* "Abuse-deterrent" formulations may not be magic bullet
* Heroin more worrisome because of HIV, hepatitis risks
By Gene Emery
July 11 (Reuters Health) - U.S. drug abusers may be more
likely to turn to heroin now that they are finding it harder to
snort, inject or smoke a new formulation of the pain-killing
opiate OxyContin, researchers said.
The reformulation was introduced in August 2010 by
manufacturer Purdue Pharma to make it more difficult to crush
the medicine into powder, greatly reducing its appeal to
But the change may be causing a shift to heroin and other
drugs, researchers said in a letter published on Wednesday in
the New England Journal of Medicine bit.ly/ORiJss.
In recent interviews, only about 13 percent of addicts with
an opioid dependence said OxyContin was their primary drug of
abuse, compared to about 36 percent before the new version of
the prescription tablet became available.
In the same time period, heroin use doubled among those
surveyed. That jump accounted for nearly all of the increase in
the use of opioids other than OxyContin, including high-potency
fentanyl and hydromorphone.
"They didn't stop (abusing drugs). They turned to something
else," said Theodore Cicero of Washington University in St.
Louis, lead author of the letter detailing the results. "We
should have asked the question, 'If they stop using the most
popular drug out there, what are they going to turn to now?'"
Cicero said that when the drug first came out, OxyContin
"was advertised by the company and the Food and Drug
Administration (FDA) as having a very low abuse potential"
because of the slow-release formula.
"What they didn't take into account was that the pill was
pretty easy to crush," allowing addicts to snort or inject it to
get an immediate rush, Cicero told Reuters Health.
The new formulation becomes a harder-to-manage gel when put
in water, or becomes too chunky to snort easily when crushed.
MANY SWITCH TO HEROIN
Cicero and his colleagues gathered their data from anonymous
surveys of more than 2,500 addicts. In addition, 103 agreed to
be interviewed, online or by telephone.
Getting around the tamper-resistant reformulation is
possible, and about a quarter reportedly did so. Yet "a lot of
work is entailed in doing that," said Cicero.
Two-thirds "indicated a switch to another opioid, with
'heroin' the most common response," the researchers reported.
The jump in heroin use came in the second quarter of 2011,
six months after OxyContin use began a long slide.
"The most amazing thing was how quickly it dropped because
they weren't able to extract the drug anymore. They switched to
drugs that were potentially more harmful to them," said Cicero.
The researchers quoted one respondent as saying, "Most
people that I know don't use OxyContin to get high anymore. They
have moved on to heroin (because) it is easier to use, much
cheaper, and easily available."
Heroin is more worrisome because intravenous use increases
the risk of HIV and hepatitis, and the heroin is often cut with
dangerous chemicals, said Cicero.
"Thus, abuse-deterrent formulations may not be the 'magic
bullets' that many hoped they would be in solving the growing
problem of opioid abuse," he and his team concluded.
In May another group of researchers reported a similar
decline based on 11 months of data from patients in 324 drug
treatment centers throughout the United States.
That study assessed the experience of patients during the
first 11 months after introduction of the new tablets. It found
that before the reformulation, about a quarter of people abusing
prescription opioids were doing it with OxyContin. The rate
subsequently fell to about one in eight.
According to that study, led by Dr. Ryan Black of Inflexxion
Inc., in Newton, Massachusetts, those reporting that they
snorted, injected or smoked the drug fell to 5 percent. It had
been 18 percent.
But the rate of oxymorphine abuse more than doubled, going
from about 2 percent to 4.5 percent.
"We need to look at the demand side" when dealing with the
problem, said Cicero. "Drug abuse is like a balloon. If you
crush one side of the balloon, the volume doesn't go away, it
just pops out somewhere else."
(Editing by Ivan Oransky and Xavier Briand)