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Oxycodone vs. Heroin

Although oxycodone and heroin are both opioids and are frequently abused, they differ in their origin, legal status, and how they are used. The use of either drug can lead to the development of dependence and addiction. Both drugs are associated with similar withdrawal syndromes and carry a high risk for overdose.

Treatment for an addiction to either drug often involves specific medications as well as  therapies that focus on changing behaviors and attitudes toward drug use.

Uses, Forms, Street Names

Both oxycodone and heroin are opioid drugs manufactured from opiate precursors found in poppy plants. Heroin is the result of a chemical modification of morphine, which is found in the seed pod of the poppy plant. Oxycodone is derived from thebaine, which is also found in the plant.1, 2

Oxycodone, unlike heroin, is a Schedule II drug, and is legally prescribed in the United States. Doctors prescribe it to treat moderate to severe pain.3 Though oxycodone has known medical uses, it also has a high potential for abuse.

Percocet and Roxicet are two brand-name combination formulations of oxycodone and acetaminophen. Percodan is another branded form of oxycodone and consists of a combination of oxycodone and aspirin. OxyContin is the trade name for an extended-release tablet form of the drug. Hillbilly Heroin, Roxy, Perc, Kicker, OC, and Ox are some of the most common street names for oxycodone.1,2

Though oxycodone is manufactured as a capsule or tablet for oral consumption, some abuse the drug by:1,2

  • Crushing and snorting pills.
  • Mixing crushed tablets with water and injecting the solution.
  • Crushing and heating the pills to inhale the vapors.

Heroin is a Schedule I drug. This means that heroin has a high potential for abuse and has no legitimate medical uses. Heroin is commonly found in powdered form, though the drug may also be encountered as a sticky substance known as black tar. Most heroin users inject it, though some may snort or smoke it, especially if the heroin is high quality.1

Street names for heroin are Smack, Big H, Black Tar, Thunder, Hell Dust, Chiva, and Negra. 1

Oxy and Heroin Use

Nearly 80% of all heroin users report first abusing prescription opioids such as oxycodone. 4 Often, those who abuse prescription drugs will switch to heroin because it is easier to obtain, cheaper, and provides a better rush or high.17

However, with heroin, a user never knows how pure or safe it is. Whereas oxycodone is prescribed in controlled doses, there is no quality control for heroin.

Dealers typically mix or cut heroin with other substances such as starch, powdered milk, sugar, and quinine to stretch it and create more product to sell. In several recent cases, fentanyl, an extremely powerful painkiller designed to treat severe pain in cancer patients, was mixed with heroin and led to fatal overdoses. 1


Oxycodone and heroin are both opioids, and they produce similar feelings of euphoria.

Oxycodone also leads to other short-term effects, such as: 1

  • Sedation.
  • Constipation.
  • Constricted pupils.
  • Relief of pain.

The short-term effects of heroin include: 1

  • Drowsiness.
  • Flushed skin.
  • Itching.
  • Dry mouth.
  • Nausea.
  • Heaviness in arms and legs.
  • Slowed or shallow breathing.

Long-term effects of oxycodone and heroin are similar and may include: 5

  • Visual problems due to frequent constriction of the pupils.
  • Increased risk of depression, suicide attempts, and completed suicides.
  • Erectile dysfunction in men.
  • Reproductive problems in women.
  • For those who snort the drugs, irritation of the nasal passages and/or nasal perforation.
  • Increased risk of accidents while intoxicated.
  • Increased likelihood of being a victim of crime.
  • Increased risk of overdose.

Further, injecting either substance leads to increased risk of: 5

  • Infectious diseases from shared needles, including HIV, tetanus, and hepatitis.
  • Increased rates of tuberculosis.
  • Vascular inflammation.
  • Hardening of the veins.
  • Skin abscesses and cellulitis.

Dependence and Withdrawal

Over time, a person’s body may not respond to oxycodone or heroin as it did when they first started using. This phenomenon is known as tolerance.6  To keep feeling the same level of euphoria, a person will often require a higher dose of the drug or begin using it more frequently.

Both oxycodone and heroin use can also lead to dependence, which means that the user’s body only functions normally in the presence of the drug. If a person stops or cuts back on the drug, they will experience withdrawal. 6

The withdrawal symptoms of oxycodone and heroin are similar, and can include: 7

  • Muscles aches.
  • Sweating.
  • Excessive tearing of the eyes.
  • Goose flesh.
  • Insomnia.
  • Agitation.
  • Anxiety.
  • Nausea and vomiting.
  • Diarrhea.
  • Stomach cramps.
  • Runny nose.

Oxycodone withdrawal symptoms usually start in about 6-12 hours after the last dose and peak within 1-3 days. The symptoms usually fade within about 5-7 days after the last dose.5

Heroin withdrawal follows a similar timeline and usually begins between 6 and 24 hours after the last dose. Symptoms usually are at their peak within 2 to 4 days. The symptoms can go on for several days, but usually stop within 7 days. In some cases, cravings, anxiety, depressed mood, and insomnia can continue for months after withdrawal from heroin or oxycodone.8.9

Regardless of which type of opioid you or your loved one is withdrawing from, there are risks associated with attempting to go “cold turkey” and detox at home alone. While withdrawal from heroin or oxycodone is seldom life-threatening, on occasion a person may become severely dehydrated from vomiting and/or diarrhea and need IV fluids to avoid severe electrolyte imbalances. 7

Another concern about at-home approaches to detox and withdrawal is relapse and overdose, since a person still has access to the drug and may find withdrawal too uncomfortable. If the person then abruptly starts using heroin or oxycodone again at the same dose they previously used, they are at a higher risk of overdose due to lowered tolerance. 7,10

Getting Addicted

Both oxycodone and heroin are addictive, as people crave the euphoric rush they experience from these drugs. The euphoria can be so pleasant that some want to experience it again and again.

