For those who have severe chronic pain, the advantage of OxyContin over other prescription painkillers is that it lasts for 12 hours. For those who like to get high on opioids, the great thing about OxyContin is that if you crush it and snort it, or mix it with water and inject it, you get 12 hours' worth of oxycodone all at once. "So basically they get a really big high," Bob Jamison, a professor of anesthesiology at Brigham and Women's Hospital in Boston, tells Popular Science.
Those injectors and snorters have plenty of company. Prescription opioids—drugs that work similarly to opium, including OxyContin, Vicodin, Percocet and others—are the number-one cause of drug overdose deaths in the U.S. That includes overdoses from illegal drugs such as heroin and cocaine. In 2010, prescription opioids accounted for 44 percent of all U.S. overdose deaths. It's a huge problem and drug companies are turning to a solution they know very well: chemistry.
Purdue Pharma first introduced OxyContin in the 1990s. The new pill combined the well-known pain reliever oxycodone with Purdue's own long-acting formula, which slowly released oxycodone once a pill made its way into the digestive system. Because swallowed OxyContin didn't provide a big, front-loaded hit of opioid, Purdue advertised it as nearly addiction-proof, Fortune reported. It turned out to be almost exactly the opposite.
In 2010, Purdue quietly introduced a new formula that made OxyContin pills weirdly difficult to crush or dissolve in water, hoping to undercut the ways people had discovered they could get a super-sized opioid hit from long-acting OxyContin. Three years later, studies are just beginning to show that crush-resistant chemistry does seem to reduce OxyContin abuse. Whether it reduces drug abuse overall is another question. Preliminary findings suggest those who used to abuse OxyContin are simply replacing it with other prescriptions or with heroin.
Meanwhile, researchers are working on several other ways of making painkillers physically more difficult to abuse. Nothing else is on the market yet, but the experts I talked to said to expect companies to try. "It's a booming industry," Jamison says.
If drug abusers respond to new formulations the way they have for OxyContin, this may mean a reduction in prescription pill abuse, although not necessarily an overall reduction in drug abuse. Instead, pharmaceutical companies will simply, finally be able to shift some blame for abuse away from their own products.
For Purdue Pharma, at least, that blame has been costly. In 2007, the company settled with U.S. federal agencies in a criminal court, paying $634 million and pleading guilty to misleading the public about OxyContin's potential for addiction.
The technology that goes into the new, crush-resistant, long-lasting OxyContin is called Intac, and it's made by the German company Grünenthal. A pill made with Intac begins life a little differently than the standard tablet, says Alexander Kraus, vice president for product development at Grünenthal USA.
Most tablets start as a powder mixture that includes the active medicine and any other inactive ingredients that may, for example, help stabilize the active ingredients. Machinery presses the powder into a pill. Crushing the pill into snort-able or dissolve-able grains is just taking it back to its original form. "If you take that tablet and put it between two spoons, you typically would be able to crush it back into the powder component," Kraus says.
OxyContin, on the other hand, starts as oxycodone, plus a plastic-like polymer material made of long-chain molecules. When heated, the polymer enters a molten phase, Kraus says. The manufacturing process forms tablets out of the hot, semi-liquid stuff and then cools them until they are solid, at which point the oxycodone is embedded in the solid polymer. The final pills have a "plasticky type of solid, monolithic form," Kraus says.
"It's not hard like a rock," he says. "It has some plasticity, so if you bang on it, it will deform, but it will not shatter, and that's the trick."
Another cool trick? If you try to dissolve the new-formulation OxyContin in water or alcohol, it forms a thick, stringy goop that's difficult to inject.
Other chemical blocks in different stages of research include putting little packets of opioid antagonists—think of them as opioid antidotes—into pills. If an abuser crushes the pills, he or she opens the packets, releasing the antagonists, which prevent the opioid from working. The packets are supposed to stay sealed if taken by mouth, however, so that the pills continue to work for legitimate patients.
Some companies are working on molecules that require something in the digestive system, such as an enzyme, to activate the opioid. It's as if both the painkiller and the euphoric effect of the medicine are locked up and there's no way to unlock them without first putting them through your entire GI tract.
