1. Exploring the Relationship Between Prescription Opioid Use and Heroin Use
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Kristen Beyea Morse, GRC MSW Candidate
The Greater Rochester Collaborative Master Of Social Work Program
Abstract
The use of prescription opioids has increased dramatically in the United States within the past two decades. Opioid use disorders have touched too many of our communities, devastated families, overexerted law enforcement and our health care systems. This epidemic has killed over 200,000 Americans and as a result the United States Department of Health declared this epidemic a public health emergency in  This paper will examine if there is a relationship between the overprescribing of opioid pain relievers and the increased use of heroin. In order to create more effective policies and treatment programs it is essential to understand the relationship between opioid pain relievers and increased use of heroin use.
Scope of the Problem
Prevention Initiatives
The number of heroin users in the United States has nearly doubled between 2005 and 2012 (National Instituted on Drug Abuse, 2014).
Around 1999 pain became known as the fifth vital sign. This is when the zero to ten pain chart was created (Juurlink, Nelson & Perrone, 2015).
From roughly 190,000 people have died in United States from prescription opioids (Kolodny et al., 2015).
In 2012, there were 259 million opioid prescriptions written which equaled the adult population in the U. S. (Back, Brady & McCauley, 2016).
From 2002 to 2011, heroin use was the highest in males aged eighteen t twenty five years old (Paulozzi et al., 2015).
Prescription drug monitoring programs and bystander administration of naloxone are both secondary preventative efforts (Juurlink, Nelson & Perrone, 2015).
The Center for Disease and Control and Prevention recently granted 16 states a total of $20 million to study prevention strategies in hope of fostering new safe prescribing practices (Juurlink, Nelson & Perrone, 2015).
Results
Prescribing of opioid analgesics, primarily for pain appears to be a main factor in the majority of nonmedical use (Juurlink, Nelson & Perrone, 2015).
Overprescribing still continues despite the ongoing epidemic.
Many users shifted to using heroin from nonmedical use of prescription opioids (Juurlink, Nelson & Perrone, 2015).
Users primarily switch to using heroin when they cannot access prescription opioids, and heroin is cheaper (Juurlink, Nelson & Perrone, 2015).
Theory
The cognitive deficits model is a genetic theory which explains that individuals who develop an addictive disorder have abnormalities in an area of their brain called the prefrontal cortex (Kosten & George, 2002).
This supports the idea that opioid use disorder is a chronic illness that needs to be addressed like other chronic illnesses.
One of the brain’s circuits that is activated by opioids is the mesolimbic reward system (Kosten & George, 2002).
Tolerance occurs when the brain cells that have the opioid receptors on them become less responsive of the opiates (Kosten &George, 2002).
Medication Assisted Treatment
Buprenorphine, methadone and naltrexone are the 3 main FDA approved medications for the treatment of opioid use disorders
Medication in combination with counseling is recommended
MAT is proved to decrease opioid use, the spread of infectious diseases, and opioid overdose deaths
MAT improves social functioning and an individuals retention in therapy