looking for drugs to satiate the need of an opiate. The fact that the abuser basically cannot get enough prescription meds to meet their dependence, coupled with a recent decrease in heroin prices, make heroin a viable alternative for these abusers.

How is the heroin people are abusing today different from older versions?

Rick Tucker: The heroin being used today is coming from four major sources – Southwest Asia, Mexico, Colombia, and to a lesser extent, Southeast Asia. In recent years all of these sources have worked to make a better “product,” resulting in heroin being more pure now than it has ever been. In addition, the price of pure heroin recently decreased to meet the “street price” of prescription medications. The prices of both heroin and prescription pain meds on the street are now basically the same.

What does the typical heroin user look like today?

Rick Tucker: Very few heroin users today used heroin in their first experience with illicit drugs. Increasingly, in the past few years according to US Substance Abuse and Mental Health Services Administration (SAMHSA) research, opiate abusers are found to have taken prescription pain medications for their first “high.” In the 2012 SAMHSA research, 1.88 million respondents age 12-25 years used prescription opiates for their first experience. Only 156,000 used heroin.1

How are prescription painkillers and heroin connected?

Rick Tucker: Typical pain medications and heroin are both opiates. When abusers of pain medications cannot obtain quantities to satiate their dependence, they often turn to heroin. According to a report from the National Institute of Drug Abuse, “although heroin use in the general population is rather low, the numbers of people starting to use heroin have been steadily rising since 2007. This may be due in part to a shift from abuse of prescription pain relievers to heroin as a readily available, cheaper alternative, and the misperception that highly pure heroin is safer than less pure forms because it does not need to be injected.”