Abstract
Heroin and other opioids are claiming lives throughout the U.S. at a staggering rate. About 4 out of 5 heroin users abused prescription drugs first. With this review, we sought to explore the use of heroin in patients being treated for pain with prescribed opioids. We also explored whether the use of heroin was associated with the use of other illicit drugs or misuse of prescription medications in this demographic. A retrospective review was conducted utilizing a database of 171,061 urine samples received from patients prescribed opioids for pain and other prescription medications, and tested for the heroin metabolite, 6-monoacetylmorphine (6-MAM), from 2012–2014. Samples were classified as heroin positive (a positive liquid chromatography/tandem mass spectrometry result [LC/MS/MS] for 6-MAM) or heroin negative (6-MAM MS was performed and negative). Samples from patients prescribed morphine, methadone, or buprenorphine were excluded from the analysis. In addition to heroin, samples were evaluated for the presence of other illicit drugs (cocaine, MDMA, PCP, THC, synthetic cathinones, and synthetic cannabinoids), for the presence of their prescribed medication (opiates, stimulants, synthetic opioids, sedative/hypnotics), and the presence of non-prescribed medications (opiates, stimulants, synthetic opioids, sedative/hypnotics). Logistic regression analyses were used to calculate odds ratios and 95% CIs. Heroin was positive in 1.3% of urine samples tested. Demographic factors associated with a positive heroin test included: males, age, and insurance status. Samples from patients prescribed opioids that tested positive for heroin were more likely to test positive for other illicit drugs such as cocaine and marijuana. In addition, they were more likely to test positive for other non-prescribed medications and negative for medications that were prescribed. Clinicians should consider testing for heroin use when conducting urine drug monitoring in patients prescribed opioids.
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