This is for our pain doctors.
Abuse-deterrent formulations (ADFs) of opioid analgesics can have the intended purpose of curtailing abuse, but their effectiveness has “clear limits,” a new study confirms.
Theodore J. Cicero, PhD, and Matthew S. Ellis, MPE, from Washington University, in St. Louis, Missouri, found that introduction of ADF oxycodone (OxyContin, Purdue Pharma LP) led to an initial steep decline in abuse of this widely prescribed opioid, but this was followed by a plateau, resulting in “significant” levels of residual abuse.
The investigators also observed an uptick in heroin use after the introduction of ADF OxyContin, as has been observed previously.
“This change is a matter of considerable concern from a public health perspective given the toxicity of heroin in terms of overdose deaths, problems associated with injection and the transmission of infectious disease, crime, and so forth,” the authors write.
The study was published in JAMA Psychiatry.
Rise in Heroin Use
In 2010, as reported by Medscape Medical News at that time, the US Food and Drug Administration approved reformulated OxyContin to mitigate the risk for overdose. Instead of turning to a powder that can be injected, chewed, or snorted, the new formulation turns into a gummy gel when crushed.
To examine OxyContin abuse patterns and behaviors, Dr Cicero and Ellis surveyed 10,784 men and women in their early 40s who had opioid use disorder and who were entering one of 150 drug treatment programs across the United States. They also interviewed a subset of these individuals.
The investigators report that ADF OxyContin led to a significant decline in past-month abuse after its introduction (from 45% in January–June 2009 to 26.0% in July–December 2012, P < .001). However, this decline leveled off, with 25% to 30% of new patients entering treatment reporting past-month abuse from 2012 to 2014.
In interviews with 51 participants, the researchers discovered that 70% of those who stopped using ADF OxyContin started using heroin instead.
Among 88 individuals who continued to abuse ADF OxyContin, 43% said they changed their preferred route of administration from injected or inhaled to the oral route; 34% managed to defeat the ADF OxyContin mechanism and continued to inject or inhale the drug; and 23% exclusively swallowed the pill regardless of formulation.
“Whether other, more improved ADFs currently under development might discourage any abuse or misuse of opioids remains to be determined,” the researchers write. “We hope that pharmaceutical firms can devise future ADFs that are even more tamper resistant than the current ADF OxyContin.”
They add, “although drug abuse policy should focus on limiting supplies of prescription analgesics for abuse, including ADF technology, efforts to reduce supply alone will not mitigate the opioid abuse problem in this country.”