High school heroin use starts with painkillers in three out of four cases

Prescription painkillers are a leading cause of the American heroin epidemic, a key issue in the New Hampshire primaries.

President Obama now proposed US$1.1 billion for urgent action to fight the epidemic. As part of this, the Food and Drug Administration recently announced several measures to deal with drug abuse, including increasing studies on drugs after they come to market. One researcher who’s all too aware of where the problem might begin – and end - is Joseph Palamar.

When Joseph Palamar's younger sister died from heroin josephaddiction he was determined to help others at risk. Five years on, his latest study on high school seniors offers context. He shows opioids and heroin use go hand in hand, and teens may transition to heroin because it's cheaper than opioid pills, including Vicodin or OxyContin, and more available.

We ask Palamar, public health expert at NYU Langone Medical Center, New York, to tell us more about his study. 

ResearchGate: What did you find in your study about the use of prescription painkillers and heroin amongst high school seniors?

Joseph Palamar: We found that over three-quarters of teens who reported heroin use had also used opioid pills in a nonmedical manner. We also found that the more frequent the use of opioids, the higher the risk of reporting use of heroin. We couldn’t deduce whether opioid use came before heroin as the data were cross-sectional, but we believe our findings add to the theory that addiction to opioids increases the risk of users moving onto heroin.

RG: How do parents’ and students’ income and education play into your results?

JP: Compared to low parental education, moderate parental education was actually a risk factor for nonmedical use of opioids. This may suggest that those in the middle class or of higher socioeconomic status are now at increased risk. Likewise, we found that higher student income was a robust risk factor for nonmedical opioid use. In fact, higher income was strongly associated with high-frequency nonmedical opioid use and this makes sense because a nonmedical opioid habit is an expensive one—a much more expensive habit than heroin as unfortunately heroin is cheaper and more available.

RG: In general, more women and white individuals are using heroin, and there’s an increasing number of overdoses in rural settings. What’s causing this demographic shift?

JP: The primary cause in this shift is addiction to opioid pills. People of these demographics rarely just start with heroin. They resort to heroin when they can no longer afford their expensive pill habit or when their source for pills has become cut off. Since white individuals are at highest risk for nonmedical use of opioid pills, this now places them at high risk for future heroin use. Addiction to opioid pills is now driving a lot of people to heroin use.

RG: What preventive measures need to be put in place, and how quickly can this be done?

JP: The most ignored preventive measure, in my opinion, is education. Teens aren’t adequately educated about drugs in general so we probably can’t expect them to be properly educated about opioid pills. Teens are often taught that marijuana and heroin are equally dangerous and when a teen learns that this isn’t true, he or she may lose trust in other information provided to them about drugs. Teens need to be taught how dangerous and addicting opioid pills can be, and that they aren’t safe just because they’re pharmaceutical grade, government-approved, and possibly in their parents’ medicine cabinet. But if teens don’t trust what we have to say about drugs like marijuana then how can we expect them to believe what we tell them about pills? I think the first step is to more properly educate our teachers about drugs. Then hopefully they will be able to provide accurate and believable information to their students.

RG: How do you feel about the use of Naloxone, a nasal spray that quickly reverses opioid and heroin overdoses, in schools?

JP: I think all high schools and colleges should have Naloxone nasal sprays available to reverse opioid-related overdoses. Arming school staff with drugs to reverse an overdose is by no means condoning use. It’s an effective way to save the life of someone experiencing a severe medical issue called addiction. In addition, if more police officers and emergency medical technicians throughout the country were able to and/or willing to carry Naloxone nasal spray, many more lives would be saved—lives of our neighbors, coworkers, and our children.

RG: How might stigma against heroin addicts affect them seeking and/or receiving help?

JP: Throughout the 1980s, we were literally taught in school that “users are losers” and this ultimately led to an entire generation of parents that stigmatize and marginalize users of any illicit drug—especially heroin. Many individuals from this generation don’t tolerate or understand heroin use, which makes it very difficult on their children if they’ve developed a drug problem. Now we have an epidemic of opioid and heroin addiction in the younger generation coupled with parents that are unable or unwilling to understand the situation. I view the stigma toward drug use and addiction as a virus that continues to be spread, and it’s unfortunate that so many parents refuse to wake up until it’s too late. The stigma associated with heroin use and with addiction in general is a major barrier for people to receive help. Sadly, as I’ve witnessed all too often, by the time the individuals around an addict finally drop the stigma it’s already too late. The individual is already addicted. Or dead.

Drug use and addiction are health issues yet we seem to be stuck on treating drug users and addicts as criminals. This doesn’t mean we must condone use, but treating users and addicts as criminals only perpetuates the stigma and prevents people who need help from seeking or receiving it.

RG: What motivated you to research this topic?

JP: My colleagues and I focused on this because it has become increasingly obvious that the problem of opioid addiction is leading to heroin use. So few studies have examined this association so we felt it was important to add to the current dearth of research. I, personally, have never been interested in researching opioid or heroin use as I have always been more interested in researching use of party drugs such as ecstasy. But after the death of my little sister a few years ago—who we lost to heroin addiction—I figured it was time to step a bit outside my research interests. My aim is to inform education to help others at risk of, or experiencing, such addiction.

Feature courtesy of hughhillphotography.