Fewer Americans died from prescription painkiller overdoses in 2012 than the year before, the first such decline in more than a decade, according to fresh data from the Centers for Disease Control and Prevention. At the same time, deaths from heroin nearly doubled from 2010 to 2012.
The CDC report presents a tally of national mortality files and doesn’t draw any conclusions about the relationship between heroin and opioid painkillers. Other research suggests that the recent surge in heroin use is connected to a wave of painkiller abuse that began sweeping the U.S. in the mid-1990s. Four out of five new heroin users reported past prescription painkiller abuse in an analysis last year (PDF) of nationally representative drug use surveys issued from 2002 to 2011. While it’s true that most new heroin users have abused pain pills, most people who abuse opioids don’t move on to heroin.
The raw numbers are important to keep in mind. Prescription opioid deaths have roughly doubled in a decade, to 16,000 in 2012. That’s far more than the number of heroin deaths, which reached 6,000 in 2012, although the numbers for heroin fatality doubled in just two years. (Because of the way overdose deaths are recorded, some may have involved both opioids and heroin, plus other substances.)
Several events might explain why prescription painkiller deaths dropped while heroin deaths climbed. In 2010 the old formula for OxyContin, a widely abused opioid, was taken off the market and replaced with pills that are harder to crush and then snort or inject to get high. Earlier CDC research suggested that raids on pill mills in Florida and further tough enforcement in 2010 and 2011 helped push down the opioid overdose rate in that state. The crackdown closed 250 pain clinics and eliminated 98 “high volume” prescribers in the state. Market forces may push some addicts away from pills toward heroin as well because it is often much cheaper to buy the illicit drug than to buy prescription medications on the street.
“At the national level like this, it’s hard to know what’s influencing any change in the rate,” says Holly Hedegaard, an injury epidemiologist at the CDC’s National Center for Health Statistics, who co-wrote the report. The one-year decline in opioid deaths may be the beginning of a trend, but it’s too soon to say for sure, Hedegaard says. “You really need three or four points to say: Here’s where the trend is going.”
The CDC’s new data confirm earlier tallies from 28 states that showed slowing opioid deaths and rising heroin fatalities in 2012. A push to make doctors more cautious in giving patients potentially addictive drugs has helped reduce prescription rates, which have historically varied widely by state. “There’s been some data that the actual prescribing of opioids has gone down as well. It’s not just the overdoses, it’s prescribing,” says Cindy Reilly, director of the prescription drug abuse project at the Pew Charitable Trusts.
While a link between painkillers and heroin is troubling, making sure medications aren’t improperly prescribed in the first place will help prevent addiction that leads people to turn to illicit drugs, Reilly says. “If you can stop that initial exposure … you can stop individuals from progressing down that path,” she says.