Heroin Epidemic versus Pain Pill Addiction Epidemic

aaaaaaaaaaaaaaaaaagraph of heroin deaths

I’m surprised at all the coverage heroin addiction has received in the past few months. Breathless headlines are appearing in all forms of media about our “new” addiction problem. Friends send me links to articles about addiction since they know that’s the field I work in. I’m as surprised to see all the media coverage now as I used to be puzzled about the lack of coverage five years ago. I’ve been treating opioid addiction for the last fourteen years, and the opioid addiction epidemic isn’t new. It’s been very well established for years.

Perhaps the idea of using heroin jolts people more than the idea of using prescription opioids. Maybe people don’t understand that prescription opioid addiction has the same physiologic process as heroin addiction. Manufactured pain pills have less variation in content than balloons of black tar heroin, so there may be less risk of overdose. However, the body responds the same to both types of opioids. The body develops addiction and physical dependency in the same way to both heroin and prescription opioids, and withdrawal symptoms and cravings are the same. Both overdose and death happens with both types of opioids.

Perhaps heroin is perceived as the hardest of hard drugs, and therefore data about heroin addiction captures more attention than pain pill use. Maybe the use of heroin crosses a line that’s not perceived by prescription opioid addiction.

Can it be that there are still people who believe if it is a prescription medication, that it’s safe? Or is it just easier to justify the misuse of a pain pill? Communities with years of rampant pain pill addiction are only now wringing their hands because of heroin addiction. These communities are now demanding action from our government.

I’m glad for the attention to the problem of opioid addiction because I’ve seen way too much complacency about this issue for way too long.

I’m also irritated.

In 2009, I wrote a book about pain pill addiction. I was extremely lucky to get an agent, and she shopped my book to four or five mid-level publishing houses. They weren’t interested because they felt the book didn’t have a broad enough appeal. I ended up self-publishing, and sold around 500-600 copies. That’s not too bad for a self-published book, but distribution could have been much broader through a publishing house. Having my book turned down by publishers with an utter lack of interest in the subject matter undoubtedly causes some of my irritation.

I went to the ASAM conference where the head of the CDC pledged to get involved in the treatment and prevention of opioid addiction. Don’t get me wrong; that’s a wonderful thing to hear. The problem is, that was in 2012.

For all who’ve just joined the movement to help opioid addicted people get help, welcome. I’m glad you’re here, and we can use your help. And forgive me for wishing you had been interested in this problem ten years ago.

6 responses to this post.

  1. Keep writing. Your message will get to the right people. I think that the heroin epidemic has surged because of the increase in the prescription monitoring programs in more states over the past few years, which reduces the availability of pain meds and in turn those addicted who don’t want to get into treatment turn to the cheaper alternative, heroin. The publicity is good but the public attention and government dollars need to be focused on expanding treatment access. Instead of focusing on law enforcement and naloxone for overdose the support needs to go to treatment. If you arrest a drug dealer another will step up to take his place. If you treat patients you decrease the number of customers. The folks in the Gloucester, Mass. police dept. have the right idea. If you don’t know the story, although I suspect you do, here’s the link: http://www.npr.org/2015/06/04/412046914/gloucester-mass-police-program-provides-treatment-for-drug-users Have a great Labor Day!


  2. Posted by Alan Wartenberg MD on September 6, 2015 at 8:11 pm

    It is my belief, on the basis of treating literally thousands (over ten thousand, actually) of people with opioid dependency, starting about 1981 (and this was 5 years after my being one of those people during med school and internship), that the true culprit is underlying, undertreated or untreated trauma history, usually sexual, but also often physical/emotional (or all 3), which gets “treated” while under the influence of the opioid. Problem is, tolerance is a bitch for that psychoactive effect, and the dose goes up and up and up, and with it the additional trauma related to be a drug addict and it becomes a merry-go-round, but for all too long, it feels just too good to jump off, until the point where it feels so BAD to jump off that you are afraid it will kill you.

    It is the failure of physicians to take trauma histories, and to treat those people (as well as young male smokers, people with histories of other drug/alcohol use, people with other psychiatric disorders) that results in failing to recognize the underlying risk, and to realize what is actually being treated (instead of or in addition to physical “pain”) that is the real cause of this epidemic. We have a lot more trauma, in part because of ever-increasing income disparity and people growing up in families that cannot find their way, combined with the “fortuitious” Russell Portnoy-propelled “the dose is just a number, we undertreat pain” drumbeat of the 90s and beyond.

    The answer lies in better parenting, better social support systems, early recognition and more care in the treatment of people with underlying risks, using opioids only as last resort and then WATCHING LIKE A HAWK. It especially involves not responding to rapid changes of tolerance and ever-increasing doses while the pain score is always 12/10, and recognizing that this was a FAILED effort at opioid treatment, and that the TREATMENT, not the PATIENT, needs to be “fired.” (a la Trump lol)


  3. Posted by Jimmy Cioe on September 7, 2015 at 11:44 am

    “Everything Old is New Again”

    one article down



  4. Posted by trying2liveat55 on September 7, 2015 at 6:40 pm

    Dr.Burson, thank you for all of you’re post’s, I read you’re blog daily. I live in Arizona& in a little community in northeastern Arizona. I’m a 36 year MMTP. My husband isn’t depend upon opiates. He doesn’t do any drugs but cigarettes& coke a cola.
    I just turned 60 in February& only go to my clinic every 28 to 30 day’s. My husband finally after 36 year’s went into the clinic with me on the 2nd& spoke to my nurse whom is also a counselor.
    He doesn’t understand addiction, although, I’m thinking maybe now he does.
    After I was born, I was born with a club foot
    I was given paregoric..by the quarts according to my late adoptive parents.
    My foot has always hurt me. They did what they could back in 1955. It wasn’t much the Dr’s knew back then about a club foot. I learned to walk at 9 month’s.
    To this day my foot hurts me. I do not get high off my dose. It’s the opposite, I never sleep anymore. I wake up every 2 hour’s to urinste. Enough of my crap. Thank you for your blog. Dr.watenberg, I haven’t yet read the comments. Thanks for you’re blog. You rock
    God Bless you
    Maureen J.Begleyi


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