You’ve probably noticed recent reports, within the Work Comp PBM industry and elsewhere, that prescription opioid use and overdoses are on the decline. It is a long journey and we cannot yet see the destination, but progress is being made. One of the goals has been to make it more difficult to secure clinically inappropriate prescription opioids thru legitimate (physician, dentist) and illegitimate (pill mills, street sales) means. Abuse deterrent formulations have also helped, creating a hassle factor for those that want to abuse them. The increase in focus on the subject in the media and government has made it more top-of-mind. Although even one death or the creation of one new addict is too many and we have lots of cleanup today on the damage already done to individuals and communities, the trends are heartening.

However, for every intended consequence, there are also unpredictable unintended consequences. And one of those that I’ve been following for some time, that two recent clinical studies have codified as accurate, is the dramatic increase in the abuse and misuse of heroin. We may be going from opioids to heroin. A good amount of that increase is theorized to be coming from those that may have become addicted or highly dependent upon the euphoric effect and/or dulling of the pain from opioids. Because today’s heroin is “pharma quality” and less expensive than opioids on the street, heroin has become the primary alternative choice. If you think this is a recent issue, this USA Today article entitled “OxyContin a gateway to heroin for upper-income addicts” was my initial warning on June 28, 2013.

The reasons for this switch are multiple and complicated. An excellent article on this issue was published in the June 2015 edition of “Pain Medicine News“.

Three quotes that struck me the most:

  • “Fewer than 20% of chronic pain patients benefit from opioids”
  • “The prolific normalization of opioid use for chronic pain within primary care has seeded the epidemic of heroin addiction”
  • “We are going to see the biggest explosion of heroin addiction ever in the next five years”

Obviously, heroin is an illegal drug and therefore cannot be tracked or managed within a PBM. But this is an important turn of events that everyone needs to be watching. While heroin use may not be a Work Comp “problem”, it is a societal problem, which ultimately always rebounds as an issue for everyone (and everything) else.

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