I wrote this story for KPLU earlier this week and I’m sharing it here, as well.

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You’ve probably heard the under-world of drug abuse has taken on a new face over the past decade, with the rise of prescription pill addicts.

The story is more nuanced than that. But before looking at the nuance, here are a few surprising facts and a disturbing trend.

• Overdose deaths in King County dropped last year, from 161 to 130. And the most recent state-wide data, from 2009, also showed a drop to 324.
• The top 5 drugs involved in King County’s overdoses were, in order: Prescription opiates (painkillers)-130; Anti-anxiety and anti-depressant medications -79; Alcohol -62; Heroin -50; Cocaine -46
• The number of dirty needles exchanged for clean ones in King County more than doubled between 2007 and 2010

These figures were compiled from various sources by Caleb Banta-Green, an epidemiologist at the University of Washington’s Alcohol and Drug Abuse Institute. He’s presenting the work this week to a panel of the National Institute on Drug Abuse’s Community Epidemiology Work Group, representing 21 major cities, which is meeting in Seattle.

From painkillers to heroin?

He also told me that his biggest concern, looking forward, is what happens to the people who get addicted to painkillers, such as oxycodone.

“Prescription type opiates are pretty potent, but they’re also quite expensive. Heroin is much cheaper. So, my concern is that as people run out of resources to afford prescription type drugs, they’re going to need to move on to heroin.”

And sure enough, nearly 40% of heroin addicts interviewed at a treatment clinic in King County say they started with prescription drugs first. Other data, from the state crime lab, show drug busts for heroin are on the rise in a number of smaller counties (particularly on the Olympic peninsula and in Whatcom County). Heroin abuse used to be confined to Washington’s cities — primarily Seattle, Tacoma, Spokane, Everett and Yakima. Now, it’s appearing in small towns and rural areas.

The reason someone might be more likely to move from painkillers to opiates, and not another drug such as cocaine, is because they’re in the same family. Opiates come from the opium poppy – and include morphine, heroin, methadone and other prescriptions such as Vicodin and Oxycontin.

The number of people getting treatment for opiate addictions has gone up dramatically – thanks largely to a new replacement drug called suboxone, according to Banta-Green’s data from prescription records. It works sort of like nicotine patches for smokers. It’s a substitute drug that satisfies the physical addiction without making the person high.

A new treatment may be helping

Suboxone (also known as buprenorphine) was introduced nationally in 2003 and now more than 5,000 people are using it in Washington. It’s easier than the older replacement drug, methadone, because regular doctors can prescribe and monitor it. Methadone is available only through a few addiction clinics.

More people getting treatment is a good sign, insofar as people are fighting their addictions. But it’s also a sign of how pervasive the problem is.

The current crop of reports has some demographic data, regarding age, gender, and race of people using various drugs. It shows that painkiller abuse is growing in every sector, but especially among whites in their 20’s. On the other hand, cocaine is abused more widely by blacks and Hispanics over age 30, and especially over age 40.

The reports don’t attempt to dig deeper into who is abusing painkillers and why. There’s a big black market for the drugs, so some addicts are buying them like any other illegal substance. Pharmacies get robbed; medicine cabinets get plundered.

There’s a very readable story by Patrik Jonnson of the Christian Science Monitor, describing how law enforcement officers in rural America are scratching their heads over what they see as a new, invisible epidemic, and how some unethical doctors are feeding the demand.

Many people also become addicted while using painkillers with a legitimate prescription. And still others use opiates for long-term, chronic pain, with good medical supervision — and they never become addicted.

And, to put it in perspective, alcohol and marijuana are still by far the most abused drugs in Washington, based on the numbers of people seeking treatment for addictions.

Information on opiate medication and heroin safety and overdose prevention is available at StopOverdose and from the state Department of Health.