Pain pill addicts use heroin when money gets tight, drug study says

The over prescription of opioid medications — like OxyContin, Vicodin, Percocet and methadone — is not only leading to increased overdose rates on those drugs, but may be leading to an increase in heroin use, according to a annual statewide study of drug trends.
The Ohio Substance Abuse Monitoring Network’s annual report, which compiles information from eight regions in the state, shows that heroin use has increased in the past six months in Dayton and statewide. The report attributes the spike in part to the wide availability of opioid prescriptions, which often lead to addiction and then heroin use when pills become too expensive.
The report, distributed by the Ohio Department of Drug and Alcohol Addiction Services, covers June 2010 through January 2011. The findings are based on interviews with treatment providers, active and recovering drug users, and law enforcement officials as well as crime lab data and coroners’ reports.
Robert Masone, a pain specialist and president of the Ohio Society of Interventional Pain Physicians, said because two or three OxyContin 80 milligram pills can cost up to $200, many addicts are forced to seek other alternatives when money is scarce.
“When they can get that money, that’s what they prefer. When they can’t there’s always a heroin pusher out there offering them a single dose of heroin,” Masone said.
Vie Ross, an outpatient counselor at Project Cure, a methadone clinic in Dayton, said once someone tells pain pill addicts they can get a similar high for a much lower cost with heroin, many switch drugs.
“Nobody ever sets out to be an addict,” said Dwight Richard, clinical director of Project Cure. Both Richard and Masone said most heroin users don’t want to use illegal drugs and aren’t even getting high. They are trying to avoid a painful withdrawal.
“The minute they experience it once, they’ll do anything they can to avoid it again,” Masone said.
Rogue doctors operating faux pain clinics are fueling the problem, he said.
Doctors running so-called “pain clinics” can write several pain prescriptions during a $100 visit. “If (the patient) can sell half those pills they’ll make a couple hundred dollars,” Masone said.
“Pain prescriptions, between 1994 and now have increased 900 percent,” Richard said. “(Opioids) are more widely and freely prescribed.”
Recognizing the problem, the medical board has tried to crack down on rogue doctors, but many move before a case can be made. Ohio doctors and pharmacies also have been encouraged to make use of the Ohio Automated Rx Reporting System (OARRS) deveoped in 2006 to track those trying to doctor shop. But Masone said since the system is voluntary, only about 17 percent of doctors and 23 percent of pharmacists enter information, creating loopholes for abuse.
Users, health care professionals and law enforcement interviewed for the OSAMN report also suggest that the recent increase in heroin use in the region could be attributed to the reformulation of OxyContin.
On Aug. 9, 2010, manufacturer Purdue Pharma discontinued the manufacture and distribution of the original OxyContin. The new formula breaks down to a gel instead of a powder when crushed.
The change was meant to make the tablets more difficult to manipulate and abuse as it is difficult to snort or inject the gel.
Abusers have found ways around the new deterrents, however, including freezing the gel and then chopping it or loosening the protective coating with water.
Meanwhile the scarcity of the older tablets has made them much more valuable. According to the OSAMN report the street value has more than doubled for the original OxyContin 50 cents to $1 per milligram to as much as $2 per milligram. Richard said it makes sense that many OxyContin users would switch to buying much cheaper heroin after the reformulation.
Increased heroin use also can be attributed to increased availability. With gel caps of powdered heroin, most commonly white or brown powder, available for as little as $7 a piece or three for $20 in Dayton, one participant in the OSAMN study called heroin easier to get than marijuana, widely regarded as the most prevalent drug in the state.
Another study participant said heroin was easier to get than beer and users described driving down some streets in Dayton where free samples are tossed into car windows.
Project Cure is searching for a new location for their clinic because the neighborhood surrounding their current location at 1800 N. James H. McGee Blvd. is such a hotbed of drug activity. Their patients often encounter heroin dealers at the bus stop just steps from the treatment center’s door.
Lt. Brian Johns, head of the narcotics unit for the Dayton Police Department, said Dayton has become a destination for heroin, with people traveling long distances to buy it cheap.
“They can drive from their hometown, take it home and use it or resell it and make two or three times the money,” Johns said.
Ross attributed the low price point to the fact that there is very little pure heroin in many of the batches found in Dayton. “They are cutting with anything,” she said, citing one recent case where a woman was hospitalized after injecting heroin cut with drywall powder.