A derivative of the larger opioid epidemic is the epidemic of something dubbed “Hillbilly Heroin.”

The opioid epidemic in the U.S. is well-documented at this point. It’s no longer something that isn’t talked about or that can go undetected. The use of opioids, including prescription narcotics and heroin, has become so prevalent that it’s on the national stage. American politicians are constantly talking about ways to curb the epidemic, but little success so far.

There are plenty of reasons given for the rise of the opioid epidemic, including the high rates at which prescription painkillers were prescribed to patients, the effects of the Great Recession and unemployment struggles in many parts of the country.

A derivative of the larger opioid epidemic is the epidemic of something dubbed hillbilly heroin.

The term hillbilly heroin refers to the drug oxycodone or brand-name drug OxyContin, and there are specific reasons why it’s been nicknamed this.

What is Hillbilly Heroin?

Hillbilly heroin is a term used to refer to the opioid oxycodone and, more specifically, OxyContin. Oxycodone is an opioid pain medication available by prescription that’s included in brand-name drugs like OxyContin. Oxycodone is a semi-synthetic opioid, and it’s about one and a half times more potent than morphine. It’s intended to treat moderate to severe pain.

Oxycodone comes in single-ingredient medicines, and it’s also often included in combination medicines.

As with other opioids, oxycodone does have euphoric effects, particularly when it’s taken in higher doses, and this is why it’s so often abused. Along with euphoria, when someone takes oxycodone they may experience relaxation, drowsiness, slowed breathing and functionality, and they may intermittently nod off. Other side effects of oxycodone include nausea, vomiting, constipation, dizziness, itching and dry mouth.

Overdose is possible with oxycodone, as with heroin and other opioids. An overdose occurs when someone who’s not tolerant to opioids or takes a high dose then has shallow or stopped breathing as a result of the drug acting on their central nervous system. Other signs of an opioid overdose can include cold or clammy skin, having a bluish tint, pinpoint pupils and losing consciousness.

Why are Oxycodone and OxyContin Called Hillbilly Heroin?

So, where does the name hillbilly heroin stem from? Oxycodone and, in particular, OxyContin has come to be known as hillbilly heroin because it affects the person in ways very similar to heroin, but it’s more available illegally and usually cheaper to buy.

The moniker hillbilly heroin relates to the fact that this drug is a cheaper version of heroin. There’s another element to the name as well. In past decades, drug use was often thought of as happening in urban areas and poor inner cities. One example was the crack epidemic of the 1980s, which was almost entirely linked to inner cities. The heroin use of the 90s was associated more with the grunge fringe that grew out of areas like Seattle.

There wasn’t a big ideological link between drug use and rural areas until the opioid epidemic. For example, OxyContin is a huge problem in the eastern United States and, in particular, rural Appalachian communities associated with drugs and high crime levels. OxyContin addiction has been estimated to be associated with a significant majority of crime in these rural areas. The use of hillbilly heroin has also been linked to an enormous number of overdoses, deaths, car accidents and suicides.

People in many of these rural communities, many of which were hit hard by the decline of the coal industry and Great Recession, may struggle with OxyContin addiction and engage in drug-seeking behaviors, which leads to the spike in crime associated with heroin use. Crimes can include theft, prescription fraud and more.

Some of the blame for the hillbilly heroin epidemic is likely because of the number of people that were injured on the job when they worked in mining and other similar high-risk occupations throughout the areas hard hit by this drug. They would be prescribed these powerful opioids, and ultimately it would not only turn into an addiction for the injured person, but it also made these drugs readily available in medicine cabinets to teens and family members.

A fair question that someone may ask in relation to the history of hillbilly heroin is, “Why OxyContin instead of morphine or hydromorphone?” The answer lies in the history of OxyContin production and marketing, which contributed greatly to today’s opioid epidemic. OxyContin was marketed as a safe drug and the risk of addiction was never publicly made clear before thousands of people became dependent on it. While OxyContin use was increasing, trends in treating pain changed and more doctors prescribed opioids to treat pain as a vital sign, which is not the norm today.

During this time, many people who were dependent on OxyContin would rely on doctor shopping. When doctors were rumored to be lax with their prescribing of OxyContin, they would often become overwhelmed by patients seeking it.

Now, hillbilly heroin isn’t something reserved for Appalachian towns. It’s a problem throughout the country, and it’s spreading to other areas of the world such as the UK.

Policymakers are looking for ways to curb the use of opioids, but in the meantime, these drugs continue to lead to countless deaths, and they wreak havoc on lives, families and entire communities.

If you or a loved one live with addiction or are using drugs recreationally and want to stop, The Recovery Village® can help. Reach out to one of our representatives today to learn how you can start on your path to recovery.

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Editor – Camille Renzoni
Cami Renzoni is a creative writer and editor for The Recovery Village. As an advocate for behavioral health, Cami is certified in mental health first aid and encourages people who face substance use disorders to ask for the help they deserve. Read more
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Medically Reviewed By – Dr. Jessica Pyhtila, PharmD
Dr. Jessica Pyhtila is a Clinical Pharmacy Specialist based in Baltimore, Maryland with practice sites in inpatient palliative care and outpatient primary care at the Department of Veteran Affairs. Read more
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