Vicodin and Percocet over to heroin in the first place??? They became tolerant and the heroin is MUCH cheaper. That’s why!. Makes sense right? We all go the path of least resistance.
NOW that we have some treatments does it make sense that patients will all of a sudden reach for a tool that is more expensive than what they are doing already? Well, maybe… depends on how bad their situation is. Since I see them at the most rock bottom my guess is they wait till the last possible moment. Medications like naloxone, vivitrol, suboxone are becoming more and more expensive while heroin is becoming less and less expensive and now stronger too (not really stronger but patients don’t know that it’s the fentanyl snuck in that makes it feel more powerful- it’s like the drug dealers have to reach to a more potent thing to keep their customers). In 1980 a gram of heroin cost $1000 !!! now it’s less than $500 and for a “bag” about $5. Same as a latte!. A shot of vivitrol self pay (many of these patients don’t have jobs or insurance) is about $1500 unfortunately.
Thankfully medicaid will pay for much of this but with the impending demise or downsizing of medicaid (thanks Trump for not understanding the first thing about addiction- don’t bother to call those of us who do) this will become more difficult. As long as its difficult to seek out treatment our patient will just keep on doing what they are doing and so far the drug dealers are offering better alternatives right???
Andreas J. Edrich MD FASAM ADM MRO “the addiction doc”