Close Cousins: The Link between Painkillers and Heroin

(Spring 2015) From 2012 to 2013, deaths due to prescription drugs rose 1% according to the Centers for Disease Control and Prevention.  While even the slight increase is not great, compared to previous year-over-year results that showed an 18% increase, a 1% increase seems pretty good, right?  All the hard work educating doctors, employees and their families; passing legislation to restrict drug access; and making medication disposal easier has finally paid off.  The prescription drug epidemic experienced by the nation is at long-last experiencing its swan song.  Hurray!

Not so fast.

The CDC also reported that in that same timeframe there was a 39% increase in heroin overdose deaths.   And this is on top of a 35% increase in deaths caused by heroin from 2011 to 2012.

What’s the connection?

Heroin and prescription painkillers are virtually the same drug.  So as painkillers have become harder and more expensive to get (a result of rules and regulations to reduce the prescription drug epidemic in the U.S.), individuals addicted to painkillers are turning to heroin.  Heroin is not only cheaper and easier to get than painkillers, but helps addicts avoid the nasty withdrawal symptoms they would experience if they stopped taking the prescription meds. Heroin is an adequate substitute for these powerful prescription painkillers because it has the same origins – the opium poppy.

From Poppy to Medicine to Heroin: A Brief History

The history of opium poppy goes back over 5,000 years.  It was known to Sumerians as the “joy plant” because of its euphoric effects.  A few thousand years later opium was used as a medicine to treat a wide range of diseases including pain, coughs and depression.

Morphine was created in 1803 by isolating opium’s active ingredient.  It was hailed by doctors for its reliability, long-lasting effects and safety, and became more popular with the discovery that injecting morphine with a syringe made the drug three times more potent and had instantaneous effects.  Morphine’s ability to treat both chronic and acute pain, using Food and Drug Administration (FDA)-approved formulas and dosages, has made it the gold standard for judging the effectiveness of other pain relievers.

Heroin was synthesized from morphine 100 years later and, because it did not cause the same side effects of morphine,  was marketed as a way to help morphine addicts give up their habit.  Unfortunately, the fast-acting euphoric nature of heroin made the drug highly addictive and its use was banned by congress in 1924 – roughly 20 years after hitting the market.

However, even though heroin was later banned, FDA continues to recognize the medical value of certain components of the opium poppy plant and over the years has approved other opium-based painkillers and cough suppressants.

Testing for Opium: What Employers Need to Know

For employers doing drug tests, the chemical similarities between organic prescription painkillers (i.e., those with ingredients directly from the plant) and heroin means that they will test positive on an opiate panel.

However, there are other prescription painkillers, not organic to the poppy plant, that will go undetected in a typical drug test.  These painkillers behave similarly to the ones listed above, but are not identified because they are composed of synthetic or semi-synthetic ingredients.

If employers are interested in expanding the range of painkillers they are testing for, they can work with their lab to add some of the more widely-abuse synthetic and semi-synthetic painkillers to the line-up of tested drugs. Drugs that are commonly added to expanded opiate testing include oxycodone (OxyContin®, Percocet®, Percodan®), oxymorphone (Opana®), hydrocodone (Vicodin®, Lortab®) and hydromorphone (Dilaudid®).

When it comes to expanded opiate testing there are a two things to remember:

1. Not all expanded opiate testing is the same. Your drug testing vendor will typically give you the option to pick what drugs you want to test for.
2. Be sure that a medical review officer (MRO) is included in the testing process to protect employees who are using their medications safely and as directed by their doctor.

It is also important to note that all drug tests – regardless of what drugs are being tested for — involve staunch privacy concerns.  This is why employers must make sure to give fair notice about what substances are being tested for, the levels at which a test will be ruled positive, under what circumstances an employee will be tested, and, in the event an employee feels the test results are inaccurate, recourses available to the employee.

Education on the subject of prescription painkillers and heroin is also prudent. The connection between organic prescription painkillers and heroin is not often heard in news stories, conversations surrounding the prescription drug epidemic or the doctor’s office.  So while many people wince when they hear about heroin, they don’t think twice about their doctor-prescribed painkillers.  These are powerful medications and should be respected.  Through education, employers can play a big role in helping their employees understand the importance of using painkillers (and any other medication) as directed and asking questions about the medication they are being prescribed.