You or your loved one may be addicted to heroin or oxycodone if:5

  • You use heroin or take oxycodone more often, or in larger amounts, than originally intended.
  • You crave oxycodone or heroin.
  • You try to stop using, or at least cut back on using oxycodone or heroin, but you find that you cannot do it alone.
  • You spend a lot of time seeking out, using, or recovering from using oxycodone or heroin.
  • You take oxycodone or heroin even knowing that they make a medical or mental health condition worse.
  • You take oxycodone or heroin even though their use leads to increased levels of family conflict or social problems with others.
  • You ignore things that are important, or that you used to enjoy, and instead prefer to take oxycodone or heroin.
  • You are using oxycodone or heroin in a situation where you know it is dangerous to do so, such as while driving or operating heavy machinery.
  • You are unable to fulfill your job, school, or other responsibilities because of using heroin or oxycodone.
  • You develop tolerance for either drug, which means you don’t feel the kind of effects you are used to, or you keep taking more to get the feelings that a lower dose used to cause in you.
  • You experience physical symptoms of withdrawal when you stop or cut back on using oxycodone or heroin.

It can be especially difficult for you to realize you have developed an addiction if you were first prescribed oxycodone by your doctor. Some signs that you may have an addiction can include going to more than one doctor to obtain an extra prescription, having medical emergencies where you claim your pain is unbearable, or refusing to follow your doctor’s recommendations.

You may avoid getting treatment because you are afraid of going through withdrawal, or you don’t feel that you can control your cravings for oxycodone or heroin. However, there are options, such as:

  • Medical detox and medication-assisted treatment (MAT), which include medications such as methadone or buprenorphine, in combination with therapy, to ease the symptoms of withdrawal and facilitate sustained recovery.11
  • Behavioral therapy, which helps you to engage in treatment, change thinking and behaviors toward drugs, manage cravings, and stay clean. Common types of therapy for addiction include cognitive behavioral therapy (CBT), motivational enhancement, and contingency management.12

For most people, a combination of medication and behavioral therapy provides the best long-term outcomes.11


Too much of either drug can result in slowed or stopped breathing

Overdoses occur with both oxycodone and heroin. One’s risk of overdose may be greatest with heroin, because a user can never be sure of the strength of heroin bought on the street.13

Often, a person who overdoses on oxycodone mixes it with other drugs or alcohol, takes more than prescribed, or takes someone else’s prescription.14

Too much of either drug can result in slowed or stopped breathing, which can lead to coma and/or death. Symptoms of an overdose include: 14

  • Pale, clammy, and/or cold skin.
  • Blue lips or fingernails.
  • Shallow breathing, or not breathing.
  • Vomiting.
  • Making gurgling noises.
  • Unresponsiveness.

Responding to an Overdose

If you see someone exhibiting these symptoms, call 911 and administer CPR if you are trained to do so.

If available, you can also give the person naloxone, a medication that can reverse the effects of opioids and save a person’s life if administered quickly enough. Depending on the setting and the specific naloxone formulation, it may be administered by injection or as a nasal spray.15

Many first responders now carry naloxone, and the U.S. surgeon general issued an advisory that more people should keep naloxone on hand to be able to save a person’s life in the event of an overdose. Naloxone may be covered by your insurance plan or otherwise available for low-cost (or no cost). Pharmacy or community-based training courses can help teach you to administer it.16

However, the best way to prevent overdose deaths is to prevent the overdose from occurring in the first place. If you or your loved one believes that you may have an addiction to heroin or oxycodone, get help today before it’s too late. Call today for more information about rehab programs in your area.



  1. U.S. Department of Justice. Drug Enforcement Administration (2017). Drugs of abuse.
  2. Drug Enforcement Administration. Oxycodone.
  3. Food and Drug Administration. (2008). Oxycontin.
  4. National Institute on Drug Abuse. (2018). Prescription opioid abuse is a risk factor for heroin use.
  5. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th Ed.). Arlington, VA: American Psychiatric Publishing.
  6. National Institute on Drug Abuse for Teens. (2018). Tolerance, dependence, addiction. What’s the difference?
  7. U.S. National Library of Medicine. (2018). Opiate and opioid withdrawal.
  8. Oregon Department of Corrections. (2015). Opiate withdrawal.
  9. Australian Government Department of Health. (2015). Guidelines for the management of heroin withdrawal.
  10. University of Arizona. Heroin overdose.
  11. Substance Abuse Mental Health and Services Administration. (2015). Medication and Counseling Treatment.
  12. National Institute on Drug Abuse. (2018). Principles of addiction treatment.
  13. U.S. National Library of Medicine. (2017). Heroin overdose.
  14. Substance Abuse Mental Health and Services Administration. (2016). Opioid overdose.
  15. Substance Abuse Mental Health and Services Administration. (2016). Naloxone.
  16. U.S. Department of Health and Human Services. (2018). Surgeon General’s advisory on naloxone and opioid overdose.
  17. National Institute on Drug Abuse. (2018). Heroin use is driven by its low cost and high availability.

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