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NIDA. (2016, February 2). Factors Predicting the Transition from Prescription Opioids to Heroin. Retrieved from

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Science Highlight

February 02, 2016
pill bottle tipped over with pills on counter©iStock/Roel Smart

Prescription opioid misuse remains one of America’s biggest drug problems. In recent years the numbers of people misusing prescription pain relievers has leveled off, however, the number of people dying from overdoses continues to rise, and a new epidemic of heroin use has emerged as many people misusing prescription opioids transition to their cheaper, often easier-to-obtain street relative.

Although the links between illicit prescription opioid use and heroin use are well-established, until now no study had prospectively examined the transition to heroin use among people misusing pain medications to understand the factors that predict such a transition.

In a NIDA-funded study, researchers at Wright State University tracked for three years a cohort of young adult (age 18-23) illicit prescription opioid users in Columbus, Ohio, who at the time of study entry were not dependent on opioids and had never used heroin or injected any illicit drug. It was found that, in this high-risk demographic, 2.8 percent of illicit opioid users initiated heroin use per year of the study (7.5 % total over 3 years). Although just half of the recruited sample were white, all individuals initiating heroin use were white (all but one non-Hispanic). The strongest predictors of initiating heroin use were non-oral use of prescription opioids (sniffing/snorting)—indicating an intensifying relationship with the drug and its associated high—along with higher frequency of opioid use and the development of DSM-IV dependence on those drugs. (The motive of illicitly using prescription opioids to get high, as opposed to self-treating for pain, was closely associated with developing opioid dependence.) Early age of onset of illicit prescription opioid use was also a predictor of heroin initiation. These findings suggest some specific targets for prevention efforts aimed at people currently misusing prescription opioids but who have not (yet) started to use heroin.