When Purdue first came out with the reformulated OxyContin, it wasn't allowed to say the new pill was abuse-deterrent because there wasn't yet evidence it made a difference to abusers. It sounded like it should work, but who's to say? "Drug users can be very inventive and so your best efforts may not work very well in practice," says Wilson Compton, director of epidemiology, services and prevention research at the U.S.' National Institute on Drug Abuse.
Now, just enough time has passed for researchers to check the effects of having the new OxyContin on the market for a few years. This past April, the U.S. Food and Drug Administration approved an abuse deterrent claim on OxyContin's label based on newly published scientific studies.
Nearly all of the studies were funded by Purdue. That doesn't necessarily mean they're biased. It's common practice for drug companies to bankroll the surveillance of their own products, and of course Purdue would like to know if Intac actually works. It helps that there have been several studies that ask slightly different questions about Intac's effect on abuse and together, they point toward Intac working, Compton says.
"The effect is significant and appears to be clinically meaningful," he says.
Studies based on the industry-funded Researched Abuse, Diversion and Addiction-Related Surveillance system found that since the introduction of Intac-enabled OxyContin, the amount of the drug diverted for abuse fell by up to 60 percent. The number of poison control calls about overdosing on OxyContin fell by 42 percent. The median street value of a new OxyContin pill is 63 cents a milligram, compared to $1 a milligram for the old pill.
In one study of people treated at rehab centers, scientists from the research company Inflexxion and Purdue Pharma found that since the new OxyContin came onto the market, abuse fell by 41 percent.
One dissenting study comes from RTI International, which did not receive Purdue funding. In a nationally representative survey, the research nonprofit found OxyContin abuse rates didn't change much after the new OxyContin appeared on pharmacy shelves. It appears un-crushable OxyContin does put off a small number of users, specifically those that seem to use crushed OxyContin and heroin interchangeably, says Scott Novak, a statistician who performed RTI International's analysis. Take the effect to the overall population, however, and it's not significant.
Why wouldn't a plasticky pill put off OxyContin abusers? One possibility is that people have gotten around the Intac technology. Human ingenuity knows no bounds. Another is that not every abuser crushes his or her pills. It's still possible to get a high, though perhaps not as big of a rush, by taking OxyContin orally. Although detailed numbers on how many people crush versus how many people swallow are difficult to come by, it's widely acknowledged in the scientific literature that some abusers simply swallow the pills, and that they won't be affected by the new formula.
As for those who are deterred, some preliminary numbers show that they're replacing their pills with other drugs.
In a letter to the editor of the New England Journal of Medicine, researchers from Washington University in St. Louis and Nova Southeastern University in Florida found that in telephone interviews, the number of drug abusers who said they primarily abused OxyContin fell by 64 percent. At the same time, those same abusers reported higher rates of using other prescription opioid drugs and heroin, which is an opioid, if not a prescription one.
Richard Dart, executive director of the Researched Abuse, Diversion and Addiction-Related Surveillance program, says he also has preliminary data showing that those other abuses rise. It will be another year before he'll have the data fully analyzed. "I think it's clear they do go to the other drugs," he says. "I don't think anybody ever thought—I mean, why would they stop abusing?"
All the researchers I talked to acknowledged abuse-deterrent OxyContin's weaknesses in, well, actually deterring drug abuse. Yet most wanted to see chemical deterrents appear in more drugs. If it works, even a little, why not? seemed to be the attitude.
Why not indeed? Some experts have argued the new formulas may make painkillers more expensive, a cost legitimate, non-abusing patients will have to shoulder. Yet insurance companies may also find they prefer covering abuse deterrent pills because they know their money is going to legit patients, Novak argues. In reality, there's no way to know yet how the market will react.
Researchers had hoped that when people ran into crush-resistant OxyContin, they would take the opportunity to get clean, Compton says. Instead, they sought their high in other ways, which he calls "not a particularly satisfying outcome."
Ultimately, this is a problem that pharmaceutical chemistry can have only a small, if any, effect on. At best, drug companies working on abuse resistant formulas are covering their own liability.
"Fundamentally, I'd like to see core approaches, whether that's treatment for the underlying addiction, or prevention to keep people from going that direction in begin with," Compton says. "But anything that stops people from using this in a lethal way is helpful."
