According to the Centers for Disease Control and Prevention, “[in] 2007, the number of deaths involving opioid analgesics was 1.93 times the number involving cocaine and 5.38 times the number involving heroin.”

Kicking off the prescription pill epidemic was OxyContin. While it was meant to be abuse-resistant with its slow-release capsule, it was so potent that users quickly discerned how to crush the pills or blend them with water in order to obtain their high.

In August 2010, OxyContin changed its formula to be “abuse-resistant,” making it impossible to crush the pills or to mix them with water. The result, says a study published in the New England Journal of Medicine, was “an abuse-deterrent formulation successfully reduced abuse of a specific drug but also generated an unanticipated outcome: replacement of the abuse-deterrent formulation with alternative opioid medications and heroin, a drug that may pose a much greater overall risk to public health than OxyContin.”

The study was undertaken by researchers at Nova Southeastern University, led by Theodore J. Cicero, PhD, and was conducted from July 2009 to March 2012. The researchers administered surveys to over 2,500 patients who had been classified as having opioid dependence. Of those, over 100 agreed to telephone or online interviews.

While they found that the amount of people whose primary drug of abuse was OxyContin had decreased from 35.6 percent to 12.8 percent. They also found that, when they asked if they had used OxyContin to get high in the past 30 days, the number of people who agreed had fallen from 47.4 percent of participants. Meanwhile, the number of respondents who said that they had used heroin had doubled.

But not everyone is convinced by the correlation. Dr. Adam Bisaga, associate professor of psychiatry at Columbia University, said that he believed that the demographics of people who abused OxyContin were not the same people who abused heroin. He said that he thought that it was more likely that previous abusers of OxyContin were ingesting six pills of Vicodin to feed their high.

Regardless, Cicero is convinced that more proactive steps need to be taken to ensure that people avoid the abuse of prescription painkillers, particularly OxyContin. He believes that instead of trying to curb supply, lawmakers and drug manufacturers should be trying to curb demand – through educational campaigns that compare oxycontin to street drugs like cocaine or crack.

The majority of people who abuse prescription painkillers, Cicero said, had started when they were 14 or 15 years old.