Narcotic painkillers are prescription drugs that are very effective at relieving pain but that come with a very dangerous potential side effect: dependence. The overprescribing of these painkillers led to an epidemic of addiction and accidental overdose deaths. As doctors began to reign in the number of prescriptions, those already addicted began turning to heroin, the illegal drug that is related to the opioid painkillers.

Policy makers, law enforcement, doctors, first responders, and even family members of those addicted are now fighting just to keep people alive. Heroin use and addiction are on the rise, and so is death from overdose. Addiction is a difficult illness to overcome, but treatments, including those that use medications, are available and can provide the support an addict needs to stop using.

The Facts about Painkillers,  Addiction, and Heroin

Narcotic, opioid painkillers, which include drugs like oxycodone, morphine, and hydrocodone, were increasingly prescribed over the last couple of decades, and this may have been a big contributing factor in the epidemic now seen in painkiller and even heroin addiction. The total number of prescriptions for these painkillers rose steadily every year from 1991 and only started to go down again in 2013, by which time the epidemic of addiction had been recognized and there were calls to do something about it.

Abusing painkillers and heroin is very serious. Not only does this lead to addiction, these drugs are also very easy to overdose on and they kill thousands of people every year. According to the National Institute on Drug Abuse, the number of overdose deaths from all opioid drugs rose every year from 2002 to 2015. In 2015 nearly 35,000 people died from an overdose of opioid painkillers or heroin.

What Are Opioids?

The root of the whole problem is a popular flower. The opium poppy is the origin of all opioid drugs, which includes prescription narcotic painkillers and heroin. Opium is the latex that comes from the seed pod of the poppy and it has long been used as both a medicine and a psychoactive drug. Three natural substances are found in opium and that have medicinal and psychoactive properties: morphine, codeine, and thebaine. These are opiates and all other opioid compounds are derived from them and made synthetically in laboratories.

Synthetic opioids include heroin, which at one time was used as a medicine for pain and as a cough suppressant, and narcotic prescription painkillers. The latter include oxycodone (OxyContin), hydrocodone (Vicodin), hydromorphone (Dilaudid), meperidine (Demerol), and fentanyl. All of these drugs are susceptible to abuse and can cause dependence. They act in the brain to block pain signals, but also to produce a euphoric effect. When someone misuses these prescriptions, such as by taking more than is prescribed, they increase the risk of getting addicted.

The OxyContin Epidemic

An early manifestation of the opioid abuse, addiction, and overdose problem occurred largely in rural regions of Kentucky and other parts of Appalachia. OxyContin, a brand name for oxycodone, was introduced by manufacturer Purdue Pharma in 1996 and pushed hard to sell it to doctors. The company sold it as a less-addictive alternative to other painkillers because it was made in a time-release form, meaning users would get a slow onset of the drug, not a hit all at once which is more likely to lead to abuse.

The big sales pitch led to a spike in prescriptions for OxyContin, many for things that didn’t really require such a strong painkiller. People who began abusing the drug quickly discovered that the time-release component could be destroyed by crushing the pills. This allowed abusers to snort or inject a huge dose of oxycodone all at once to get a high that was similar to that provided by heroin. This practice really took off in parts of Kentucky, Ohio, and West Virginia, earning OxyContin the nickname, “hillbilly heroin.”

It also caused a huge increase in addiction and overdose deaths in this region and the repercussions are still being felt today. In 2007 Purdue Pharma pled guilty in a lawsuit brought against the company by the Department of Justice. The charge was misleading doctors and consumers about how addictive OxyContin was. Purdue ended up paying over $600 million and three executives pled guilty to criminal charges.

From Prescriptions to Heroin

OxyContin and other prescription opioids caused huge amounts of abuse, addiction, and overdoses, and when doctors pulled back on prescriptions, a new epidemic began to arise. In 2015 heroin overdose deaths in the U.S. surpassed the number of deaths by gun homicide for the first time ever. In addiction treatment facilities around the country, heroin addiction is becoming the most common reason to enter treatment, surpassing even alcohol addiction.

