Making OxyContin harder to abuse led to more deaths, study suggests

The reformulation of OxyContin in 2010 may have had the unintended consequence of driving up heroin overdose deaths, a new working paper suggests. 

Purdue Pharma, which makes the addictive painkiller, reworked the drug in an effort to deter people from crushing it up or liquefying it to get a faster, harder high.

The 2010 formula made the drug turn instantly to a gummy mess if someone tried to crush it. 

The move did work to make OxyContin itself harder to misuse – but it had the unintended consequence of driving more people to heroin instead, the National Bureau of Economic Research study suggests. 

Heroin overdose death rates began to climb more steeply following the August 2010 introduction of ‘addiction-deterrent’ OxyContin, the study’s data suggest 

The vast majority – 80 percent – of people who use heroin started down the road to addiction with prescription opioids, according to the National Institute on Drug Abuse (NIDA).  

OxyContin, the blockbuster painkiller introduced in 1996, has been widely cited as one of the most significant drivers of the opioid epidemic that now has a firm hold on millions of Americans. 

In the past year, several states have filed lawsuits against the drug’s maker, Purdue Pharma – among other opioid manufacturers – and famed photographer Nan Goldin launched her own petition against the company. 

But these lawsuits and campaigns are hardly the first time that OxyContin’s dangerously addictive qualities have been brought to the attention of the company.

When it was introduced, OxyContin quickly became a favorite for doctors to prescribe because the drug was inexpensive. 

More importantly, the pill had a higher content of oxycodone, the active ingredient responsible for the ‘high’ associated with painkillers because it was intended to provide an ‘extended release’ over a 12-hour period. 

But OxyContin could easily be crushed up and snorted or reduced to an injectable liquid, delivering more of the drug to a person’s system faster. 

The drug became a quick hit in illicit and hard-partying circles.

Everyone from average men and women on the street, to celebrities and the high-powered and wealthy got hooked, including billionaire Matthew Mellon, who has passed away at a rehabilitation facility in Mexico. 

The banking heir and former husband to Jimmy Choo show mogul Tamara Mellon traced his own battle with opioid addiction back to an OxyContin prescription he was written after surgery for a surfing injury many years ago.  

Between 1991 and 2011, prescription rates tripled and oxycodone drugs cornered a full quarter of that market. 

By 2010, however, word had gotten out that OxyContin was uniquely formulated in a way that made it all too easy to abuse. 

In response, Purdue Pharma went back to the chemical drawing board, and released an ‘addiction deterrent’ version of its star drug. 

To keep consumers from inhaling or injecting a full powerful dose all at once, they created a pill that turned into a gummy substance when you tried to crush it up. 

Purdue completely phased out the old, easily crushed version and replaced it with the new self-destructing formula in August 2010. 

According to the new study, the strategy worked. Sales of the drug had been on a steady upward trend, but fell sharply for a brief period after the new formula was introduced, and indeed continued to decline slightly thereafter. 

But the opposite happened to the heroin market, the researchers from Notre Dame University and Boston University suggest.

‘Unfortunately, at the time of the reformulation, there was a readily-available and inexpensive substitute for OxyContin: heroin,’ the authors wrote.  

Almost immediately following the formula switch, heroin deaths shot up, especially in areas along illegal import and trade routes for the drugs. 

As OxyContin became harder to get a high from, more and more people switched to heroin.  

The researchers estimate that the heroin death rate in the US tripled following the introduction of the new OxyContin formula, which they call the ‘precipitating event’ to the the lethal substitutions.   

Meanwhile, ‘a back-of-the-envelope calculation suggests that in the long run, the reformulation might only prevent a combined 120 opioid and heroin overdose deaths per year’ the study authors wrote. 

They also point out that, unlike OxyContin, heroin can be combined with the more concentrated fentanyl, which has been widely recognized as a primary reason that the opioid epidemic is so deadly.  

Dr Andrew Kolodny, executive director of Physicians for Responsible Opioid Prescribing, says that fentanyl is the real culprit of the spike in heroin-related deaths. 

‘The very sharp increase in deaths that we’ve seen in the past few years among heroin users starts to occur around the same time that OxyContin was reformulated, but the heroin supply became more dangerous due to fentanyl,’ he says. 

Dr Kolodny asserts that the upward trend in switches from prescription opioids to illicit ones – among the ‘young white Americans’ that have sparked the deep concern gripping the US currently – began in the late 1990s and has continued steadily. 

‘We don’t see, after the reformulation, a sharp increase in switching, we see a sharp increase in deaths involving heroin’ Dr Kolodny says. 

‘Until fentanyl emerged’ – most notably in 2012, two years after the reformulation – ‘switching from OxyContin to heroin didn’t really mean much.’ 

Though he doubts that the reformulation is such a primary driver as the new study purports, Dr Kolodny concedes that switching from pure, carefully formulated OxyContin to powerful, inconsistent fentanyl could well contribute to the surge in deaths related to heroin.