Prescription Painkillers Tagged as Gateway Drug to Heroin

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By Dr. Mercola

According to a recent report commissioned by the Office of National Drug Control Policy,¹ as many as 1.5 million Americans were chronic heroin users in 2010. Such statistics add further fuel to concerns about rising narcotics abuse and drug-related deaths.
Over the past five years alone, heroin deaths have increased by 45 percent²--an increase that officials blame on the rise of addictive prescription drugs such as Vicodin, OxyContin, Percocet, codeine, and Fentora, all of which are opioids (derivatives of opium).
According to Gil Kerlikowske, director of the U.S. Office of National Drug Control Policy,³ approximately 100 Americans died from drug overdoses each day in 2010.
Prescription painkillers were responsible for 16,600 deaths that year, and heroin was involved in about 3,000 deaths. (Meanwhile, cocaine use decreased by about 50 percent between 2002 and 2010.)
The reason for the resurgence of heroin is in large part due to it being less expensive than its prescription counterparts, and US officials now warn that narcotic painkillers are a driving force in the rise of substance abuse and lethal overdoses. According to the US Justice Department, prescription opiates and heroin are two of the most lethal substances available.

Prescription Narcotics—A Driving Force in Rising Substance Abuse

This connection finally received some media attention following the death of Philip Seymour Hoffman,⁴ a 46-year-old Oscar-winning actor. He died from heroin overdose on February 2. Last year, Hoffman entered rehab when addiction to prescription painkillers led him to switch to heroin.
US Attorney General Eric Holder recently announced his office is taking steps to address the problem head-on. This effort includes⁵ but is not limited to tracking drug overdose trends, educating health care professionals and the public about prescription drug abuse, and promoting programs shown to prevent such abuse.
The federal government will also require manufacturers of extended-release and long-acting opioids to provide prescribers with educational programs explaining the risks and benefits of opioid therapy, and how to select appropriate candidates for such therapy. Also, as reported by Reuters:⁶

"As part of that campaign, Holder reiterated the Obama administration's call for more law enforcement agencies to train and equip personnel with an overdose-reversal medication called naloxone... Holder said 17 states and the District of Columbia have amended their laws to increase access to naloxone, a blocking agent that can reverse the effects of an overdose and help restore breathing."

Doctors Are the Primary Opium Pushers of the 21st Century

According to a study published in JAMA Internal Medicine,⁷ while most opioid drug abusers obtain the drug from a friend or relative, (23 percent pay for them; 26 percent get them for free), individuals who are at greatest risk for drug abuse are just as likely to get theirs from a doctor's prescription.
Previous drug abuse prevention programs have primarily focused on those who get their hands on opioids without a prescription. You may recall ads from previous years promoting the safe storage and disposal of prescription medication.
But such efforts have completely missed those at greatest risk for a drug overdose, i.e. those who use such drugs per doctor's orders. Twenty-seven percent of the highest-risk users get their drugs from their doctor even when they're using the drug nonmedically for 200 or more days per year... CDC Director Tom Frieden M.D., M.P.H recently echoed the study's authors when he said that:⁸

"Many abusers of opioid pain relievers are going directly to doctors for their drugs. Health care providers need to screen for abuse risk and prescribe judiciously by checking past records in state prescription drug monitoring programs. It's time we stop the source and treat the troubled."

Another JAMA study⁹ notes that, of the drug overdose deaths occurring in Tennessee between 2003 and 2010, more were caused by prescription drugs than heroin and cocaine combined. Incredibly, between 2007 and 2011, one-third of the population of Tennessee filled at least one prescription for an opioid each year... According to the authors:

"High-risk use of prescription opioids is frequent and increasing in Tennessee and is associated with increased overdose mortality. Use of prescription drug–monitoring program data to direct risk-reduction measures to the types of patients overrepresented among overdose deaths might reduce mortality associated with opioid abuse."

Doctors Are Prescribing More Sedatives Than Ever

In related news, preliminary research¹⁰ presented at the 2014 meeting of the American Academy of Pain Medicine in Phoenix, Arizona found that 12.6 percent of all primary care visits made by Americans between 2002 and 2009 involved prescriptions for sedatives and/or narcotic painkillers (opioids). The study also found that:

The number of prescriptions for sedative drugs rose by 12.5 percent a year

Patients receiving a narcotic painkiller were 4.2 times more likely to receive a second prescription for a sedative

The number of joint prescriptions of opioids and sedatives also increased by 12 percent a year in that time frame

Prescription sedatives and narcotic painkillers are responsible for at least 30 percent of narcotic painkiller-related deaths

Besides deaths caused by overdose, other risks associated with sedative use include falls in the elderly, emergency room visits, and drug dependence

According to co-author Dr. Ming-Chih Kao, a clinical assistant professor at Stanford University Medical Center:¹¹"Doctors need to be better educated about the risks of combining the two medications, and there needs to be better coordination between those who prescribe narcotic painkillers (often primary care doctors or pain specialists) and those who prescribe sedatives (often primary care doctors or psychiatrists)."

