In earlier posts, I provided background for a problem that has captured headlines in recent years, namely the problem of addiction to opioid pain medication. My reason for providing background was to make clear that addiction to opioids is not a problem confined to high school kids or back-alley junkies, but rather cuts across all age groups and socio-economic divisions.

Moreover, the problem of prescription drug addiction blurs the dividing line between illicit use of substances and the appropriate use of medication; appropriate use that can become problematic over time. And while there are people, policies, or companies that can be blamed for some of the increase in opioid dependence, a number of cases arise from reasonable efforts by doctors or patients to relieve pain and suffering.

Poppies in Afghanistan

There are also, of course, many cases of opioid addiction arising from experimentation with prescription medication, particular among the high school-aged population.  Teenagers trade medications including clonazepam (Klonopin), oxycodone (Percocet), alprazolam (Xanax), and amphetamines, sometimes with disastrous results.

Studies suggest that young people often get these substances from friends, who originally gain access to the medications by taking them from a parent’s supply. ‘Pharm parties’ are likely part reality and part urban myth, and are rumored to involve random ingestion of medications collected from family medicine cabinets. In recent weeks the DEA has announced programs across the country to collect unused medications gathering dust in household cupboard. I encourage readers to watch for such collections in their local areas.

There is a tendency among people with substance addictions to consider one’s own problems less severe than the problems of other addicted people, taking comfort in thinking “At least I’m not like that!”

Some people tell themselves that things aren’t so bad, since they only take medications prescribed by their doctor– or maybe by several doctors who are not aware of each other. Some people reassure themselves that they aren’t as bad as those who take ‘street drugs,’ figuring that while they obtain medications illicitly, at least they don’t take substances that are not manufactured by pharmaceutical companies. Still others rationalize that using nasal Heroin is less of a problem than using intravenous Heroin.

In reality the dividing line between these different patterns of use is illusory, based more on cultural stigma than on the severity of a person’s addiction. It is true that there is a general progression of specific substance and route of administration over the course of one’s addiction. A person who becomes addicted to pain pills prescribed by a physician will move to illicit sources when use spirals out of control, and physicians ‘wise up’ to the problem.

As addiction becomes more severe there is also a tendency to seek more rapid and efficient means of taking the substance. A person who is sick from withdrawal wants to be free of withdrawal as quickly as possible. And if that person is having trouble making a supply of medication last between prescriptions or pay periods, there is motivation to take the medication efficiently, so that a given amount lasts for a longer period of time.  And desperate to avoid withdrawal, who are short on cash, eventually lean that swallowing tablets is less efficient than sniffing or injecting them.

There are differences in patterns of opioid use for different cultural and socioeconomic groups. Several months ago the Milwaukee Journal Sentinel reported data from the Milwaukee County coroner’s office that showed a predominance of deaths related to heroin in the city of Milwaukee, compared to deaths from oxycodone in the suburbs. But oxycodone and heroin target the same receptors in the brain, produce the same sequence of behaviors, and cause the same constellation of consequences.

In fact, ‘Heroin’ is the trade name for a pain-relieving molecule with the chemical name diacetylmorphine; a pain medication legally prescribed in Great Britain. The molecule is exactly the same, whether produced in sterile pharmaceutical plants or crudely manufactured from the sap of poppies in Afghanistan.

To the uninitiated, it probably seems unreasonable to discuss oxycodone and Heroin in the same sentence.  But to people who have become addicted to opioids, difference between opioid substances become irrelevant at some point.  A person who is sick with oxycodone withdrawal may avoid Heroin for some period of time, trying to preserve the sense of being a bit better than THOSE people.  But withdrawal causes a frantic obsession that eventually makes the distinction a moot issue.

Meanwhile, Heroin has become potent and inexpensive in some parts of the country, the result of political forces tens of thousands of miles away—but resulting in a deadly epidemic in neighborhoods across the US.