Purdue's abuse-deterrent OxyContin reformulation and the shift to heroin

Purdue's abuse-deterrent OxyContin reformulation and the shift to heroin mark a consequential turn in the opioid crisis: a change intended to make a widely misused prescription drug harder to manipulate coincided with a migration from pills to heroin. The reformulation altered how the drug could be used, but it did not extinguish dependence or demand; in the account of one suburban user, the pill supply gave way to heroin just as the crisis was spreading through peer networks beyond the communities where officials had expected to find it.

The reformulation and its limits

In 2010, Purdue Pharma launched an abuse-resistant version of OxyContin. Victoria, a suburban user interviewed in the book, recalled trying to crush one of the reformulated pills: it gelled, making it unusable by the methods she had expected. The pills then either became unavailable or too expensive, she said, while people who had dealt pills began dealing heroin instead. Her account gives the reformulation a concrete, double-edged effect: it obstructed particular routes of misuse, but did not by itself resolve the conditions that sustained opioid use or the market serving it.

That shift unfolded amid a broader change in where heroin was encountered. Before the suburban outbreak, heroin in Roanoke, Virginia, was widely treated as an inner-city drug, associated in public understanding with Black users and dealers. Don Wolthuis, a federal prosecutor, recalled that the local group of users in the 1980s and 1990s was small and largely out of public view. By contrast, the book describes newer suburban users encountering opioids through peer groups rather than through family networks. Police attention to those users came roughly around the time of Purdue’s 2010 reformulation. The reformulation thus belongs to a transition in both drug supply and the social geography of the epidemic, not to a simple ending of prescription-opioid misuse.

From pills to heroin

The book places that transition alongside the death of Scott Roth. Around the time Purdue introduced the reformulated drug, Spencer Mumpower gave Scott the heroin that led to his death. The timing connects the new formulation to the changing drug environment without making it the sole cause of an individual death: prescription pills had been part of a wider pattern of exposure, and heroin was increasingly available as that pattern changed.

The consequences also appeared in family life and in the ability to seek help. When reporting began in 2012 on heroin’s arrival in the suburbs of Roanoke, many families were too ashamed to speak publicly. Parents in different parts of the state had not yet formed online groups to exchange treatment advice or provide practical and financial support. The book describes families as operating in the gaps between criminal justice and health care, while people with addiction struggled to survive and avoid withdrawal. Reformulation could change the form of the drug supply; it could not supply the connected, timely care that families lacked.

The petition and the delayed response

Barbara Van Rooyan had petitioned the U.S. Food and Drug Administration for changes to OxyContin, including an opioid antagonist and the withdrawal of approval for the original formulation. Two weeks before Jesse Bolstridge’s death, the agency notified her that it had approved the portion of her petition seeking withdrawal of the original drug’s approval. By then, Purdue Pharma had already withdrawn the original formulation voluntarily, three years after the reformulated version reached the market. The approval therefore arrived after the practical change it concerned.

Van Rooyan believed her petition may have helped push reformulation, but she also recognized that many people had died while the process was pending. After later reading about the Sackler brothers, she concluded that the change was likely prompted by Purdue’s approaching loss of the original formulation’s patent, rather than by a belief that the new version was safer or by her petition. The agency also denied her separate request to limit OxyContin to severe, acute, or terminal pain, with chronic prescribing reserved for cases in which other treatments had been explored. The two decisions expose different limits of the response: changing a formulation did not settle the question of appropriate prescribing, and regulatory action came after the market had already moved.

Treatment and enforcement after the shift

The account places the move toward heroin within a larger mismatch between public-health language and criminal enforcement. Calls to say that the epidemic could not be solved through arrests were applied most readily to a largely white population of opioid users involved in dealing or property crime, and less consistently to people such as Ronnie Jones, a Black man imprisoned for heroin distribution. The book also cites 2014 data showing that doctors prescribed painkillers to people of color at substantially lower rates, amid distrust that they would misuse them; by then, overdose deaths among young white people had risen sharply from 2002, while the rate among people of color was comparatively unchanged. These unequal patterns complicate any account that treats the shift from prescription pills to heroin as a purely pharmacological or individual development.

Local responses sought to connect people to treatment, but access remained difficult. Roanoke’s Hope Initiative proposed trained volunteers who could guide people toward care and draw on housing, mental-health, and employment resources. A proposed hospital handoff to outpatient Medication-assisted treatment and counseling faced shortages of providers, detoxification and treatment beds, and bureaucratic, financial, and legal barriers. In the initiative’s first month, twenty-two people made contact, but none entered residential treatment and only a handful obtained outpatient Medication-assisted treatment. The reformulation’s central contradiction therefore persisted in the aftermath: a technical change could make one form of misuse harder, while the need for treatment, the demand for heroin, and the institutional gaps surrounding both remained.