This is How Heroin and Prescription Opioids Are Different

Heroin, opioids, Lynn R Webster, MD

Patrick Clarke, of Rockville, is correct in his letter to the Washington Post‘s editor.

Heroin is not the same thing as prescription opioids.

There’s a huge difference. I’m not talking only about the pharmacology. I’m talking about the reasons why people use heroin and prescription opioids.

Heroin and Opioids Are Different

Heroin is most commonly used to treat mental pain, while prescription opioids are intended to treat physical pain.

Yes, there are people who use heroin for physical pain. But they are not doing so under any medical supervision, and many heroin users usually can sustain that use only for short periods of time. Then, ultimately, they overdose and die.

Most people use prescription opioids to treat physical pain. Unfortunately, opioids are sometimes exploited for their psychoactive properties and ability to relieve mental anguish. But that is not their primary purpose. Opioids’ main purpose is to help people with pain get through the day.

Different Functions

Because their functions are so different, it is wrong and punitive to paint heroin and prescription opioids with the same brush. It’s also wrong to cite statistics that treat heroin and prescription opioids as one entity.

To do so denigrates and stigmatizes both people in pain and people with the disease of addiction. The whole purpose of suggesting that heroin and prescription opioids are the same is to demonize all opioids and all of the people who use them.

That is judgmental and unfair. And, ultimately, it is unhelpful.

Opioid Crisis

Of course, the opioid crisis is a hot topic now, while the presidential campaign is in full swing. Just uttering the words “heroin” and “opioids” results in instant and intense media attention. Voters pay attention, too.

Unfortunately, some of the presidential candidates combine the disparate topics of heroin and prescription opioids to create a type of emotional shorthand. It’s not unusual for politicians to replace facts and substantiation with sound bites. In fact, we’ve come to expect it of them. It’s too bad that such important topics as heroin and prescription opioids have become nothing more than sound bite opportunities for these politicians.

But, sometimes, politicians surprise us by doing the right thing.

For example, notice how President Obama has addressed the issue. He has avoided castigating either heroin users or people who use opioids for pain. He sticks to the facts as he understands them. The people surrounding him don’t always do that, but the president, himself, has tried.

I hope all presidential candidates, and all of us, can follow the president’s example.




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Copyright 2016, Lynn Webster, MD




  1. Richard Oberg M.D. on February 25, 2016 at 5:01 pm

    Dear Dr. Webster,
    I’m a 30 year senior staff pathologist at a very large city/county owned hospital system and am (was) hospital based. I have a 23 year history of bad progressive psoriatic arthritis and continued practice even after primary medical management resorting to chronic pain management during over 16 of those years as part of my treatment strategy largely with hydrocodone – it worked extremely well. This isn’t the place and feel free to email me if interested in any discussion. I lost access when our hospital system followed the politics and forced my internist (and all outreach physicians who were employees) to terminate their prescribing for these immediately. Needless to say this didn’t bode well and forced me out of practice and was devastating to a large group of patients who relied on these guys for help and were literally thrown out into the street.

    I’m very curious – you and others seem to ‘parrot’ the hyperbolic language used by politicians and those in addiction about this so-called ‘opioid crisis, epidemic, etc.’ which is actually what is fueling patients like me and others not getting treatment anymore. Have you ever bothered looking into the actual data behind it because I have and it doesn’t wash. CDC statistics are a misleading lie – fewer people die from prescription pain meds than auto accidents (by little over half) and this is only the tip of the iceberg. Both lay publications and others peddle propaganda and it’s worked great. If prescription pain meds are an epidemic then so is alcohol, nicotine, antibiotic resistance, inhouse hospital errors, and on and on which actually cause more death and destruction than prescription pain meds. More people benefit and never get included in what should be done for any pharmaceutical agent – positive benefit vs. negative effect. In fact, they have to given lay publication’s false dichotomy of extremely high numbers scripted vs. relatively small numbers with negative consequences even when you take into account diversion which should be listed under ‘drug addicts’ anyway.

    So I have to ask – do you really stand for chronic pain patients?? You appear to be well intended with your book but I’ve been in healthcare politics for a long long time and with unhealthy stands like you seem to have (that this being politicized and channeled into drug addiction which you seem to approve of) this will only result in things getting worse not better.

    I’d love to discuss.

    Best – Richard Oberg M.D.

    • Lynn Webster, MD on February 26, 2016 at 10:19 am

      Hi Richard
      I’m glad you contacted me. I can tell that you’ve been having a difficult time. There are far too many people struggling like you. I think you misunderstand me.
      I recognize that there are two public health problems, opioid abuse and unrelieved pain. I believe most of our politicians have it all wrong. They seem to be listening to a small group of people who only have the experiences of people with tragedies in their lives.

      It is sad because your voice and those like yours are seldom heard. This is the reason I wrote my book and have a documentary that will be aired later in this year. I am trying to give you a voice that affects change.

      I intend to spend the rest of my career working to try and discover safer and more effective pain medication. I’m also committed to advocate for people like you. I realize my family or I may one day be among the people who need help like you. It should be personal issue to all Americans.
      I’d love to speak to you. Please give me a call at your convenience (I sent you my office number via private email). If I’m not available leave a message and I’ll get back to you.

