Study: With OxyContin harder to misuse, abusers shift to harder drugs

A reformulation of OxyContin that makes the pills harder to crush or dissolve has led to less abuse, a new study finds. But abusers turned to more potent opioids, including heroin – evidence that demand is what most needs tackling.

The OxyContin craze that swept America beginning in the early 2000s appears to be fading, thanks to a reformulation of the pills that deters recreational users from abusing them. The bad news is that almost all illicit users of OxyContin have switched to more potent medications – and to heroin.

Those are the unanticipated results of a new study, and they underscore the challenges inherent in dealing with drug addiction, says Theodore Cicero, a professor of psychiatry at Washington University in St. Louis and one of the study's authors. 

Cutting off the supply of illegal drugs, he says, is a worthy goal, but to make a real dent in addiction, a comprehensive approach that addresses demand for drugs is needed.

“There is a percentage of the population that is going to, that wants to, use and abuse drugs. The treatment of the problem can’t just be focused on the drugs they’re taking,” says Dr. Cicero. “If there’s a demand there, it will be met.” 

To try to eradicate abuse of OxyContin, a prescription painkiller, Purdue Pharma in August 2010 changed the pill's formula. OxyContin contains oxycodone, derived from the opium poppy, and some illicit users had been crushing and snorting pills or dissolving the tablets to inject the drug, which delivers a heroin-like high. The new formulation makes it harder to do that.

To conduct their research, scientists tracked more than 2,500 opioid abusers from July 2009, before OxyContin’s formula change, through March 2012. They had 39 treatment centers around the US distribute surveys to drug users that asked them to list their primary means of getting high. Respondents then sent their answers directly to the research team. That way, users could give honest answers, without revealing prohibited drug use to treatment staff. Researchers also interviewed 103 of the opioid users.

The scientists expected that OxyContin abuse would fall after the reformulation, and their hypothesis was borne out. Their study was released Wednesday.

“But it appears that what they turned to was actually much more potent opioids,” like oxymorphone, hydromorphone, and fentanyl, says Cicero. “A number also switched to heroin, which I think was the most unexpected finding." Twenty percent of users reported that heroin was their drug of choice by March 2012, as opposed to 10 percent in 2009.

Abuse of legal prescription drugs, especially painkillers, has become a leading cause of accidental death in the United States. Painkillers now are responsible for more deaths than are heroin and cocaine combined, according to the Centers for Disease Control and Prevention.

However, heroin is the more dangerous drug, because of its varying levels of purity and potential adulterants, experts say. Some reports suggest that it’s also cheaper and more available than it used to be.

“We are seeing some possible evidence that heroin may be increasing in prevalence in some areas around the country,” says Wilson Compton, director of the division of epidemiology, services, and prevention research at the National Institute on Drug Abuse.

“Unfortunately, what we’re seeing in this report is that you can push down on one area, but [drug abuse] may pop up in another area,” he says.

Evidence is mounting that some prescription-drug abusers are switching to heroin, Dr. Compton says. That’s a potential reversal from the past, when heroin users would switch to pills because they were unable to find heroin.

The boom in OxyContin abuse was accompanied by rising burglaries at pharmacies, forcing pharmacists to keep the painkiller under lock and key. It also spawned a sizable black market, as patients sought prescriptions from multiple doctors in a bid to resell the pills to addicts.

Both Compton and Cicero say a greater focus on prevention and treatment is what's needed.

As a means of prevention, Cicero says, it’s more important to figure out what drives abuse in the first place. Among teenagers, he says, “there’s a lot of anxiety, they have depression, and most importantly, they lack self-esteem. A lot will say, ‘When I’m on drugs, I feel better and I’m able to interact,’ and so we need to take into account why people are taking drugs. Perhaps we ought to focus more on psychiatry."

Compton says an educational and evidence-based approach is one promising way of intervening and preventing all users, starting with teens, from experimenting with prescription drugs in the first place.

“If we can do something about [the demand], we can do something about the raging epidemic of opioid abuse and prescription-drug abuse,” says Cicero.