eaths from heroin overdoses doubled
in much of the country between 2010
and 2012, according to a 2014 report
from the U.S. Centers for Disease Control and Prevention.
And while deaths from overdoses of Vicodin, OxyContin
and other prescription opioids declined over the same period,
deaths from legal painkillers are still almost three times more
common than deaths from heroin.
These statistics reflect an increasingly common scenario,
says psychologist Jennifer Sharpe Potter, PhD, a substance abuse
researcher at the University of Texas Health Science Center in
San Antonio. With prescription opioids now harder to get, she
says, users are switching to heroin for an easier-to-get high.
“It just makes sense, both in terms of the availability of
heroin, the price of heroin and the ratcheting up of regulatory
controls of prescription opioids,” says Potter, the assistant dean
for research and student programs. “It’s a natural progression.”
Recent regulations, for example, have made it harder for
physicians to prescribe opioids and for patients to “doctor
shop,” or seek prescriptions from multiple providers. The
manufacturer of OxyContin reformulated the drug to make it
harder to inject or snort. Plus, heroin is much less expensive
than prescription drugs. A fix of street heroin costs about
$10, The Washington Post estimated in a 2014 article, while an
equivalent dose of OxyContin sold on the street costs eight
The result of these and other changes has been a shift in
who is using heroin, according to new research by Theodore
J. Cicero, PhD, of the University of Washington School of
Medicine and colleagues (JAMA Psychiatry, 2014).
While the heroin users of the past were typically young,
low-income, racial and ethnic minorities from urban areas,
that’s no longer true. Today’s heroin users are increasingly older
whites from more affluent suburbs and rural areas, according
to Cicero’s analysis of data from an ongoing study of patients
in substance abuse treatment programs. In contrast to past
users, who started out with heroin, three-quarters of the current
patients got their first introduction to opioids via prescription
Treatment is changing, too. While the gold standard for
opioid addiction is still medication, says Potter, psychologists
are researching how to help patients with heroin and
prescription drug addiction. They’re investigating whether
adding counseling enhances outcomes for patients on
medication-based treatment. They’re also exploring new ways
of getting treatment to patients, whether in primary-care
settings or via computer.
Supplementing pharmacological therapy
Pharmacological treatment, such as methadone and
buprenorphine, is the basis of most opioid addiction treatment.
Can adding psychological interventions increase the chances of
“The jury’s still out on that,” says Potter.
Treatment programs typically include a behavioral
component, she explains. In fact, federal law requires providers
who prescribe buprenorphine on an outpatient basis to
provide some kind of wraparound or behavioral treatment,
such as training in life management skills, symptom reduction
and other recovery-oriented topics. And the highly regulated
dispensing of methadone, whether at a clinic or in take-home
dosing, requires intensive case management.
But the evidence from clinical trials on whether that
behavioral therapy enhances the pharmacological treatment for
opioid addiction treatment remains murky, says Potter.
In a randomized clinical trial of 653 outpatients dependent
By Rebecca A. Clay
on prescription opioids, for example, Potter and her co-authors
found that individual drug counseling offered no additional
exploring what kind of treatment works best.