A formula change in the prescription painkiller OxyContin that makes inhaling or injecting the opioid more difficult has led many abusers to switch to heroin, according to research published in the New England Journal of Medicine.
For almost three years, researchers at Washington University School of Medicine in St. Louis have been gathering information from patients entering treatment for drug abuse.
Over 2,500 patients from 150 treatment centers in 39 states answered survey questions about their drug use with special focus on the formula change of OxyContin.
Originally, the widely prescribed painkilling drug was considered a hopeful solution to the abuse of opioid drugs, as OxyContin was designed to be released into the system slowly, therefore not triggering an immediate “high.”
But drug abusers could evade the slow-release mechanism by crushing the pills and inhaling the powder, or by dissolving the pills in water and injecting the solution, getting a fast high as large amounts of the drug entered the body all at once.
Furthermore, since OxyContin was designed to be a slow-release form of the generic oxycodone, the pills contained large amounts of the drug, making it even more attractive to abusers. Standard oxycodone tablets contained smaller amounts of the drug and did not cause as big a high when inhaled or injected.
Then in 2010, the makers of the drug introduced a new formula—the new pills were much more difficult to crush and dissolved more slowly. The reason behind this, according to principal investigator Theodore J. Cicero, Ph.D., was to make the drug less attractive to abusers who wanted to experience an immediate rush.
“Our data show that OxyContin use by inhalation or intravenous administration has dropped significantly since that abuse-deterrent formulation came onto the market,” said Cicero, a professor of neuropharmacology in psychiatry. “In that sense, the new formulation was very successful.”
The researchers are still analyzing data, but Cicero said they wanted to make these findings public as soon as possible. The new report shows that although many users stopped using OxyContin, they didn’t stop using drugs.
“The most unexpected, and probably detrimental, effect of the abuse-deterrent formulation was that it contributed to a huge surge in the use of heroin, which is like OxyContin in that it also is inhaled or injected,” he says.
“We’re now seeing reports from across the country of large quantities of heroin appearing in suburbs and rural areas. Unable to use OxyContin easily, which was a very popular drug in suburban and rural areas, drug abusers who prefer snorting or IV drug administration now have shifted either to more potent opioids, if they can find them, or to heroin.”
Since the researchers started gathering data, the number of users who selected OxyContin as their primary drug of abuse has decreased from 35.6 percent of respondents before the formula change to 12.8 percent now.
When users answered a question about which opioid they used to get high “in the past 30 days at least once,” OxyContin fell from 47.4 percent of respondents to 30 percent. During the same time period, the use of heroin nearly doubled.
In addition to answering a questionnaire, over 125 of the study participants also agreed to longer phone interviews in which they discussed their drug use and the impact of the new OxyContin formulation on their individual choices.
“When we asked if they had stopped using OxyContin, the normal response was ‘yes,’” Cicero said. “And then when we asked about what drug they were using now, most said something like ‘Because of the decreased availability of OxyContin, I switched to heroin’.”
Cicero said these findings help explain why so many police officers around the country are reporting increases in heroin use. He compares attempts to limit illicit drug use to a levee holding back floodwaters.
“This trend toward increases in heroin use is important enough that we want to get the word out to physicians, regulatory officials and the public, so they can be aware of what’s happening,” he says.
“Heroin is a very dangerous drug, and dealers always ‘cut’ the drug with something, with the result that some users will overdose. As users switch to heroin, overdoses may become more common.”