Here’s the thing: There’s a mythology being propagated that suggests there’s a natural progression from pharmaceutical opioid addiction to heroin addiction. This mythology suggests that it’s Big Pharma’s fault that heroin addiction is “an epidemic.” But, and I say this with certainty, heroin addiction is a category all on its own and not even all heroin addiction is the same. While I do think that opioid prescriptions were way too freely written, I don’t think they’re the reason heroin addiction rates appear to be growing.
First of all, addiction of any kind requires several factors to come together in to a perfect storm. The most basic factor is a predisposition to Addiction. This predisposition is revealed through family history; that is, if a family has a history of addiction then there’s a good chance that there’s a genetic risk for Addiction. The next factor to consider is a given person’s emotional state. If a person has experienced trauma, either physical or emotional, and didn’t receive appropriate treatment, the trauma will create overwhelming emotions with which a given person may not cope well. Now, on top of the previous two factors is a factor that is often way too under-discussed: Whether a person is externally locused or internally locused. If a person is externally locused, he or she will believe that the source of events in his or her life is outside of his or her control. If, however, a person is internally locused, he or she believes that he or she makes things happen. Therefore, if a person has a genetic predisposition to Addiction, has experienced a breakdown in emotional regulation as a result of trauma, and is externally locused, then that person is ripe for an addiction to develop.
This is where opioids enter the equation. Exposure and access to an opioid can be risky for a person who presents as I described above. However, even if an opioid addiction develops, there’s yet another factor to consider: Economics. If a person has economic resources, he or she can maintain an opioid addiction and probably won’t delve into the heroin underworld. But, an unscrupulous dealer (and there are really no other kind) may present heroin as an option when opioid become too expensive. While there was a relationship between the opioid and heroin, it’s far too simplistic to suggest that there’s a “natural” progression.
Plus, the heroin underworld is wacky, in and of itself. In treatment, heroin smokers look down on needle heroin addicts. For that matter, opioid addicts generally look down on heroin addicts. The world of heroin and opioids is shady and heartless and consumes people who simply lack inner and outer resources to stave off its allure. But to think that it’s Big Pharma’s fault that this lack of resources exists is to refuse to look in a mirror and see our role in the creating the problem.