According to the CDC, heroin use has doubled since 2007. This seems to be linked to the rise in abuse of prescription opioids like oxycodone, but there’s more going on here than the gateway effect: these two drugs act on the body the same way, making it easy for addicts to switch between them.
English physician Charles Romley Alder Wright created diamorphine as an alternative to morphine as it seemed to treat pain without the side effects. Bayer marketed the new drug as “Heroin” and touted it as a cure for morphine addiction. What Bayer and Wright didn’t realize was that Heroin is a “prodrug,” becoming morphine once it was processed by the liver: users weren’t being relieved of morphine withdrawal, they were getting more morphine into their bodies. In fact, heroin can pass more easily more easily than straight morphine, giving the use a stronger hit.
When the effects of Heroin were realized, it was pulled from the market and oxycodone was developed to take its place. The new drug, more commonly known under the brand name “Oxycontin,” offered the same pain relief, but didn’t last as long or give the user the same hit when taken. By itself, oxycodone acts on different opiate receptors than morphine. However, like heroin, it metabolizes into an new drug, oxymorphone, that acts on the same receptors as morphine.
While heroin gives the user a bigger rush than oxycodone when first injected, the real reason for its rise is cost. The average street price for oxycodone is around $1 per milligram in the U.S, which means a single hit can be anywhere between $30-$80. That same amount of money can buy 10-20 doses of heroin, making it much more affordable for addicts to manage their addiction. Metabolites from both drugs act on the same receptors, so they both can relieve withdrawal symptoms, even if the high is different.
This rise has been pushed by a gradual switch to the OROS delivery system. It uses a series of holes and coatings to gradually release the drug over hours or even days for long term pain relief. Converting these tablets into an injectable form is difficult, while heroin can be injected immediately.
If you or someone you love has had trouble with pain medications and heroin, things aren’t as bleak as they seem. Opioid addiction is hard to break free from, but use of both drugs means having a single addiction, not multiple chemical dependencies.