The new abuse-deterrent formulation of OxyContin isn’t preventing abuse in many addicts, a new study has found. In 2013, there were over 16,000 overdose deaths related to prescription painkillers, according to the Centers for Disease Control and Prevention (CDC), and the opioid abuse epidemic is still a big problem throughout the U.S. The abuse-deterrent formulation of OxyContin (brand name of oxycodone) promised to help bring statistics like this down, but in many ways the switch to a harder-to-abuse version hasn’t had the intended effect.
Reformulation of OxyContin
Prescription drug abuse has been a growing problem in the U.S. since the 1990s, and although it’s recently shown signs of leveling off—largely thanks to increased awareness of the risks and legislative measures taken to combat it—in many ways, the problem has simply shifted to similar drugs. The basic issue is that prescription painkillers are opioids, just like heroin, and when used for non-medical reasons (or for medical reasons, particularly when taken in larger doses than prescribed) they can be addictive in exactly the same way. Along with things like prescription drug monitoring programs—which keep track of opioid prescriptions to make it more difficult for users to get multiple prescriptions for the same complaint—OxyContin maker Purdue Pharma aimed to reduce abuse of the drug by changing its formulation. Users would previously crush the extended-release form (which itself was also intended to make the drug harder to abuse) and snort or inject it to get a fast-acting high. Now when the drug is crushed, the new version turns lumpy and gooey, making injecting or snorting it virtually impossible. This abuse-deterrent formulation was released in 2010, and although it did have an immediate impact, there have always been issues with the approach. To look at the impact of the reformulation, and particularly to investigate why there is still residual abuse of the drug, researchers surveyed almost 11,000 opioid addicts (using prescription drugs or heroin) who presented to any of 150 treatment programs across 48 states from January 2009 to mid-2014. The core aim was to determine what impact the introduction of the abuse-deterrent formulation of OxyContin had on drug-seeking behavior. Despite an initial drop in abuse of OxyContin after the abuse-deterrent version was released, the researchers found that 25 percent to 30 percent of those presenting to rehab centers from 2012 to 2014 still reported abusing the drug. To understand what was happening, they looked specifically at the 88 participants with experience abusing both the older, extended release and the new, abuse-deterrent forms of OxyContin and found that people were able to circumvent any effort to deter misuse of the drug. Lead author Theodore J. Cicero, PhD, pointed out that online chat groups exist where users provide step-by-step instructions on how to get around the new protections.
Unintended Consequences of Reformulating OxyContin
The vice president of corporate affairs at Purdue, Raul Damas, points out that the new formulation only claimed to make abuse “difficult” and adds that “the report parallels other studies that show reformulated OxyContin is associated with a reduction in abuse.” This is a very carefully worded statement. He’s technically right: the new formulation was associated with a reduction in abuse — of OxyContin. For all opioid drugs, not so. In fact, evidence shows that those unable to get high using OxyContin simply switched to other prescription opioids, and most worryingly of all, many moved on to heroin. While abuse rates of OxyContin technically dropped, it’d be more accurate to say the majority simply migrated to other licit or illicit drugs in the same class. The logic behind the switch to heroin from a user’s perspective is easy to understand: with increased scrutiny of prescribing practices and prescription drugs overall, switching to the comparatively easily accessible and definitively cheaper drug heroin ($10 per hit compared to $20, $30 or more per hit) is the easiest way to continue getting your fix. Said Cicero: Heroin used to be an inner-city problem involving poor minority groups. That problem has now moved to the suburbs and rural areas. White, middle class individuals are now peddling heroin. This shift was supported by a paper from 2014, which found that 90 percent of heroin abusers in the last decade were Caucasian and over three-quarters lived outside urban areas. Most notably, three-quarters of heroin abusers in the study started out on prescription opioids.
Tackling Addiction, Not Individual Drugs
The big problem with abuse-resistant forms of prescription painkillers is that it isn’t the specific substance that drives abuse. While OxyContin may be the most practical drug for someone who can obtain prescriptions, for example, the real driving forces behind drug abuse and addiction are the underlying psychological issues that make people want to get high in the first place. Whether it’s stress, depression, loneliness, anxiety or more severe mental health issues, these are the things that make somebody crush an OxyContin pill and snort it instead of taking it as directed. Changing OxyContin to be harder to abuse doesn’t teach those at risk of addiction healthier ways to deal with these underlying issues; it just means that those same underlying issues will drive them to different substances for the same reasons. Without tackling the underlying issue of addiction, such approaches are dead in the water before they even get going. This study doesn’t really add much new, but it does underline the problems with Purdue Pharma’s “solution,” namely that if addicts are determined, they’ll find a way to circumvent any abuse-deterrent strategy. There is only one solution: helping those in need find treatment and overcome their addictions.