In February 2015, our own Dr. Steven Moskowitz posted a blog on “Heroin: The Other Opioid.” Since then, the problem of heroin has become even more entangled with prescription opioid misuse and the epidemic still rages. Let’s take a look at the current state of prescription opioid use and misuse in medical treatment, and how the risk of heroin use plays a part in car planning for injured workers.

Who Uses Heroin?

In the late 1800s and early 1900s, heroin was actually marketed as a “less addictive” opioid to help stave off an epidemic of morphine and opium addiction. Even today, many heroin users don’t fit the cliché of a seedy street “druggie” – they’re moms, dads, and everyday members of our communities. As more people are introduced to prescription opioids, the risk of heroin use rises. For when the prescription is gone and the pain remains, some people will turn to illicit heroin use. On the other side of the coin, people with prior heroin addiction are seeking diverted prescription opioids in place of street heroin.

Heroin use and prescription opioid use can’t be separated into separate boxes – these are complex, interrelated conditions that must be addressed in unison to make a difference in society. An article published in the March 2015 issue of the Annual Review of Public Health indicates that “According to the federal government’s National Survey on Drug Use and Health (NSDUH), 4 out of 5 current heroin users report that their opioid use began with OPRs [(opioid pain relievers)]. Most of those users who switched from opioids to heroin stated they did so because prescription opioids ‘were far more expensive and harder to obtain.’”

Statistics from the Opioid Epidemic

According to a January 2016 article on opioid addiction in the CDC’s Morbidity and Mortality Weekly Report, the rate of deaths from opioid-related drug overdose has increased over 200% since the year 2000 – far above the average increase of overdose deaths across all drugs of 137%. The rate of opioid-related deaths has tripled since 2000, and there has been a sharp increase in deaths involving synthetic opioids instead of methadone since 2014. In that year, there were one and a half times as many deaths related to drug overdoses in the U.S. as there were deaths associated with motor vehicle crashes.

According to the National Institute on Drug Abuse, 1 in 15 prescription opioid users will try heroin within a decade. The alarming increase in opioid overuse and misuse has led to action at the highest levels of U.S. government. This March, the White House got involved, releasing a new federal plan to address the opioid and heroin epidemic in this country. In this environment, it has never been more important to walk a fine line, protecting our injured workers from the dangers of addiction while providing the most up-to-date treatment options available.

Injured Workers and Opioids

Some injured workers on opioid medications could classify as addicts based on a physical dependency and certain behaviors. Finding solutions for this vulnerable population is, of necessity, both an art and a science. Each case is unique, and it takes a highly nuanced approach to understand each injured worker’s emotional, behavioral and physical needs.

At Paradigm, our case managers know from experience that there is no routine formula for addressing opioid misuse and abuse. They also know how important it is to take into account pre-injury addiction without conflating it with the work-related claim. We all share the goal of helping injured workers stay well and out of the grips of opioid dependence and addiction, now termed opioid use disorder by DSMV. We advocate for a biopsychosocial approach to treating complex pain conditions, one that embraces evidence-based medicine and responsible prescribing practices for the benefit of the whole person. Work with us to help change the course of the opioid epidemic – follow us on LinkedIn, Facebook and Twitter, and keep up with our efforts on the blog.