What prompted Ameritox to conduct this research?

Mike DeGeorge: As Rick mentioned, heroin use has been on the rise in the US. Recent data showed that 75% of heroin users were introduced to opioid use through prescription opioids.2 For that reason, we sought to investigate the use of heroin in a population of individuals prescribed opioids for pain. We did this by examining over 170,000 samples from patients prescribed opioids that were received at our lab.

How is this current heroin epidemic affecting pain patients?

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Mike DeGeorge: In our study, we found that 1.3% of the 170,000 samples tested positive for the heroin metabolite, 6-monoacetlymorphine. This is significantly greater than the 0.3% seen in the general population.1

Ameritox: Does Ameritox’s research show that there is a relationship between opioid and heroin abuse?

Mike DeGeorge: Based on our research, there does appear to be a relationship between heroin use and misuse of prescription opioids. We found that when patients were positive for heroin, their urine samples tested negative for their prescribed opioid 56% of the time. In 23% of those same samples we also found evidence of the use of a synthetic opioid without a prescription, including drugs such as methadone, fentanyl and buprenorphine.

What other trends are you finding among chronic pain patients who tested positive for heroin?

Mike DeGeorge: The other trend we saw was that heroin positive samples were more likely to test positive for cocaine, marijuana, a non-prescribed prescription stimulant product, or a non-prescribed sedative hypnotic, including benzodiazepines. Interestingly, heroin positive samples were more likely to test negative for those same sedative hypnotics when they were prescribed to them.

The demographics of the heroin positive patients in our study matched well with those of the general population reported previously. Specifically, males and patients between the ages of 19 and 39 years were most likely to test positive. Geographically, samples from the Midwest and Northeast were the most likely to test positive for heroin. From a payer standpoint, samples from patients who have Medicaid as their primary payer were the most likely to contain evidence of heroin use.

How do “drug cocktails” affect people using heroin?

Mike DeGeorge: When heroin is used with prescription opioids and benzodiazepines, the individual is at greater risk for central nervous system and respiratory depression, which can ultimately lead to an overdose death. In our study, more than 4% of the samples tested positive for heroin, a sedative hypnotic, and a synthetic opioid. Additional, slightly more than 1% of the samples tested positive for the combination of heroin, a sedative hypnotic, a synthetic opioid, and cocaine.

1. Substance Abuse and Mental Health Services Administration. Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings and Detailed Tables. Available at: http://www.samhsa.gov/data/NSDUH/2012SummNatFindDetTables/index.aspx?from=carousel&position=1&date=09052013. Accessed on August 21, 2014.
2. Cicero TJ, Ellis MS, Surratt HL, Kurtz SP. The changing face of heroin use in the United States: a retrospective analysis of the past 50 years. JAMA Psychiatry. 2014; 71(7): 821-826.