One of the most powerful and addictive painkillers on the market, OxyContin, used to the drug of choice for addicts, who would crush the pill to snort or inject. However, in 2010, the formulation of OxyContin changed to an anti-abuse formulation, which meant that if it was crushed it would gel up instead of become water-soluble. It is because of this change in formulation that researchers have noted a drastic fall in overdose rates, because people are not able to use the oxycodone in the same way they once did. When the formulation of OxyContin changed, so did the overdoses and prescribing of the drug, and this also was due to another painkiller being taken off of the market in 2010.
Darvon, which is also known as propoxyphene, was taken off the market the same year as the OxyContin changes, mostly due to the risk of cardiac arrest, which was due to people abusing the drug. The deal with Darvon was that it was so weak in terms of opiod properties that addicts would take a handful of the pills to get high, but those pills contained other ingredients and chemicals, which actually lead to heart failure and kidney failure. If you took a lot of Darvon you would get toxicity in the blood before you would get high, so it was not related to people overdosing from the opioid component of the drug, it was the horrid toxicity that would lead to heart failure, then death.
The changes in the OxyContin and Darvon being taken off the market led to a substantial decrease in the amount of opioid prescriptions being written. There was a 19 percent decrease in the amount of prescriptions being written after the changes, and also a 20 percent decrease in overdoses as a result. According to JAMA International Medicine, the decrease in 2 years time could have supplied 5 percent of the population with a 5 milligram oxycodone each day during the fourth quarter of 2012.
Dr. Marc Larochelle, who works at Harvard Medical School and the Boston University School of Medicine decided to look at prescribing data from 31 million different commercial health plan members. Dr. Larochelle and the other researchers also noted that the average level of morphine-equivalent dose, MED, increased though between 2003 and the third quarter of 2010. In that time, the MED for commercial health plan members rose from 95 milligrams to 163 milligrams. Once the changes went into effect, it dropped 14.8 milligrams, then down to 139 milligrams per member overall in 2012. Dr. Larochelle noted that the voluntary changes by the drug companies are a great way to stem the prescription drug abuse problem, noting that you still can’t cut off opiates to those who truly need them. While prescribing these drugs less often is a good thing overall, those who need access to these medications should not have to go without because people are abusing them.
One bad thing about the changes in drugs like OxyContin is that people have began moving towards heroin instead. Since you can snort and inject heroin, it has become the drug of choice for addicts looking for that high, which they now cannot get through OxyContin. The number of heroin overdoses during the study period rose by 23 percent, which is not a fluke. The rise in heroin use is also due to demand still being high for opiates, but doctors prescribing the painkillers less, which means addicts have to go to other avenues to get their high. OxyContin was termed as “hillbilly heroin” for a reason, because the high is similar to that of heroin, just in a safer pharmaceutical form. With the changes in the formulation though, people are now turning to heroin, and it’s also a lot cheaper than pills on the market. More research and treatment needs to be done to be able to help these people who are moving from the pills to the heroin, and stopping painkiller prescriptions will not cure that.
