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Are oral opioids the new gateway drug to heroin?

Posted on 04-12-16 in Addiction, Substance Abuse

Are oral opioids the new gateway drug to heroin?

Many people have heard the term “gateway drug,” a usually less harmful drug that leads to the use of more dangerous drugs. Marijuana has been known as the ultimate gateway drug and this natural substance is controversial in terms of its risks and benefits. In fact, the use of marijuana has been shown to lead people to experiment with more dangerous drugs such as cocaine, prescription pain medications and other harmful substances. Recently, much debate has surrounded prescription opioids and whether they can be a gateway drug to heroin.

A dangerous drug class

Opioids, or narcotics, are a class of pain medications that are prescribed by a physician and closely regulated by the Drug Enforcement Administration. There are many different types of opioids and some are more potent than others. For example, codeine is a relatively weak opioid compared to morphine or fentanyl. Recently, there has been a lot of controversy and limitations placed on physicians to regulate how often they prescribe prescription pain medications. Unfortunately, these prescription painkillers are one of the most abused classes of drugs by the general public. The Centers for Disease Control and Prevention has said that more than 16,500 people died after overdosing on opioid-based painkillers in 2010. No other class of drugs, legal or illegal, is responsible for as many deaths, its figures show.

Law enforcement and the federal government have been acting to decrease the use of non-medical opioids and, as a result, they have seen an increase in heroin use, raising the questions as to whether oral opioid use can lead to heroin use. Two papers have been researched and published on whether non-medical opioids can be the gateway drugs to heroin. Heroin, itself, is considered an opioid, but it is the only illegal opioid as it is not used for medical purposes and, therefore, is considered as a Class I substance, according to the DEA. Heroin is used via the intravenous route, which can lead to many complications including acquiring blood-borne diseases such as HIV and hepatitis.

Key factors that lead to transition

Researchers discovered that non-oral opioids have shown the greatest potential to lead people to use heroin. Non-oral opioids include fentanyl patches and fentanyl lollipops, but many users choose to crush the pills and snort the crushed substance, allowing for a quicker high. The study’s lead author discovered that the key factors that lead people to transition to heroin were:

1) the age at first use
2) the desire to get high rather than self-medicate
3) the use of non-oral opioids, which was the strongest predictor

This data suggests that cutting back prescription opioid use can potentially increase heroin use, leading to even bigger problems. It is important to educate the general public on the harmful reasons not to use heroin or any other forms of intravenous drugs, as these are worse than oral opioids.

“Our results suggest that preventing transition to non-oral pharmaceutical opioid use, preventing transition to opioid dependence by reducing or eliminating the frequency of pharmaceutical opioid use and educating users about the risks involved for those who are non-opioid dependent are important intervention targets,” said Robert G. Carlson, Ph.D., principal investigator in a study that identified predictors of heroin use initiation among pharmaceutical opioid users.

The Sovereign Health Group is a leading behavioral health treatment provider with locations across the United States that treat people with substance use disorders including opioid and heroin addictions, mental health disorders and co-occurring conditions. For more information, please call our 24/7 helpline.

About the author

Kristen Fuller, M.D., is a senior staff writer at the Sovereign Health Group and enjoys writing about evidence-based topics in the cutting-edge world of medicine. She is a physician and author, who also teaches, practices medicine in the urgent care setting and contributes to medicine board education. She is also an outdoor and dog enthusiast. For more information and other inquiries about this article, contact the author at