The Hospice Clinician Blog

Two years ago, Purdue Pharma released a new formulation of the widely abused long-acting opioid OxyContin. The new formulation was designed to discourage medication misuse and abuse by being more difficult to cut, break, chew, crush or dissolve to release more medication or use via injection or inhalation. This week, in the New England Journal of Medicine, results were published of a study examining the effect of the new OxyContin formulation on the abuse of OxyContin and other opioids.

The authors collected data for 3 years, starting in July 2009 and ending in March 2012. The data came from anonymous self-administered surveys completed by a total of 2566 opioid-dependent patients entering treatment programs for opioid abuse.

Before the release of abuse-deterrent OxyContin, 35.6% of patients entering treatment programs throughout the United States were using OxyContin as the primary drug of abuse. Twenty-one months later, after the release of the abuse-deterrent formulation, just 12.8% selected OxyContin as their drug of choice. So, it appears the abuse-resistant formulation did its job: it decreased OxyContin abuse.

However, it does not appear that OxyContin abusers stopped abusing opioids altogether. Instead, they moved on to other opioids, including, most commonly, heroin. While Oxycontin abuse declined, abuse of other opioids, especially high-potency opioids like hydromorphone and fentanyl, rose markedly. And perhaps most troubling is the fact that heroin use nearly doubled.

To gather more details, the investigators interviewed 103 patients. Patients unanimously reported a preference for the old version of OxyContin, even though 24% of them had found a way around the abuse-resistant formulation. Most (66%) indicated that the release of the abuse-resistant formulation led them to switch to another opioid, with heroin being the most common choice.

As the authors conclude, “abuse-deterrent formulations may not be the ‘magic bullets’ that many hoped they would be in solving the growing problem of opioid abuse.” Indeed, it appears that the new OxyContin formulation, while achieving the obvious goal of reducing OxyContin abuse, may have caused more problems than it solved by pushing abusers toward heroin, a drug that “may pose a much greater overall risk to public health.” Clearly, a more comprehensive strategy is needed to help these individuals who are suffering from opioid addiction and fight the prescription drug abuse epidemic.

Reference
Cicero TJ, Ellis MS, Surratt HL. Effect of Abuse-Deterrent Formulation of OxyContin. N Engl J Med. 2012;367:187-189.

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