According to the CDC, opioid painkillers addicts are 40 times more likely to be addicted to heroin than general population. “Most heroin users have a history of nonmedical use of prescription opioid pain relievers, and an increase in the rate of heroin overdose deaths has occurred concurrently with an epidemic of prescription opioid overdoses."
I can't say opioid painkillers are the only reason, but the experts seem to agree they're, at least, a major contributing factor.
I was listening to a social worker discuss the problem recently. His experience was that most new heroin addicts started on opioid painkillers, often with legitimate prescriptions, and weren't hard drug users previously. When their doctor refused to prescribe more painkillers (or the pills they were stealing from mom ran out, etc.), they turned to the black market, where it's much easier to obtain heroin than painkillers. He estimated 90% of his cases fit this pattern of prescription drugs being the gateway to heroin.
This same guy also discussed how a lot of overdoses he saw were from recovered heroin addicts that relapsed after being prescribed an opioid painkiller for a legitimate need, e.g., after an injury. As you say, they went back to their "old dose," without realizing a) their tolerance was lower and b) black market heroin is typically much better quality and a wider range of qualities these days. In the 80's (and 90's I think) heroin was usually <10% pure (i.e., 90% filler/other), but heroin on the streets today is often around 30% but sometimes as high as 70%. I don't remember the exact numbers, something close to that. He said you could tell when a super pure batch of heroin came through town, because overdoses would spike.
Another factor I've read, can't remember where, is that the higher quality heroin has made snorting it more feasible. So, that reduces some of the stigma/ickiness associated with needles, trackmarks, etc., increasing the pool of people who'll try it. And it can be easier to overdose via snorting, because it takes several minutes to feel the full effects, unlike injecting.
According to the CDC, opioid painkillers addicts are 40 times more likely to be addicted to heroin than general population. “Most heroin users have a history of nonmedical use of prescription opioid pain relievers, and an increase in the rate of heroin overdose deaths has occurred concurrently with an epidemic of prescription opioid overdoses."
I can't say opioid painkillers are the only reason, but the experts seem to agree they're, at least, a major contributing factor.
I was listening to a social worker discuss the problem recently. His experience was that most new heroin addicts started on opioid painkillers, often with legitimate prescriptions, and weren't hard drug users previously. When their doctor refused to prescribe more painkillers (or the pills they were stealing from mom ran out, etc.), they turned to the black market, where it's much easier to obtain heroin than painkillers. He estimated 90% of his cases fit this pattern of prescription drugs being the gateway to heroin.
This same guy also discussed how a lot of overdoses he saw were from recovered heroin addicts that relapsed after being prescribed an opioid painkiller for a legitimate need, e.g., after an injury. As you say, they went back to their "old dose," without realizing a) their tolerance was lower and b) black market heroin is typically much better quality and a wider range of qualities these days. In the 80's (and 90's I think) heroin was usually <10% pure (i.e., 90% filler/other), but heroin on the streets today is often around 30% but sometimes as high as 70%. I don't remember the exact numbers, something close to that. He said you could tell when a super pure batch of heroin came through town, because overdoses would spike.
Another factor I've read, can't remember where, is that the higher quality heroin has made snorting it more feasible. So, that reduces some of the stigma/ickiness associated with needles, trackmarks, etc., increasing the pool of people who'll try it. And it can be easier to overdose via snorting, because it takes several minutes to feel the full effects, unlike injecting.