Tightening the Rules on Oxycontin Pushes Abusers and Pain Sufferers Toward More Dangerous Drugs


"The most unexpected, and probably detrimental, effect of the abuse-deterrent formulation was that it contributed to a huge surge in the use of heroin," reads a letter in the New England Journal of Medicine, written by researchers at the University of Washington: 

"We're now seeing reports from across the country of large quantities of heroin appearing in suburbs and rural areas. Unable to use OxyContin easily, which was a very popular drug in suburban and rural areas, drug abusers who prefer snorting or IV drug administration now have shifted either to more potent opioids, if they can find them, or to heroin."

Since the researchers started gathering data from patients admitted to drug treatment centers, the number of users who selected OxyContin as their primary drug of abuse has decreased from 35.6 percent of respondents before the release of the abuse-deterrent formulation to 12.8 percent now.

When users answered a question about which opioid they used to get high "in the past 30 days at least once," OxyContin fell from 47.4 percent of respondents to 30 percent. During the same time period, reported use of heroin nearly doubled.

In addition to answering a confidential questionnaire when admitted to a drug treatment program, more than 125 of the study subjects also agreed to longer phone interviews during which they discussed their drug use and the impact of the new OxyContin formulation on their individual choices.

"When we asked if they had stopped using OxyContin, the normal response was 'yes,'" Cicero says. "And then when we asked about what drug they were using now, most said something like: 'Because of the decreased availability of OxyContin, I switched to heroin.'"

Jacob Sullum wrote about this phenomenon last year, when Ohio reported that its OxyContin diversion efforts had made the pills more expensive, and thus heroin more alluring.  

And because prescribing Oxy is tantamount to inviting a DEA audit, doctors are prescribing methadone more often, which accumulates in the system over time and can depress breathing. As a result, deaths from methadone are on the rise, says a new report from the Centers for Disease Control: 

Increased use of methadone since 1999 might have been prompted by growing costs of treating pain with opioids and increasing reports of abuse of other, more expensive, extended-release opioids (1). Overdose reports and interventions by FDA and DEA might have resulted in declines in the amount of methadone distributed and methadone-related fatal overdoses in 2008, although the number of methadone prescriptions did not decline. The parallel trends in the amount of methadone distributed for use as a pain reliever and in the methadone mortality rate are consistent with methadone prescribed as a pain reliever being the primary determinant of methadone mortality rates (1,3).

Data suggest that some of the current uses of methadone for pain might be inappropriate. According to an analysis conducted by FDA, the most common diagnoses associated with methadone use for pain in 2009 were musculoskeletal problems (such as back pain and arthritis) (46%), headaches (17%), cancer (11%), and trauma (5%). Most methadone prescriptions were written by primary care providers or mid-level practitioners (e.g., nurse practitioners) rather than pain specialists. Nearly a third of prescriptions appear to have been dispensed to patients with no opioid prescriptions in the previous month (i.e., opioid-naïve patients) (10).