Really, the “heroin epidemic” is NOT Big Pharma’s fault. It’s all of ours.

Here’s the thing: There’s a mythology being propagated that suggests there’s a natural progression from pharmaceutical opioid addiction to heroin addiction. This mythology suggests that it’s Big Pharma’s fault that heroin addiction is “an epidemic.” But, and I say this with certainty, heroin addiction is a category all on its own and not even all heroin addiction is the same. While I do think that opioid prescriptions were way too freely written, I don’t think they’re the reason heroin addiction rates appear to be growing.

First of all, addiction of any kind requires several factors to come together in to a perfect storm. The most basic factor is a predisposition to Addiction. This predisposition is revealed through family history; that is, if a family has a history of addiction then there’s a good chance that there’s a genetic risk for Addiction. The next factor to consider is a given person’s emotional state. If a person has experienced trauma, either physical or emotional, and didn’t receive appropriate treatment, the trauma will create overwhelming emotions with which a given person may not cope well. Now, on top of the previous two factors is a factor that is often way too under-discussed: Whether a person is externally locused or internally locused. If a person is externally locused, he or she will believe that the source of events in his or her life is outside of his or her control. If, however, a person is internally locused, he or she believes that he or she makes things happen. Therefore, if a person has a genetic predisposition to Addiction, has experienced a breakdown in emotional regulation as a result of trauma, and is externally locused, then that person is ripe for an addiction to develop.

This is where opioids enter the equation. Exposure and access to an opioid can be risky for a person who presents as I described above. However, even if an opioid addiction develops, there’s yet another factor to consider: Economics. If a person has economic resources, he or she can maintain an opioid addiction and probably won’t delve into the heroin underworld. But, an unscrupulous dealer (and there are really no other kind) may present heroin as an option when opioid become too expensive. While there was a relationship between the opioid and heroin, it’s far too simplistic to suggest that there’s a “natural” progression.

Plus, the heroin underworld is wacky, in and of itself. In treatment, heroin smokers look down on needle heroin addicts. For that matter, opioid addicts generally look down on heroin addicts. The world of heroin and opioids is shady and heartless and consumes people who simply lack inner and outer resources to stave off its allure. But to think that it’s Big Pharma’s fault that this lack of resources exists is to refuse to look in a mirror and see our role in the creating the problem.



  1. I agree with the reasons you give in this post for addiction developing wholeheartedly. I too have read many articles saying that the heroin epidemic in the United States is caused by over prescription of opioid painkillers that people become addicted to. My experience in the UK is the opposite of this – people turn to heroin because of childhood trauma and predisposition to addiction then get clean off heroin. Then, through the prescription of opioid painkillers for genuine medical reasons they get hooked on the painkillers, start abusing them and then relapse on heroin again. I am surrounded by recovering addicts in NA who have quite hardcore drug histories so maybe my experience is not typical. But among people I know the heroin comes first.


  2. Funny (But not really) how addicts look down on one another as if one addiction is set higher/lower than the other when all could just be one hit away from ODing. I am getting ready to start a Job with a major provider of recovery services and want to learn as much as possible about this epidemic. Not just for my job but I have addicts in my life that I have enabled a bit and I need recovery myself!! Glad I came across your blog😊


  3. Are you referring to the book “Dreamland,” by Sam Quinones? He wrote about Big Pharma and their development of opioid painkillers. If so, I don’t recall reading that opioid addiction was a ‘natural’ progression to heroin, but that BP nurtured addictions to opioids by making them 5 and 10x stronger, and doctors freely prescribing them, which caused the body’s reliance on the painkiller. Once addicted and the pills weren’t as readily available, heroin pushers took advantage of this market.

    I do believe, as you’ve pointed out, that addiction comes from many internal and external sources but whatever the source, the responsibility to stop using and begin recovery lies with a person themselves. At that point, blaming others isn’t going to save their life.


    1. hi there…no i’m referring to the recent 20/20 special that did its best to link a “heroin epidemic” to rx opioids. heroin addiction is something all on its own and while i’ve seen cases of opioids leading to heroin addiction, they aren’t the cause of the heroin problem. at least not in NM.


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