Prescription Drug Crackdown Fueled Rise in Heroin Use

From the beginning, the U.S. government’s decade-long crackdown on prescription drug abuse has run an unsettling risk: that arresting doctors and shuttering “pill mills” would inadvertently fuel a new epidemic of heroin use.

State and federal officials have pressed their campaign against prescription drug abuse with urgency, trying to contain a scourge that kills more than 16,000 people each year. The crackdown has helped reduce the illegal use of some medications and raised awareness of their dangers.

But at the same time that some pain medications have become less available on the street and pricier, many users have switched to cheaper heroin, since prescription pills and heroin are in the same class of drugs and provide a comparable, euphoric high.

With the nationwide heroin problem gaining greater attention after the recent death of actor Philip Seymour Hoffman from heroin and other drugs, experts on addiction say the government’s actions contributed to the problem it is now confronting. The war on drugs, they say, is an unwieldy conflict where targeting one illicit substance can be an unintentional boon to another.

“Absolutely, much of the heroin use you’re seeing now is due in large part to making prescription opioids a lot less accessible,’’ said Theodore Cicero, a psychiatry professor at Washington University in St. Louis. He co-authored a 2012 study, cited in the New England Journal of Medicine, that found that a reformulation of OxyContin to make it harder to abuse caused heroin use to nearly double.

Although policymakers “did the best they could at the time” in fighting prescription drugs, Cicero said, “there were signs years ago that this was going to happen, and there was just a lot of inaction.” He said the government could have acted sooner to mitigate heroin’s toll, such as by promoting the use of medicines to fight overdoses and ease withdrawal symptoms.

The government itself predicted that targeting prescription drugs could give heroin use an unintended lift. The Justice Department’s drug intelligence arm in 2002 highlighted the potential consequences: “As initiatives taken to curb the abuse of OxyContin are successfully implemented, abusers of OxyContin . . . also may begin to use heroin, especially if it is readily available, pure, and relatively inexpensive.’’