Here is a Q&A with Michele Caliva, RN, and Nicholas Nacca, MD.

Caliva is the administrative director of the Upstate New York Poison Center. Nacca is a medical toxicology fellow.

You can listen to an extended version of this interview on Upstate's HealthLink on Air.

Q The Upstate New York Poison Center fielded 14 calls about heroin overdose in 2009, compared to 84 in 2013, and there has been a dramatic increase in the number of heroin-related deaths, too. Why the increase in heroin use?

(Nacca) A “A lot of it has to do with the epidemic proportion of people addicted to prescription painkillers right now.

“Back in the 80s and early 90s there was a big push for physicians in general to treat all of their patients‘ pain. There was even some drug company misinformation that some of these prescription painkillers are not addictive, but in fact they are.

“Many people are on prescription painkillers such as Lortab, Vicodin and Oxycontin for chronic back pain when, in fact, those drugs really not efficacious in the long term for chronic pain at all. What we‘ve ended up doing is creating a lot of people who have opioid addiction. Then, as we start to recognize this and we start to cut off some of the prescribing practices of these prescription pain medications, patients who have developed an addiction have to turn to an alternative like heroin, which is much cheaper and easier to get ahold of.”

Q What makes heroin so available?

(Caliva) A “Back a year or two ago when the synthetic drug problem was rampant throughout our community, The folks who distribute heroin had to stay competitive, so they dropped the prices. So heroin now is fairly inexpensive on the streets.”

Q Are people drawn to heroin for the high?

(Nacca) A “There‘s definitely a euphoria associated with it, and they‘re definitely looking for a high. If you talk to addicts, they‘re always talking about their first high and trying to get back to that same feeling of euphoria they experienced.

“A common story that I find when I interview my patients in the emergency department is -- with a lot of the young people, especially – that their parents had a prescription pain medication in the cabinet from a surgery. They found that, they used it once or twice and liked the feeling. They maybe just ate the tablet, and then they realized if they crush it up and snort it they get an even stronger effect of the drug. As that runs dry, they find a source for the heroin.

“They may start by snorting heroin, because that‘s not a needle that‘s not as scary. But eventually they find if they inject it, it‘s an even stronger high.

“So it‘s kind of this progression, going from the prescription pain medication that was left over from a surgery to a full-blown heroin addiction.”

Hear about the heroin problem in Central New York

Hear about the synthetic drug problem