Why Reformulating Painkillers is No Solution to Oklahoma’s Pill Abuse Problem
In the last several years, there's been a trend toward the reformulation of prescription opioids so as to prevent their abuse. The first announcement came in April 2010 from the Food and Drug Administration. “The U.S. Food and Drug Administration today approved a new formulation of the controlled-release drug OxyContin that has been designed to help discourage misuse and abuse of the medication,” their press release said. While there might have been good intentions to prevent people from becoming addicted or overdosing by changing this formulation, that is not and will never be an effective solution. We’ll explain why.
The Backstory
Here’s a little background on why the FDA would want painkillers reformulated and why OxyContin was the first one to go through this change. In general, painkillers do not last very long. So patients with chronic or around-the-clock pain needed to take a pill every few hours. OxyContin was originally formulated as a time-release painkiller to appeal to these people who had to pop pills several times a day. Only one OxyContin pill every 12 hours was needed because the pill was designed to release the painkiller slowly—or so the marketing claimed. (In practice, many patients began to suffer again after eight hours.)
The prescribing instructions for OxyContin actually give this drug’s secret away: “Abuse, or misuse of OXYCONTIN by crushing, chewing, snorting, or injecting the dissolved product will result in the uncontrolled delivery of oxycodone and can result in overdose and death.” By crushing, chewing, snorting or dissolving the drug, you circumvent the time-release formulation and send the entire dosage of the pill into your bloodstream. Conveniently, the directions on how to abuse the pill were printed and sent with each bottle.
As the word went out on how easy it was to get high with OxyContin, more people began to show up in emergency rooms with problems due to opioid misuse. Between 2004 and 2008, hospital visits due to nonmedical use of opioid analgesics increased from 144,600 in 2004 to 305,900 in 2008. And they only kept going up after that.
The Federal Government Goes After OxyContin Manufacturer
In 2007, federal attorneys in Virginia went after Purdue Pharma for their overly aggressive marketing tactics that made this addictive drug wildly popular. As three top executives pleaded guilty to misleading marketing, the company issued a statement: “(S)ome employees made, or told other employees to make, certain statements about OxyContin to some health care professionals that were inconsistent with the F.D.A.-approved prescribing information for OxyContin and the express warnings it contained about risks associated with the medicine.” In other words, these employees told doctors that OxyContin was not addictive and that it could be used freely to keep patients from suffering from pain. But it soon became apparent that people were becoming addicted as they followed their doctors’ instructions. And of course, others were becoming addicted after crushing and abusing these pills that had not been reformulated yet.
After this case was settled, Purdue began to work on the reformulation. In their new formula, the active ingredient, Oxycodone, was embedded in material that would become gummy if a person tried to crush, chew or dissolve the pill. OxyContin quickly became a less popular drug of abuse.
Why This Isn’t an Effective Solution
There’s two main reasons. The first is that the pill can still be abused by simply swallowing more of them than directed. The second reason should have been predicted by anyone connected with this situation in any way: This change would drive many people to find heroin as an alternative. Which is exactly what happened. It also helped that heroin was much cheaper than OxyContin.
By 2015, the Centers for Disease Control and Prevention reported that the number of people using heroin had increased 150% in six years. Along with this increase came increased overdoses and deaths due to the unpredictable potency of heroin and adulterants like Fentanyl, another opioid vastly stronger than heroin or Oxycodone.
Oklahoma has struggled with high rates of prescription drug abuse for several years. In June 2016, a new report from the Substance Abuse and Mental Health Services Administration again placed Oklahoma at the top of the prescription drug abuse list.
As more painkillers are reformulated to prevent abuse, more people are going to migrate to heroin. This situation practically begs heroin traffickers to move more of their product into the state. Oklahoma has enough of a problem with painkillers. We don’t need to add the unpredictability and potency of heroin and its additives to the problem. By doing so, we would only lose more of our friends and neighbors.
