A review published last week in New England Journal of Medicine concludes that although nonmedical use of prescription opioids is a major risk factor for heroin use, the emergence of efforts to impact opioid prescribing may not be to blame. In their concluding remarks, coauthors Wilson Compton, MD, MPE, Christopher Jones, PharmD, MPH, and Grant Baldwin, PhD, MPH, write, “Although some authors (of other studies) suggest that there is an association between policy-driven reductions in the availability of prescription opioids and increases in the rates of heroin use, the timing of these shifts, many of which began before policies were robustly implemented, makes a causal link unlikely.” An alternative explanation for recent increases in heroin use may be heroin market forces that include reduced price, increased availability, and higher purity.
According to the authors, these findings imply support for current initiatives aimed at addressing the combined and interrelated opioid epidemics, while recognizing the need to maintain access to prescription opioids when indicated for legitimate indications, including chronic pain. Commenting on the conclusions, Paul Gileno, founder and president of the US Pain Foundation, said, “This is positive news for people with chronic pain who use their medication responsibly…the discussion about addiction is extremely important and needed but equally important is the discussion of how we can best treat the person with pain.”
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Read more about the review and conclusions here.
The journal article may be read here.