I like how the solution is to make drugs harder to do instead of... you know, not giving this sh*t out like candy.
Addicts will swallow the new pills... with alcohol... or vinegar... or baking soda... or whatever dissolves them the fastest... or just dissolve them and shoot up like nothin' to it.
We wouldn't even be discussing this problem if it hadn't been for what happened from 1914 to 1925.
Opiates were not considered to be a major problem in society until 1915. They were freely sold over-the-counter with few restrictions. Kids could buy the stuff. Heroin was included in some baby colic remedies, and cocaine was included in everything from soda pop to toothache drops to tobacco cheroots (crack cocaine). Before 1906, there no laws at all - not even any labeling or advertising laws. Drug sellers advertised their products as good for any ailment had by you or your mule, and even the Pope was in ads telling people to drink cocaine wine for the health benefits. Moreover, people didn't even know what they were taking because the contents weren't on the label.
Even under those conditions, we didn't have the major problems we had today. Addiction rates weren't much different than they are today, but addicts were not typically criminals.
Then, in 1914, a fairly small group of anti-drug zealots promoted the Harrison Narcotics Tax Act. On its face, the act appeared to be a simple licensing and regulatory act. The trick was that they placed a tax on the drugs that was so high that nobody would pay it. Then they arrested people for a tax violation, not a drug offense. It is clear from the history that few people realized this law would be recognized as a general prohibition.
Within a few months of the passage of the Harrison Act, medical societies across the nation were calling the law a medical, moral, social, and criminal disaster.
But they still had heroin maintenance programs for addicts which -- if they still existed - would make this Oxycontin thing a non-issue.
The newly-formed Federal Bureau of Narcotics didn't like heroin maintenance, so they prosecuted a Dr. Linder for giving heroin maintenance to his patients. The case went all the way to the US Supreme Court. The USSC ruled unanimously that the FBN had no business interfering in the doctor-patient relationship, even if the doctor was engaging in heroin maintenance.
In response, the FBN completely ignored the ruling and indicted thousands of doctors across the US. They deliberately sent the doctors wrong information about the court ruling. They never brought any cases to court, because they knew they would lose every time. However, no doctor wants to fight the Federal Government in court, so the indictments alone were enough to eliminate heroin maintenance programs forever. It was the first major abuse of the law by the FBN. It would be followed by many, many more.
And that's why we are discussing this problem now. If it hadn't been for the illegal abusive actions of the FBN, this would be a non-issue today. All those addicts could simply go to a doctor and get a properly maintained prescription.
Anyone who wants more info on the subject should read the following:
Licit and Illicit Drugs at http://druglibrary.org/schaffer/Library/studies/cu/cumenu.htm
The Drug Hang-Up at http://druglibrary.org/special/king/dhu/dhumenu.htm
Jailing the Healers and the Sick - the story of how heroin maintenance was stamped out at http://druglibrary.org/special/king/king1.htm
"...If it hadn't been for the illegal abusive actions of the FBN, this would be a non-issue today. All those addicts could simply go to a doctor and get a properly maintained prescription..." ~ wm97ab
All addicts could simply go to a doctor and properly maintain THEIR ADDICTION! Hello?! Is this a desired result?
Yea, I get your long winded argument; you want drugs to be free for all, while acting of nothing to the harmful effects of addictions.
GROW UP, " wm97ab "!
"As for those who are deterred, some preliminary numbers show that they're replacing their pills with other drugs."
Yeah, this is a problem with all these plans. Drug addiction is driven by anxiety-related disorders. If you don't deal with the underlying disorder then the problem comes back. The only thing that happens is that they choose another drug -- and often one that is far more harmful.
Heroin maintenance clinics in Europe show that opiate addiction can be successfully managed for most addicts as long as they get ongoing treatment from a doctor. Our own experience with pain patients taking morphine is also proof of that.
"All addicts could simply go to a doctor and properly maintain THEIR ADDICTION! Hello?! Is this a desired result? "
As many treatment experts will tell you, most methods of drug treatment only work for about five percent of people per year. It doesn't much matter whether you pat them on the head, throw them in jail, or whatever, only about five percent per year will come off of the addiction and be clean of drugs.
