After reforming the components of the drug OxyContin, there were many studies that claimed that it cannot be used to get high. But a new research revealed that 25% of drug-users entering rehab said they still used the prescription painkiller despite package labeling that emphasizes its abuse-deterrent properties.
The study, by researchers at Washington University School of Medicine in St. Louis, was published recently in JAMA Psychiatry
Surveying almost 11,000 drug users at 150 drug-treatment facilities in 48 states, the researchers from the Department pf Psychiatry found that an abuse-deterrent formulation of OxyContin was successful in getting abusers and addicts to stop using the drug, but only to a point.
"We found that the abuse-deterrent formulation was useful as a first line of defense," said Prof Theodore J. Cicero, senior investigator of the study. "OxyContin abuse in people seeking treatment declined, but that decline slowed after a while. And during that same time period, heroin use increased dramatically."
The original formulation of OxyContin contained high levels of the pain-killing drug oxycodone. It was designed so that small amounts of the drug were released over a long period of time. However, abusers found they could crush the pills and snort the powder, or dissolve the pills in liquid and then inject the drug.
To discourage abuse, the newer formulation of OxyContin was designed to make it harder to crush or dissolve the pills. It was introduced in 2010 at a time when 45% of study participants entering drug treatment reported they had used OxyContin to get high at least once in the previous 30 days. Two years later, the percentage of those who got high with the newly formulated drug in the month before entering rehab had fallen to 26%.
These abusers continued to use OxyContin to get high by either taking the drug orally or finding new ways to snort or inject it. Perhaps even more worrisome was the fact that almost half of the drug abusers surveyed in 2014 reported they had used heroin in the 30 days before they entered treatment.
"Some people found ways to get around the abuse-deterrent formulation so that they could snort or inject it, and others simply swallowed the pills," Cicero explained. "But many people switched to heroin, and that's a major concern."
Cicero explained that of those who had stopped using OxyContin and switched to another drug, 70% started using heroin instead. Many said they made that switch for economic reasons. "A few years ago when we did interviews with people in treatment, many would tell us that although they were addicts, at least they weren't using heroin," he said. "But now, many tell us that a prescription opioid might run $20 to $30 per tablet while heroin might only cost about $10."
In addition, he said, many of the people who sell heroin aren't quite as frightening as they once seemed. Addicts no longer have to find dealers in dark alleys in rough neighborhoods. It has become easy to find heroin virtually anywhere, including suburban and rural areas.
"Some people have come to see it as a cost-effective method of getting high," Cicero said. "If they can tolerate the intravenous injection and overcome their reluctance to give themselves a shot, many of the people in our study said it was a fairly simple decision and that heroin now represents a cheaper, more attractive alternative."
Limiting access to a prescription drug by making it harder to abuse does not change the demand side of the drug abuse equation, he said. People who want to get high find ways to continue doing so.
"It's naive to think that an abuse-deterrent pill can eliminate drug abuse; we have data that demonstrates this," he said. "There are people who will continue to use no matter what the drug makers do, and until we focus more on why people abuse drugs, we won't be able to solve this problem."
The data were collected as part of the SKIP (Survey of Key Informants' Patients) program, a component of the RADARS (Researched Abuse, Diversion and Addiction-Related Surveillance) system, funded through an unrestricted research grant sponsored by the Denver Health and Hospital Authority, which collects subscription fees from 14 pharmaceutical firms. The researchers also were supported by private university funds.
Cicero TJ, Ellis MS. Abuse-deterrent formulations and the prescription opioid abuse epidemic in the United States. JAMA Psychiatry
, published online March 11, 2015. doi:10.1001/jamapsychiatry.2014.3043
Washington University School of Medicine's 2,100 employed and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children's hospitals. The School of Medicine is one of the leading medical research, teaching and patient-care institutions in the US, currently ranked sixth by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children's hospitals, the School of Medicine is linked to BJC HealthCare.