The Grapevine

Crush-Proof OxyContin Pills Have Done Little To Curb America's Problem With Drug Abuse

OxyContin
Abuse-deterrent OxyContin has not solved prescription drug abuse. Almond Butterscotch, CC by 2.0

Law enforcement’s approach to curtailing drug abuse has been heavily focused on taking away the supply while the demand part of the equation works itself out. Many “experts,” however, fail to understand that active drug addicts will do almost anything to get their “high.” A recent study conducted at Washington University School of Medicine in St. Louis has revealed that drug users in the United States have not let crush-proof OxyContin get in the way of abusing their drug-of-choice.

“We found that the abuse-deterrent formulation was useful as a first line of defense,” Dr. Theodore J. Cicero, a professor of neuropharmacology in psychiatry, said in a statement. “OxyContin abuse in people seeking treatment declined, but that decline slowed after a while. And during that same time period, heroin use increased dramatically.”

Cicero and his colleagues surveyed nearly 11,000 drug users from 150 drug-treatment facilities across the U.S. OxyContin was originally designed to release small amounts of the pain-killing drug oxycodone over time. Drug abusers soon realized that they could get a more intense “high” just by crushing up the pills and snorting or dissolving the powder in liquid and then injecting themselves. Drug manufacturers sought to end this practice by designing a new OxyContin pill that cannot be crushed or dissolved.

Crush-proof OxyContin was introduced to the market in 2010. At that time, 45 percent of the study’s participants said they had used OxyContin in the past 30 days. Although crush-proof OxyContin did successfully deter drug abuse among some users, the effect has not been widespread. In fact, approximately 25 percent of abusers and addicts entering a drug rehabilitation facility said they found a way around the prescription drug’s abuse-deterrent formulation.

“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, but many people switched to heroin, and that’s a major concern,” Cicero explained. “The newer formulations are less attractive to abusers, but the reality is — and our data demonstrate this quite clearly — it’s naïve to think that by making an abuse-deterrent pill we can eliminate drug abuse. There are people who will continue to use, no matter what the drug makers do, and until we focus more on why people use these drugs, we won’t be able to solve this problem.”

Among drug users who stopped using OxyContin but ended up switching to another drug, 70 percent started using heroin. The heroin trade in the U.S. has moved past the dark alleys of city streets and the abandoned buildings in impoverished neighborhoods. Today, heroin can be purchased easily in both suburban and rural areas of the country. Around 50 percent of drug abusers surveyed in 2014 admitted to using heroin in the 30 days prior to entering treatment. The majority of users who switch from prescription drugs to heroin do so 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, but now, many tell us that a prescription opioid might run $20 to $30 per tablet, while heroin might only cost about $10,” Cicero added. “Some people have come to see it as a cost-effective method of getting high. 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.”

Source: Ellis M, Cicero T. Abuse-Deterrent Formulations and the Prescription Opioid Abuse Epidemic in the United States Lessons Learned From OxyContin. JAMA Psychiatry. 2014. 

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