Chicken vs. Egg: Which Came First, Heroin or OxyContin Addiction?

man holding pill
Which came first; heroin addiction or OxyContin addiction?

For centuries, people have debated one age old question: which came first, the chicken or the egg? While both sides of this argument have their valid points, the question itself has evolved, making its way into other areas of society, including the addiction community.

So, in true “chicken vs. egg” style, many people are asking: Which came first; heroin addiction or OxyContin addiction? Do people resort to heroin when their prescription painkiller resource runs dry? Or, do heroin addicts pick up painkillers in hopes of transferring to a “safer” high?

The Danger of Opiates

To understand the debate, it’s important to recognize the power of both drugs and how their abuse can impact the human body. OxyContin and heroin are both members of the opioid family; they significantly impact the brain and nervous system. In these areas, opiates generally:

  • Depress breathing by altering neurochemical levels in the brain stem, where automatic body functions like breathing and heart rate are controlled.
  • Create feelings of euphoria by altering activity in the limbic system, which is the area that controls emotions.
  • Block the transmission of pain signals that are normally delivered via the spinal cord.

According to Substance Abuse and Mental Health Services Administration (SAMHSA) data, somewhere between 26 and 36 million people abuse opioids worldwide. In the United States, approximately 2.1 million people are struggling with a prescription painkiller addiction, while another 467,000 are addicted to heroin.

…2.1 million people are struggling with a prescription painkiller addiction, while another 467,000 are addicted to heroin.

The Heart of the Debate

The problem is that prescription opioids like OxyContin mimic the effects of heroin in both the body and mind. The two drugs are virtually interchangeable, leading many addicts to jump from painkillers to heroin and from heroin to painkillers. And that’s why we are seeing opiate-related death and addiction rise to epidemic proportions that far surpass those of other illicit drugs.

In the end, the chicken vs. the egg debate centers on one question: Is OxyContin causing heroin addiction or vice versa? For example, when doctors sever a patient’s access to legal opioid painkillers or an addict can no longer afford to buy pills off the streets, they often transition to heroin.

On the flip side of that argument, a lot of people who are addicted to heroin believe that switching to OxyContin will ultimately make it easier to get sober.

Since knowledge is power, it’s important to look at both sides of this debate.

Argument #1: Heroin Addiction Comes First

Believe it or not, heroin was considered a “safe and therapeutic” drug a little less than 100 years ago. In fact, heroin was actually doled out to patients of all ages—even children. By the 1920s, thousands were addicted to the legal opiate, prompting its removal from the market.

According to data from the 2012 National Survey on Drug Use and Health (NSDUH), about 669,000 Americans reported using heroin in the past year, a number that has steadily risen since 2007. Those between the ages of 18 and 25 have seen the most significant increase of heroin abuse.

Even more frightening, both rural and metropolitan areas of the country are currently being flooded by heroin. For example, heroin in Charlotte, NC has become so easy to get that dealers are actually delivering their products to the suburbs. Some are even brazen enough to run “specials” as a way to attract more young, professional and upper-income customers.

“You don’t know what’s in there from batch to batch,” says Karen Simone, director of the Northern New England Poison Center, which documented the spike in heroin overdoses in rural states like Maine, New Hampshire and Vermont. “It may be strong; it may be weak. They don’t know what they are getting. Suddenly, the whole game changes.”

So, why would a heroin addict switch to OxyContin? Turns out there are a few different reasons—the main one being an overwhelming misconception about medication-assisted detox. After drugs like Suboxone and Subutex hit the market and exploded in popularity, more people began gravitating toward the detox method known as “tapering.”

There are some serious misconceptions about medication-assisted detox, the most pressing being that you can get clean by substituting OxyContin for heroin.

Essentially, one drug replaces another and the patient’s dosage is gradually tapered down. Over a designated period of time, the patient eventually transitions off the drugs with little to no withdrawal symptoms experienced. It’s the promise of a painless withdrawal process that appeals to heroin addicts.

The problem is that there are some serious misconceptions about medication-assisted detox, the most pressing being that you can get clean by substituting OxyContin for heroin. After all, prescription painkillers can’t be as dangerous as an illicit street drug like heroin…right? Wrong.

Argument #2: OxyContin Addiction Comes First

Despite its dangers, OxyContin is still one of the most frequently prescribed pain-relieving opioids in the U.S. Its main ingredient is oxycodone, which mimics the molecular structure of heroin. That’s how OxyContin earned its nickname: hillbilly heroin.

Many people who take OxyContin to treat legitimate pain don’t understand the ramifications; they just don’t realize the dangers lurking at the bottom of that pill bottle. Addiction develops rapidly; suddenly one or 2 pills per day no longer keeps the debilitating withdrawal symptoms at bay. Patients find themselves taking more and more, running out of pills before their next doctor’s visit or coming up short on mandatory pill counts at pain clinics. Eventually, they’re cut off by doctors or kicked out of their pain management programs.

When getting OxyContin legally is no longer an option, people are forced to start buying pills off the street. And with black market pills going for up to $90 a piece, the money runs out in the blink of an eye. Eventually, someone suggests switching to heroin, pointing out that the illicit drug is much cheaper and easier to find.

Next thing you know, you’ve moved from legitimate prescriptions to the dirty world of heroin, needles and blackened kitchen spoons.

Next thing you know, you’ve moved from legitimate prescriptions to the dirty world of heroin, needles and blackened kitchen spoons. For many, it’s nothing more than a drug of last resort…an opiate that is accompanied by massive health dangers, violent crime and serious communicable diseases. In short, heroin is a life-altering—and often life-ending—opiate that doles out much more than you ever bargained for.

“One substance will go down, but another will go up. And unfortunately, I think (heroin abuse) is going to grow,” says Ronni Katz, a substance abuse prevention program coordinator in Portland.

The dangerous switch from OxyContin to heroin is clear to Mark Publicker, who oversees a 24-bed detox ward at Mercy Hospital Recovery Center in Portland. “As bad as oxycodone is, heroin is worse,” Publicker said. “It’s worse because here in Maine, it’s injected. We’re talking about a novice population of drug injectors who are not educated about needle use.”

Should We Care Which Came First?

At the heart of this issue, one has to wonder if it really matters which opiate addiction came first and which came second. Both drugs have the very real ability to destroy lives, making them equally dangerous. When you factor in the crime that always accompanies drug sales and the medical costs associated with overdoses, opiate addiction is an epidemic that touches and affects everyone.

If you or someone you love is currently struggling with an addiction to opiates, don’t waste your time switching from one drug to the next. Instead, reach out for help and fight to get your life back. No one is a lost cause; no matter how long you’ve been living in active addiction, you can regain your sobriety. And before you know it, you’ll be using the chicken and egg debate in a much different way: making out your grocery list!

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