In other words, after about ten years, about half of all addicts will be clean, no matter what the method of treatment.
As many of these treatment experts have noted, it seems to be a process of maturation as much as anything else. Eventually, the addicts just get tired of being addicts and quit.
The major problem with that is that, because drug use is illegal, there are a lot of problems associated with it that could kill them, or infect them with dreaded diseases. Therefore, the plan used in the heroin maintenance clinics is to keep the addicts alive and healthy until they can get to that maturation point.
These clinics show good results. The rate of diseases among the addicts drops dramatically. Crimes committed by addicts drop by about eighty percent. Most of the addicts are able to hold down regular jobs. Overdoses fall to just about nothing, and the related medical costs are much, much lower. Even the cops -- who were once against it -- are now in favor of such programs.
and, BTW, it isn't any different than the way we currently treat severe pain patients. There are lots of pain patients getting morphine on a regular basis. If they are under good medical care, people can take morphine for decades without any significant medical problems.
You can read about one such heroin maintenance clinic, and the results, at http://druglibrary.org/misc/60minliv.htm
"Yea, I get your long winded argument; you want drugs to be free for all, while acting of nothing to the harmful effects of addictions."
Tell you what. Read the following book and get back to me:
That is the best overall review of the problem ever written. If you haven't read it then you simply don't know the subject. I can tell you haven't read it.
Purdue Pharma must be putting a real cramp in your stile of using OxyContin, ROFL..... ha ha.... funny!
Are you still a user or pusher or both?
Recovering pill popper checking in. Mallinckrodt, Actavis, and several other pharmaceutical companies still manufacture INSTANT release oxycodone pills (known as "roxies"). They are generally small 15-30mg green/blue pills and are just as easy, if not easier, to crush up and snort/inject as Purdue's old formula. These have become the prevalent prescription pills on the streets of San Francisco, where they go for ~65¢/mg. To put that in perspective, the old Purdue pills went for ~50¢/mg here and new Purdue ones are ~25¢/mg.
@wm97ab, I really appreciate your responses. They show that it's a matter of perspective more than anything. We have millions of people on doctor prescribed drugs who are kept healthy and millions of "street" abusers who overdose and/or commit crime as a result of their addictions. Unlike some of the knee jerk reactions on here, I can see the benefits of the system you described. How it can keep addicts from desperate acts, which leads to lower crime, death, costly prison terms, etc. Overall, the cost savings from such a plan would dramatically outweigh the costs of maintenance. All the prisons, guards, police, DEA, hospitals, and on and on and on that we spend money on because of drugs is just crazy, especially because they don't stop the addiction.
Most problems associated with drug use, legal or illegal, stem from addiction.
Addiction is a chronic, progressive brain disease. It's treatable. Perhaps not as successfully as one might like, but on a par with other chronic diseases that require substantial behavioral change, like diabetes and hypertension.
Unfortunately, many people still don't believe addiction is a disease. That's why science-based education is so important.
For a not-for-profit website that discusses the science of substance use and abuse in accessible English (how alcohol and drugs work in the brain; how addiction develops; why addiction is a chronic, progressive brain disease; what parts of the brain malfunction as a result of substance abuse; how that malfunction skews decision-making and motivation, resulting in addict behaviors; why some get addicted while others don't; how treatment works; how well treatment works; why relapse is common; what family and friends can do; etc.) please google AddictScience.
"and, BTW, it isn't any different than the way we currently treat severe pain patients. There are lots of pain patients getting morphine on a regular basis. If they are under good medical care, people can take morphine for decades without any significant medical problems."
I'm not sure it is the same. Addicts usually are addicts because of the high they get off of their drug of choice. Severe pain patients don't get that high. I know from experience. I've had severe low body pain since 2006. A doc last month told me he thinks it's small fiber fibromyalgia. I've been on 15 mg x3 per day of morphine (in the form of ms contin) for 5 years now. As well as gabapentin (900mg x3 per day) and, lortab (7.5/500mg as needed, which turns out to be multiple times per week, more in winter.)
