Abuse-Deterrent OxyContin Produces Unexpected Outcome

OxyContin abuse down, but increase noted in use of alternative opioid medications and heroin

THURSDAY, July 12 (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, Ph.D., 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 through 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 percent before introduction of the abuse-deterrent formulation to 12.8 percent 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 percent. 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 30.0 percent 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 percent 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.

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