In the record book of unintended consequences, this one’s sure to be a groan-worthy entry: A frightening rise in addiction to the drug OxyContin prompts a reformulation that makes the prescription pain medication harder to abuse. So addicts switch to heroin instead.

Clearly, not the hoped-for effect. But according to a letter published Wednesday in the New England Journal of Medicine, it’s a switch that appears to be happening across the country -- especially in rural and suburban communities, where OxyContin abuse and addiction had gained a firm foothold.

In August 2010, the makers of the opioid pain reliever OxyContin, Purdue Pharma LP, rolled out a new version of OxyContin designed to thwart efforts to crush, split, grind or dissolve the tablet in water. Those abusing the drug had routinely broken the original slow-release version of the tablet and snorted or injected it -- actions which afforded an intense high.

While the U.S. Drug Enforcement Administration applauded the new tamper-proof formulation, officials there did warn that emergency departments might see an uptick in drug-abuse-related visits, as OxyContin abusers endured withdrawal or embraced new ways to get high.


Between July 2010 and March 31, 2012, three researchers -- two from Washington University in St. Louis, Mo., and one from Nova Southeastern University in Coral Gables, Fla., surveyed 2,566 people seeking treatment for abuse of or dependence on opioid drugs. Their aim was to gauge how their habits had changed. They further interviewed 103 of those who filled out surveys anonymously to flesh out their findings.

Those surveyed came from 150 different treatment centers in 39 states.

The reformulation of OxyContin, the researchers found, had fulfilled its mission, in a sense: Almost two years after the new OxyContin was rolled out and the old discontinued, only 12.8% of those surveyed -- down from 35.6% at the start -- considered OxyContin their drug of choice. Among the smaller group interviewed, 24% of the treatment-seekers reported they had found a way around the measures designed to reduce OxyContin’s abuse. But 66% reported they had moved on to a new drug -- and the most common choice was heroin.

The number of those who reported having taken heroin in the last 30 days to get high doubled.


“Most people that I know don’t use OxyContin to get high anymore,” one interviewee told the researchers. “They have moved on to heroin [because] it is easier to use, much cheaper, and easily available.”

In addition to nudging many drug users toward more dangerous drugs of abuse, the OxyContin reformulation appeared to have shifted the demographics of heroin use a bit as well, the researchers reported.

“We’re now seeing reports from across the country of large quantities of heroin appearing in rural and suburban areas,” said Theodore J. Cicero, vice chair of research at Washington University’s department of psychiatry. “Unable to use OxyContin easily, which was a very popular drug in rural and suburban areas, drug abusers who prefer snorting or IV drug administration now have shifted to more potent opioids if they can find them, or to heroin.”

In the bid to stem the rise of prescription opioid abuse and dependence, wrote the authors, reformulating popular drugs of abuse “may not be the ‘magic bullets’ that many hoped.”