A change in the formula for the powerful painkiller OxyContin – designed to make the drug less likely to be abused — may be encouraging the use of more dangerous drugs. Many abusers are switching from OxyContin to heroin to get high, according to researchers at Washington University School of Medicine in St. Louis, who reported their findings in the New England Journal of Medicine.
The widely prescribed and abused painkiller was designed to be released into the system slowly, so it wouldn’t produce an immediate high. But drug abusers found they could crush OxyContin pills and inhale the powder or dissolve the pills in water and inject the solution to get an immediate rush.
To discourage that practice, Purdue Pharma, the maker of OxyContin, changed the formula for the drug in 2010 to make the pills harder to crush and dissolve.
“Our data show that OxyContin use by inhalation or intravenous administration has dropped significantly since that abuse-deterrent formulation came onto the market,” said principal investigator Theodore J. Cicero, PhD, a professor of neuropharmacology in psychiatry. “In that sense, the new formulation was very successful.”
Over the course of three years, Cicero and his colleagues surveyed 2,500 patients at 150 drug treatment centers in 39 states, asking them about their use of OxyContin. They found that while many abusers stopped using OxyContin, they switched to heroin and other opioids to get high. The researchers are still analyzing the data, but wanted to make their findings known as quickly as possible. Their report appears as a letter to the editor in the journal.
“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,” Cicero said. “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 from patients in the study, the number of users who selected OxyContin as their drug of choice decreased from about 35 percent under the old formula to less than 13 percent now.
When asked which opioid they used to get high in the past 30 days, OxyContin fell from about 47% of respondents to 30 percent. During the same time period, reported use of heroin nearly doubled.
“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.'”
“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,” said Cicero. “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.”
A new formulation of OxyContin called OxyNeo was introduced in Canada in March to combat widespread abuse. Like the 2010 formulation, it is also designed to be harder to crush and turns into a gel when dissolved in water. But that didn’t stop efforts addicts and drug dealers from finding new ways to process the medication. On internet forums, addicts are sharing recipes for turning OxyNeo tablets into powder, a complicated process that includes microwaving and freezing the tablets.
A surge in heroin use is also being reported in London, Ontario and other Canadian cities.