FDA Clamps Down on Painkiller Prescriptions, But Approves New Pure Hydrocodone Product

The US Food and Drug Administration (FDA) recently recommended tighter controls on painkiller prescriptions,^12, ¹³ and has announced its intention to reclassify hydrocodone-containing painkillers from a Schedule III to a Schedule II drug. The drug schedule system classifies medications based on their potential for abuse and addiction, as well as other medical criteria. The reclassification will affect how hydrocodone-containing drugs can be prescribed and refilled. Doctors will only be allowed to prescribe a 90-day supply of the drug per prescription, and they will no longer be permitted to phone in refills.
Rather, the patient has to bring the prescription with them to the pharmacy. The new regulations are expected to take effect sometime this year. Ironically enough, while talking about the need for stricter controls and less addictive painkillers, it recently approved the first drug containing pure hydrocodone for the US market, called Zohydro ER (Zogenix). All other hydrocodone-containing painkillers on the market are mixed with other non-addictive ingredients.

Prescription Medications Are the New Gateway Drugs

Many are still under the illusion that prescription drugs are somehow safer than street drugs, but it's important to realize that prescription medications like hydrocodone and oxycodone are opioid derivatives—just like heroin. Heroin is actually diacetylmorphine and much stronger than morphine. A perfect example of this nonchalance can be seen in statistics¹⁴ showing that more than 14 percent of pregnant women are prescribed opioid drugs during their pregnancy...
As explained by Dr. Wilson Compton,¹⁵ deputy director of the US National Institute on Drug Abuse, heroin, morphine, hydrocodone, and oxycodone "are all classified as opioids because they exert their effect by attaching to the opioid receptor found in our brain and spinal cord."
They also create a temporary feeling of euphoria, followed by dysphoria, which can easily lead to addiction. Some people end up taking increasingly larger doses in order to regain the euphoric effect, or escape the unhappiness caused by withdrawal. Others find they need to continue taking the drugs not only to reduce withdrawal symptoms but to simply feel normal. Opioids also depress your heart rate and breathing. Large doses can cause sedation and slowed breathing to the point that breathing stops altogether, resulting in death.¹⁶

13 Non-Drug Solutions for Pain Relief

Considering the risks, I strongly recommend exhausting your options before resorting to a narcotic pain reliever. I believe there are better, viable alternatives. If you are suffering from pain, whether acute or chronic, I recommend working with a knowledgeable health care practitioner to determine what's really triggering your pain, and then address the underlying cause.
Remember, along with exposing you to potentially deadly risks, medications only provide symptomatic relief. They do NOT address the underlying cause of your pain. The following options provide excellent pain relief without any of the health hazards that prescription (and even over-the-counter) painkillers carry. So if you're in pain, try these first, before even thinking about prescription painkillers of any kind.

Eliminate or radically reduce processed foods, grains, and processed sugars from your diet. Avoiding grains and processed sugars will lower your insulin and leptin levels and decrease insulin and leptin resistance, which is one of the most important reasons why inflammatory prostaglandins are produced. That is why stopping sugar and sweets is so important to controlling your pain and other types of chronic illnesses.

Optimize your production of vitamin D by getting regular, appropriate sun or safe tanning bed exposure, which will work through a variety of different mechanisms to reduce your pain.

Emotional Freedom Technique (EFT) is a drug-free approach for pain management of all kinds. EFT borrows from the principles of acupuncture, in that it helps you balance out your subtle energy system. It helps resolve underlying, often subconscious, negative emotions that may be exacerbating your physical pain. By stimulating (tapping) well-established acupuncture points with your fingertips, you rebalance your energy system, which tends to dissipate pain.

Astaxanthin is one of the most effective fat-soluble antioxidants known. It has very potent anti-inflammatory properties and in many cases works far more effectively than anti-inflammatory drugs. Higher doses are typically required and one may need 8 mg or more per day to achieve this benefit.

Ginger: This herb has potent anti-inflammatory activity and offers pain relief and stomach-settling properties. Fresh ginger works well steeped in boiling water as a tea or grated into vegetable juice.

Curcumin: In a study of osteoarthritis patients, those who added 200 mg of curcumin a day to their treatment plan had reduced pain and increased mobility.¹⁷ A past study also found that a turmeric extract composed of curcuminoids blocked inflammatory pathways, effectively preventing the overproduction of a protein that triggers swelling and pain.¹⁸

Boswellia: Also known as boswellin or "Indian frankincense," this herb contains specific active anti-inflammatory ingredients. This is one of my personal favorites as I have seen it work well with many rheumatoid arthritis patients.

Bromelain: This enzyme, found in pineapples, is a natural anti-inflammatory. It can be taken in supplement form but eating fresh pineapple, including some of the bromelain-rich stem, may also be helpful.

Cetyl myristoleate (CMO): This oil, found in fish and dairy butter, acts as a "joint lubricant" and an anti-inflammatory. I have used this for myself to relieve ganglion cysts and a mild annoying carpal tunnel syndrome that pops up when I type too much on non-ergonomic keyboards. I used a topical preparation for this.

Evening Primrose, black currant, and borage oils: These contain the essential fatty acid gamma linolenic acid (GLA), which is useful for treating arthritic pain.

Cayenne cream: Also called capsaicin cream, this spice comes from dried hot peppers. It alleviates pain by depleting the body's supply of substance P, a chemical component of nerve cells that transmits pain signals to your brain.

Methods such as yoga, Foundation Training, acupuncture, meditation,¹⁹ hot and cold packs, and other mind-body techniques can also result in astonishing pain relief without any drugs.