Two years ago the FDA approved an abuse-resistant form of OxyContin. The intent was to make it more difficult for drug abusers to dissolve or crush the tablets. It was hoped this would discourage abusers from injecting or inhaling the OxyContin, both popular methods of getting high.
An article in the July 12, 2012 issue of The New England Journal of Medicine reported on the effectiveness of the abuse-deterrent OxyContin in reducing drug abuse. “Data were collected quarterly from July 1, 2009, through March 31, 2012, with the use of self-administered surveys that were completed anonymously by independent cohorts of 2,566 patients with opioid dependence...who were entering treatment programs around the United States and for whom a prescription opioid was the primary drug of abuse.” Of these patients, 103 agreed to online or telephone interviews to provide more in-depth information.
While the new formulation did succeed in reducing the number of people abusing OxyContin, it did not reduce drug abuse overall. Instead, drug abusers simply switched their drug of choice. Following are some very interesting statistics:
OxyContin use as a primary drug of abuse decreased from 35.6% to 12.8%.
High-potency fentanyl and hydromorphone abuse rose from 20.1% to 32.3%.
24% found ways to defeat the tamper-resistant properties of the new OxyContin formulation.
66% switched to another opioid – most frequently heroin.
One of the patients interviewed was quoted as saying, “Most people that I know don't use OxyContin to get high anymore. They have moved on to heroin [because] it is easier to use, much cheaper, and easily available.” This was said to be a typical reason given for switching their drug of choice.
The article concluded the report by saying, “Our data show that an abuse-deterrent formulation successfully reduced abuse of a specific drug but also generated an unanticipated outcome: replacement of the abuse-deterrent formulation with alternative opioid medications and heroin, a drug that may pose a much greater overall risk to public health than OxyContin. Thus, abuse-deterrent formulations may not be the 'magic bullets' that many hoped they would be in solving the growing problem of opioid abuse.”
The phrase that jumped out at me in the conclusion was “unanticipated outcome.” I am incredulous that anyone actually believed making one drug more difficult to use would result in addicts giving up drug abuse altogether. Addicts are not going to stop using drugs just because it's a little more difficult to use their drug of choice––especially when there are so many other drugs readily available on the streets.
This is a perfect example of why I find all the efforts to keep adding restrictions to opioid prescribing so frustrating and irritating. I wouldn't mind so much if there was a real chance the restrictions might actually reduce the number of people who abuse drugs, but they won't. Addicts will always find a way to get the drugs they want. There are plenty of drug dealers out there who are ready, willing and able to accommodate them. The only people who are truly hurt by the added restrictions on opioids are legitimate chronic pain patients who have more and more difficulty getting the medications they need.
Cicero TJ, et al. Effect of Abuse-Deterrent Formulation of OxyContin. N Engl J Med 2012; 367:187-189.