David Amsden’s gripping Rolling Stone profile on Eve Rivait demonstrates how a teenager looking for excitement and escape can go from stealing her grandfather’s prescription drugs to quickly becoming a full-blown heroin addict:

In 2004, when Eve was 12, she discovered what seemed an easier way to rein in a mind that felt hard-wired to pinball from one extreme to the other. Her grandfather had just died of brain cancer, leaving behind a medicine cabinet stocked with the powerful opiate OxyContin, a substance Eve understood was prescribed by doctors to “make pain go away.” She swallowed one. The sensation it produced was more seductive than any she had ever felt: Home, she thought. This is home. “I could be alone with myself,” she says, “and not freak out.”

 

Eve was not alone in discovering the effects of prescription opioid drugs:

By the time she was 18, the same kids who once talked about the thrill of smoking pot were now praising the joys of “oxys,” not to mention “vikes” and “perc-30s,” the street names for Vicodin and the pale-blue 30-milligram tablets of oxycodone.

 

Within a matter of months, white, middle class, country-girl Eve was shooting up heroin.

A new study in JAMA Psychiatry challenges our preconceived notions of who becomes a heroin addict in America.  No longer is heroin addiction confined to minority teenagers in the inner city:

[R]ecent users of heroin were older, white men and women currently living primarily in nonurban areas who were introduced to opioids through prescription drugs or who used heroin as a cheaper and more accessible alternative to their preferred prescription opioid (eg, OxyContin).

 

JoNel Aleccia identifies the late actors Corey Monteith and Phillip Seymour Hoffman as the “new faces” of heroin users in America:

In the 1960s, nearly 83 percent of users were boys and men, with a median age of 16.5, who lived in urban areas and started using heroin as their first opiate, the study found.

Before the 1980s, whites and other races were equally represented. But in the last decade, nearly 90 percent of new heroin users were white. New users now are typically older, with a mean age of 23, and they start their addiction with prescription narcotics like Oxycontin, only to progress to heroin.

“Our typical image of a heroin user is a ‘dirty junkie,’” said lead study author Theodore J. Cicero, a professor of psychiatry at Washington University School of Medicine in St. Louis. “This is not the current heroin user.”

 

Amsden tells the story of prescription narcotics as the modern gateway to heroin:

Eve’s coming of age happened to coincide with a period during which prescriptions for these legal opiates were being written in astonishing numbers, with drugs manufactured for cancer patients and those suffering paralyzing levels of pain being given out to treat “conditions” as minor as root canals. In 2009, 257 million prescriptions for painkillers were dispensed from retail pharmacies, a 48 percent increase from 2000, and in 2010 enough painkillers were prescribed to treat all 242 million adult Americans around the clock for a month. It didn’t take long for authorities to realize that large quantities were being “diverted” – to use the term that conflates Eve’s misguided self-medication with wanton recreational use. Today, overdoses have surpassed motor-vehicle fatalities as the leading cause of accidental death in the nation, with the majority connected not to heroin but to legal substances attached to prescriptions.

 

A recent study in Pediatrics looked at one drug often prescribed by physicians caring for children which may be a gateway to heroin for some: codeine:

In this nationally representative study documenting rates of codeine prescription to children in the United States in the emergency department setting, we found that although there has been a decline in codeine prescription over the past 10 years, a large number of children are still being prescribed codeine yearly.

 

A large number of codeine prescriptions are written in emergency departments and other outpatient settings to treat pain as well as viral coughs and colds.  Most pediatricians don’t prescribe codeine to their patients due to its unpredictable metabolism seen in children.  About 30% of children metabolize codeine too slowly and don’t get the pain-relief benefit the drug is known for. Children who metabolize codeine too quickly — the “ultra-rapid metabolizers” (up to 40% of children, depending on ethnicity) — convert so much codeine into morphine so fast that fatal overdoses have occurred.

Despite these pharmacokinetic facts, and the fact that more than half-a-million prescriptions for codeine are written for children each year in the U.S., Michelle Healy says there are really no good reasons to prescribe codeine anymore:

In an editorial in Pediatrics, physicians Alan Woolf and Christine Greco of Boston Children’s Hospital write that “some remedies have long outlived their usefulness,” and that “there are good reasons why we should encourage all pediatric clinicians to give up their codeine-prescribing habit.”

It cites an “inordinately high number of adverse effects,” including allergic reactions, constipation, nausea and vomiting, the fact that “there is no evidence that codeine shortens the duration or reduces the severity of pediatric coughs,” that it is “an ineffective analgesic in many pediatric patients,” and is often “diverted for recreational drug use by substance abusers.”

 

Read David Amsden’s article here.