Abuse-Deterrent OxyContin Produces Unexpected Outcome
(HealthDay News) – Introduction of an abuse-deterrent formulation of OxyContin correlated with a significant reduction in its abuse, but was accompanied by an increase in abuse of other opioids and heroin, according to a letter published in the July 12 issue of the New England Journal of Medicine.
Theodore J Cicero, PhD, from Washington University in St. Louis, and colleagues examined the effect of the introduction of an abuse-deterrent formulation of OxyContin using data collected from July 2009–March 2012 from self-administered surveys, completed by 2,566 patients with opioid dependence, for which the primary drug of abuse was a prescription opioid. Qualitative data were collected from 103 of these patients.
The researchers found that there was a significant decrease in OxyContin as the primary drug of abuse, from 35.6% before introduction of the abuse-deterrent formulation to 12.8% 21 months later. This was accompanied by a slight increase in the selection of hydrocodone and other oxycodone agents and a marked increase in other opioids, including high-potency fentanyl and hydromorphone, from 20.1% to 32.3%. For all the opioids that were used by respondents to get high at least once in the past 30 days, OxyContin decreased from 47.7% to 30% of respondents, while heroin use nearly doubled. Twenty-four percent of patients interviewed had found a way to defeat the abuse-deterrent OxyContin and 66% had switched to another opioid, most commonly heroin.
"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," the authors write.