I have yet to get any type of high feeling out of it. All of us have the same issue. If there is too much pain to cut through, the high feeling doesn't kick in. Most don't get the addiction either. I've gone cold turkey at various times both on accident (forgetting to take them or, running out before the refill was ready) and on purpose (having a good day or 2 and deciding I don't want to take some of the meds.)
I do get some physical withdrawal symptoms (usually in the form of diarrhea) but, I have no desire to take the medication. I HATE being on it actually. Most of us do.
Not saying that everything you have typed about our handling of drug use is wrong. Just that I don't think that is a good comparison to make.
This is genius
I'm sorry Popular Science. This is a crack pot article.
Being close friends with a number of opiate addicts myself, the new Oxy pill was nothing but a blip on their radar a few years ago, a casual mention while smoking a cigarette at best. They still crush their pills to snort or inject. The new formula has done nothing to curb their addiction, and I'm seriously skeptical of the studies cited in this piece.
The reason for all of this is...GENERICS! Generic oxycontin is still the old formula from before, and way more prevalent than the brand name prescription. It's nearly impossible to find brand name oxy on the street anymore because there is no demand. Demand is only for generics that use the same old powder. The strength of 80mg generic tablets are the same, and the price is generally the same. But now patients who sell their prescriptions make sure to get generics from the pharmacy when they get their monthly refill.
This story is a cute anecdote, but is seriously lacking in common sense and some actual real world experience. Check your facts, talk to people, come to your own conclusion.
There is a much simpler way of making an addiction free painkiller. It's called marijuana, treats the pain, inflammation, boosts immune response and shortens healing time. Any addictive behavior with this substance is purely psychological and indicative of a previously existing psychological condition which it usually also effectively treats, versus opiates creating an actual physical addiction that leads to the creation of psychological conditions and chemical dependency. The cool thing with marijuana is most patients automatically self regulate the dosage, they often start out using it very heavily but within a few days time they nearly always find a consistent lower amount that stays consistent throughout their course of treatment. I've never heard of a person turning to a life of crime such as prostitution to support their marijuana addiction, but it happens all the time with opiates. And long term opiates can lead to such great tolerance that in the end nothing works for the pain.
"I'm not sure it is the same. Addicts usually are addicts because of the high they get off of their drug of choice. Severe pain patients don't get that high."
I am aware that people with "real" pain don't get high from narcotics. The drug goes into already open pain receptors. I have known a lot of opiate patients with "real" (physical) pain.
Drug abusers typically show very high rates of things like ADD, ADHD, and PTSD - anxiety-related disorders. For example, some surveys have shown that as many as eighty percent of female heroin addicts report that they were sexually abused as children. Drug abuse is often an attempt at self-medicating their own anxiety disorders. They are doing what other people might do if they went to the doctor and got a prescription for Valium. They do get "high" or "escape reality" but, for them, that is the relief of their particular pain.
Research has already shown that even "real" (physical) pain is a combination of both physical and mental factors. The amount of each seems to vary in everybody.
The title of this article maybe should be, "How do you make a pain killer idiot proof"?
Their are a few who get hooked unaware of what the results will be, but they are not the abusers. The other group would eat a dog turd if they thought they could get high.
When I see the crazy things they do to make meth at home, I have a bad feeling that Purdue Pharma's experience from the 1990s to 2010 will be replicated.
I must admit that I am a recovering addict and when they released these OP's or at least the first time I had received them, less than an hour later after calling around and doing research I knew how to break down the binding agent using a particular process and tada. Not even an hour later I had the new OP (oxycontin) up my nose. I have never shot up any drug, but the process allows you to be able to break it down for IV. The desire is too strong, I wouldn't be surprised if someone with the pharmaceutical company sold the directions to the process to a contact. Too much money, fun and users to EVER stop this cultural enigma.
I must agree with the comment just above. This formulation was cracked the same month that it was released to pharmacies. The original method have been improved, but the fundamentals remain the same. Hence, formulation changes are not effective.
What's more, abuse by the oral route (chewing, for example) is by far the most prominent method. Formulations do nothing to reduce this method.
To understand the real motives behind these efforts, google the term "evergreening" as it relates to the pharmaceutical industry.