Maurice Ludwick says OxyContin used to be the drug of choice in Louisville. But that changed around 2010, when the drug was formulated to make it impossible to crush and snort.
Then came heroin.
“They’re all efforts to control the people from using, instead of dealing with the problem that they are using. These people just moved to something else,” says Ludwick, director of the Brady Center, a halfway house run by the Healing Place. “Before this it was methamphetamine and before that it was crack cocaine. The underlying issue is addiction.”
Ludwick’s experience — and that in Louisville — rings true across the U.S.
In 2010, as opioid overdose deaths were soaring in Kentucky and other states, OxyContin manufacturer Purdue Pharmaceuticals reformulated the prescription drug. It could no longer be crushed, enabling users to snort or inject it, which is how most people misused the drug.
State government implemented a prescription drug monitoring program, limited the number of prescriptions doctors could give and expanded substance abuse treatment.
Following the OxyContin reformulation, abuse of prescription opioid medications and overdose deaths decreased for the first time since 1990, according to a new report from research group RAND Corporation. This reduced non-medical OxyContin use by as much as 40 percent, according to the report.
But the unintended consequence was that more people started using heroin. Kentucky had a 97 percent rate of OxyContin misuse between 2004 and 2008. Overdose rates from heroin also started decreasing in 2010.
The RAND study shows that for every percentage point that misuse went down, there were three more heroin-related deaths per 100,000 people.
Meanwhile, heroin-related overdoses rose for the first time since 1999 – they more than tripled between 2010 and 2014.
“People would try to drive the price of the pills up, and they cost more and more on the street. And what that did was make a huge vacuum for heroin to move right into,” Ludwick says. “It created a monster that we now know.”
Now, the use of pure heroin has shifted to deaths related to fentanyl, a drug that is 30 times more powerful than heroin. In 2015, the number of deaths involving fentanyl, either alone or combined with heroin, jumped 34 percent of all overdose deaths. Fentanyl is commonly sold as heroin or mixed with it. Pure heroin overdose deaths accounted for 28 percent.
RAND authors write that supply-side strategies to stop drug abuse are inadequate ways of dealing with drug problems, especially when there are other drugs that can act as substitutes.