The recently aired HBO documentary, “Heroin: Cape Cod USA,” focuses attention on how heroin has ripped a swath of destruction in one of America’s iconic communities, but it could easily be a story of thousands of other communities throughout America. It is a movie that should be seen by everyone. That said, my reaction to it is mixed.

On the one hand, heroin addiction affects people of all ages, from every walk of life, from coast to coast. It’s great to see an evocative and emotional television documentary focusing attention on the horrific problem. Denying that we have an epidemic will not solve the problem. Calling attention to heroin addiction might help us find solutions and prevent deaths.

On the other hand, I am bothered by the implication in the movie that heroin addiction is due to prescription drugs. It’s not as if prescription drugs are floating around and jumping into the mouths of innocent people who are just minding their own business in the same way as a virus inoculates a passenger on a subway.

Prescription opioids are supposed to be used for pain. When people choose to use them for other reasons, that’s when the disease of addiction begins to own the person’s soul. People addicted to heroin also choose to use the drug, at least initially. There are no physicians who prescribe heroin. Of course, just because people choose to use heroin doesn’t lessen the tragic effects of the devastating disease of opioid addiction.

Connecting the prescribing of painkillers to heroin use may be valid for a limited number of cases, but the implication of cause and effect is flawed. The Centers for Disease Control (CDC) reports that there were 250 million prescriptions of painkillers in 2012. Yet a recent study shows that only 0.022% of exposures to an opioid are associated with overdose deaths. It is impossible to know how many people are misusing opioids prescribed for pain. Understanding the reasons for misuse is more important than knowing the prevalence of misuse. This is where our lance should tilt.

Addiction is part of human beings’ biology that sadly imprisons far too many innocent victims. All of the people in the documentary admitted to using heroin or prescription drugs to feel good or to relieve emotional pain. Most began using addictive substances before being exposed to an opioid.

Before the abundance of unused and diverted prescription opioids, people who wanted to get high on chemicals would go directly to heroin or cocaine. Remember the 60’s and 70’s? In those days, the chemicals of choice were THC, LSD, Quaaludes and more. In the 80’s, we had a national epidemic of “crack babies” from cocaine.

Alcohol has always been the fallback for those seeking a recreational high when other drugs are not available. Even today, there are more deaths due to alcohol than opioids or any other drug of abuse except for products that contain nicotine. However, heroin appears to be more lethal than most other drugs of abuse because of its tendency to make some users stop breathing.

Recreational drug users who participate in my clinical research studies on drugs of abuse admit to using prescription opioids for fun because prescription opioids are legal substances, because others can’t smell opioids if they’re working, and the opioids are cheaper than a six-pack of beer.

Understanding the root causes of the opioid epidemic is crucial to reversing the problem. Believing it is just about the supply will not solve the problem and will likely have serious unintended consequences by allowing the disease to continue its carnage. And the belief that heroin addiction always, or even usually, arises because someone has been prescribed opioids is misinformed.

So my thanks go out to HBO for airing “Heroin: Cape Cod USA.” It’s a start at drawing nationwide attention to the horrific heroin problem. Future documentaries, I hope, will help shine a light on the real causes, and possible solutions, of the heroin addiction epidemic and not just its ruination of our families and communities.


Lynn Webster, MD, Vice President of the Scientific Affairs PRA Health Sciences; Author, “The Painful Truth: What Pain Is Really Like and Why It Matters to Each of Us”; Researcher; Past President of American Academy of Pain Medicine; and Board Certified Pain Medicine and Certified Addiction Medicine. Visit him online at

By Dr. Lynn R. Webster