In combatting the prescription painkiller addiction epidemic, public officials may have unwittingly contributed the heroin epidemic. As getting prescription opioids became more difficult, and more expensive, addicts turned to a cheaper, but similar high: heroin. Mexican drug cartels were more than willing to supply the demand and much of the cheap heroin in use in the country now comes through Mexico.

Overdose and Treatment

One of the biggest problems with both painkiller and heroin addiction is overdosing. Overdosing on these substances is easy to do accidentally, even for experienced drug users. Opioids act in parts of the brain related to breathing and can depress respiration even in small amounts. Too much of an opioid drug can completely stop a person’s breathing and lead to death. Signs of an opioid overdose include slowed breathing, pinpoint pupils, and loss of consciousness. The risks are increased when these drugs are combined with other depressants, like alcohol or sedatives.

Because of the overdose epidemic, many first responders and even loved ones of addicts are being equipped with a drug that can reverse an opioid overdose. It works for overdoses caused by painkillers and heroin and is called naloxone (Narcan). It is available as an injection and more recently a nasal spray that is easier for a responder or loved one to administer to save someone’s life. Naloxone is an opioid antagonist, which means that it reverses the action of the drug. It is literally lifesaving. It can cause some side effects, but the risks are worth the life-saving effect. Some of the most dangerous risks of naloxone are triggering opioid withdrawal or causing hallucinations or loss of consciousness. These should be treated as a medical emergency.

Addiction Treatment

Preventing abuse of opioids is important in slowing and halting the epidemic, but for some people it is too late and addiction is a reality. For these people, treatment is essential. Stopping use of opioids without support is nearly impossible. The first hurdle is detox and withdrawal, which can be painful and even dangerous and should not be done unsupervised.

People undergoing opioid addiction treatment often choose residential treatment because the temptation and cravings to use again are strong. Being in a residential facility can provide therapy, support, and even medical treatment in a safe environment. Unlike some types of addiction, too often opioid addiction is too extreme to treat with therapy alone. Many people need to turn to medications.

Medications for Treating Opioid Addiction

There are several medications that are used to effectively treat heroin and painkiller addiction. Methadone, for instance, has been used for many years to treat heroin addicts. It acts as a replacement for heroin, reducing withdrawal symptoms and reducing the cravings that lead so many to use again. A criticism of methadone is that it is simply substituting one opioid for another. Although much less so, methadone is actually addictive too.

Other, more recent drugs used to treat opioid addiction are buprenorphine and naltrexone. Buprenorphine is used in a way similar to methadone. It is an opioid, but it is not addictive. It does not produce the euphoric feeling that drug abusers seek, but it does reduce withdrawal and is difficult to overdose on. Buprenorphine may also be combined with naltrexone in a drug called Suboxone.

Naltrexone is an opioid antagonist, so it blocks the action of opioid drugs. If an addict is taking it and uses heroin or another opioid, he or she will not get the desired effect. In other words naltrexone makes using the drug pointless. This only works, though, if the addict actually takes naltrexone as prescribed. A patient could simply stop using it to get a high from heroin. To combat this, a new form  was developed called Vivitrol. This form is injected and its effects last for a month.

There are risks and side effects to these drugs, but most doctors and their addiction patients agree that they are worth the potential benefits of successfully quitting heroin and opioids. One risk, as an example, is that naltrexone in large doses can cause serious liver damage. Naltrexone and buprenorphine can also cause side effects like nausea, vomiting, headaches, diarrhea, constipation, and sleep difficulties.

Heroin and opioid painkiller addiction is a serious medical and social problem. Thousands of people are dying every year because of the dependence these drugs cause. Treatments are available, even medications that can help, but for people addicted to these drugs, treatment is a long, hard road.