Opioid Prescription Drug Abuse and Its Relation to Heroin Trends

This chapter focuses on the emerging epidemic of opiate abuse in relation to increased availability and use of prescription opioids for both medical and recreational purposes. Abuse of prescription opioids, including synthetic opioids such as fentanyl, Vicodin, Subutex, Oxycontin, methadone, pethidine, and desomorphine, has been increasing in certain areas of the world. The prescribing and availability of these prescription opioids vary greatly from one country to another. For example, within the United Kingdom 1.7% of the population in Scotland abuses opioids, whereas only 0.13% of the population of Northern Ireland and 0.76% of people in England and Wales abuse opioids. These percentages are dwarfed by the United States, which leads the world in percentage of population (6%) abusing opioid drugs. In response to opiate abuse and addiction there has been an increase in the distribution of addiction-replacement medications, such as Subutex, which presents yet another public health risk. When Subutex inundated the Republic of Georgia in response to their escalating heroin addiction, street diversion of this prescription opioid resulted in a Subutex abuse epidemic. In countries where the prevalence of prescription opioid abuse is greater than 1% of the population, the rate of opioid abuse exceeds the rate of heroin use, with the exception of Afghanistan, which produces 90% of the world's illicit heroin.