It is preposterous that the public have to pick up the massive bill for abuse of this drug. Doctors who dispense this drug carelessly should not be practising medicine - indeed they should be charged with supplying opiates illegally, the SIR should be shut down and those addicted to the drug should be legally forced to detoxify. It isn't difficult - detoxify with assistance or go to jail. Once detoxification is achieved all ex users should be subject to random drug tests to confirm their abstention with a 'do not pass go' implication.
I have made several attempts to understand the implications of the heroin drought and its seeming success at permanently weaning addicts of heroin. One possible explanation is the rise in the use of substitute prescription pain-killers. I have searched the literature quite a bit but comprehensive data and analysis seems unavailable. The evidence is overwhelming that use of such drugs is skyrocketing but the extent to which this is displacing heroin is unclear.
BTW these trends are occurring around the world.
The interesting economic story is that
People have suggested that the switch away from heroin involved a move toward addictive stimulants such as cocaine and amphetamine. This seems implausible to me as levels of usage of such drugs have not increased enough to suggest this is plausible. But the role of prescription analgesics has not been properly examined. It should be.