Drug overdose deaths involving prescription opioid pain relievers have increased dramatically since 1999. Concerted federal and state efforts have been made to curb this epidemic. In 2011, the White House released an interagency strategy for Responding to America’s Prescription Drug Crisis. Enacting this strategy, federal agencies have worked with states to educate providers, pharmacists, patients, parents, and youth about the dangers of prescription drug abuse and the need for proper prescribing, dispensing, use, and disposal; to implement effective prescription drug monitoring programs; to facilitate proper medication disposal through prescription take-back initiatives; and to support aggressive enforcement to address doctor shopping and pill mills and support development of abuse-resistance formulations for opioid pain relievers.
Improvements have been seen in some regions of the country in the form of decreasing availability of prescription opioid drugs and a decline in overdose deaths in states with the most aggressive policies.1 The rate of heroin-involved overdose deaths increased from 0.8 deaths per 100,000 people in 2007 to 4.9 in 2016. Since then, the mortality rate has steadily declined to 4.1 deaths per 100,000 people—an estimated 13,200 heroin-involved overdose deaths in 2020.2
In an effort to combat the intertwined problems of prescription opioid misuse and heroin use, in March of 2015 the Secretary of Health and Human Services announced the Secretary’s Opioid Initiative, which aims to reduce addiction and mortality related to opioid drug abuse by:3
- reforming opioid prescribing practices
- expanding access to the overdose-reversal drug naloxone
- expanding access to medication-assisted treatment for opioid use disorder
The relationship between prescription opioid abuse and increases in heroin use in the United States is under scrutiny. These substances are all part of the same opioid drug category and overlap in important ways. Currently available research demonstrates:
- Prescription opioid use is a risk factor for heroin use.
- Heroin use is rare in prescription drug users.
- Prescription opioids and heroin have similar effects, different risk factors.
- A subset of people who abuse prescription opioids may progress to heroin use.
- Increased drug availability is associated with increased use and overdose.
- Heroin use is driven by its low cost and high availability.
- Emphasis is needed on both prevention and treatment.
- Johnson H, Paulozzi L, Porucznik C, Mack K, Herter B. Decline in drug overdose deaths after state policy changes – Florida, 2010-2012. Morbidity and Mortality Weekly Report (MMWR). Atlanta, GA: Centers for Disease Control and Prevention; 2014.
- CDC WONDER. Multiple Cause of Death 1999-2020. Centers for Disease Control and Prevention, National Center on Health Statistics. Released December 2021. Accessed January 2022.
- HHS takes strong steps to address opioid-drug related overdose, death and dependence [news release]. Washington, DC: U.S. Dept. of Health and Human Services; March 26, 2015. http://www.hhs.gov/news/press/2015pres/03/20150326a.html. Accessed October 8, 2015.