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From opioid pills to heroin injecting

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SMMGPSMMGP reviews research relevant to primary care in its July bulletin. Dr Euan Lawson covers a paper called  “Every ‘Never’ I Ever Said Came True”: Transitions from opioid pills to heroin injecting. 

The paper studies those moving from prescription pill opioids (e.g. oxycodone) to heroin:

People who had progressed to heroin from prescription opioids typically reported doing so for reasons of cost and the ease-of-access. Their transition usually moved from sniffing the heroin to injecting and they expressed dismay at the turn of events.

A 25 year old man who had made the transition is quoted:

I was that type that said. “I’ll never do Oxies”. I was the type that said “I’ll never” and every “never” I ever said came true. “I’ll never shoot heroin” and you know so yeah the older guys were already doing heroin and I was like “Dude, no way, I’d rather eat a pill.”

Dr Lawson reflects on the harsh injustice of the problem

The authors highlight the final irony in this study – heroin is thoroughly outlawed, subject to a “war” and, yet, it ends up as the default option because it’s the most readily available and the cheapest. The irony piles up when it becomes apparent that the healthcare market in the States created the problem and yet market forces ultimately drive these same people to heroin.

We don’t seem to have the same level of problems with oxycodone here, though that’s not to say we won’t develop them given the problems with prescribing for chronic pain in vulnerable populations despite lack of an evidence base. Nevertheless I have heard variations on the theme of ‘every never I ever said came true’ so many times from clients. I have yet to meet someone who is substance dependent who signed up for the level of addiction and negative consequences they ended up with.

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