      Take care,

      • Katie on February 26, 2016 at 6:03 pm

        I was glad to hear the doctor’s response. I haven’t had the chance to read your book yet Lynn. I have spoken to you several times on twitter. I read just about all of your tweets. It is becoming worse out here for chronic pain patients. Being ill now for 21 years, I can say it’s a struggle not to jump off of a cliff. I am in horrific pain every single day and it wakes me nights. I don’t misuse my meds nor get high. There is a Huge difference. I’m sick of being grouped together with people that are out right addicts. I am sick of the government misinformation. My friend died of an overdose this month. It will be reported the Wrong Way. If I just give up from the pain and many years of doctors moving or shutting down from fear. If I gave up and had to end my life, they would report it as a Pain Patient with Opioid medicine in me. Large doses. Even if I did it with carbon monoxide. Because I can tell you. I would never overdose on a medication to get a doctor in trouble or it not work and I’d be in even worse shape. I stay Terrified that my doctor will leave. I had one for 8 yrs another for 4 1/2 years. In between a doc for a year or two.It is Hell when your doctor is transferred or moves. You have to find one that takes your insurance. Then hunt a doctor that isn’t afraid or doesn’t understand Pain. It takes months. Palliative care won’t help me anymore because “I am not dying fast enough”. I just pray, and fight. Honestly, at times I would give up but I’m afraid of Hell and don’t want to hurt people that do love me. The Government needs to lay off of the doctors. Patients need care and to have a tolerable pain level. More and more will turn to the street for Heroin. For actual pain relief. The suicide rates will continue to climb. I am sorry for families of addicts, when they loose a family member to an overdose due to Addiction. I am to sick the majority of time to even go online. I wanted to get a group together. Wanted to try and make a change. From not getting proper pain care, I am worse. My muscle’s have atrophied from laying in bed. Its made my medical problems so much worse. I have never lost a script, had a bad urine, had a low pill count. I haven’t done those things. I am fed up. Thank you Dr. Webster. Also to the other Dr. Richard who is also a patient, for your wisdom and input. Thank you for fighting for us. Hope I can continue this battle also.

        • Lynn Webster, M.D. on February 27, 2016 at 9:52 am

          I am receiving a message or two a week like this. These messages reassure me I am doing the right thing for people struggling. With all the criticism I personally receive I wonder for a brief moment if i am wrong. But when I hear from people like this I am energized to do more.

  2. Kerry on February 29, 2016 at 5:25 pm

    Dr Webster we need you in our corner! I appreciate all your work! What can we do to turn this around as patients? I appreciated the first half of President Obama’s statement to the governors at their conference when he said “…their pain is real…” But then in the same sentence he said “…their mental illness is real”. Im so confused! I haven’t seen any negative response to that sentence and I can’t understand why! Was he saying pain patients pain is real and addicts mental illness is real? If he has it right he can fix this in a second. Why is he allowing people in his administration and even the VA to continue this deadly mantra? Because I can say without reservation the life of today’s pain patient is at risk more by limiting or eliminating opioids.

  3. Diane WAGNER RN on March 4, 2016 at 4:53 pm

    I am outraged over the doctor losing his practice over prescription opioids and chronic pain. I have had chronic pain and fibromyalgia for 20 years. I am a retired RN who was able to work due to a wonderful family practice doctor who has managed my care during this time. I have ruptured spinal discs, fusions, stenosis, and scoliosis yet was able to have to a 40 year career as a nurse though the last 20 were in management. Being in management allowed me to lengthen my career. I have had my share of depression, anger and anxiety over the years yet have not been suicidal but I understand the feeling.

    My blood boils when I hear chronic pain sufferers lumped in with drug abusers. I use many techniques to deal with my pain, but the bedrock is the opioid patch that allows me to move.
    I treat my pain because if left untreated , it literally will send me to my knees with excruciating back pain. I can do nothing! I am in spasms and on the couch or bed. I need a cocktail of muscle relaxants and low dose of opioids to function. Yet after 20 years, the dose I take is low!

    I follow the fibro warrior we stream as it gives me much good information. Thanks!

    • Lorna McCarthy on March 7, 2016 at 5:55 pm

      I am in exactly the same position. Opioids gave me my life back after over 5 years of excruciating fibromyalgia pain. Now I work as a psychotherapist dealing with everyone else’s pain, but I still have my career. I have never had an increase in my prescribed opioids in 10 years, contrary to what much of the research says. My body might need the pain relief, but only to keep me on level where I can be a very productive human being.

  4. Laura Cereta on March 8, 2016 at 11:28 am

    It has become so bad that taking prescription opioids, even though done under a doctor’s care for chronic pain, is looked at as the same as snorting lines of cocaine. We are way off base in our national discussion, as you pointed out.

  5. SHARON on March 10, 2016 at 3:02 am

    Diane Wagner–I am exactly like you. I am RN for 24 years the last 12 years had been in management which allowed me to lengthen my career. I have been on the same low dose opioids and muscle relaxanters for severe spasms. They have started decreasing my dosage stating it is required and completely cut me off of the Benzo I took for spasms. They are causing me increased pain and treating me like a drug addict.
    I was made go to pain clinic due to my wonderful pcp who started me on this treatment clinic stopped treating chronic pain patients. Anyway, I am pissed I have never failed pill count or drug test NEVER not once. I don’t know what tio do.

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