Narcotic painkillers that have features that make them hard to abuse may be linked to a drop in both the number of prescriptions and overdoses of these drugs, a new study finds.
Overdoses drop by 20%
After a tamper-resistant form of OxyContin was introduced in 2010, prescriptions dropped 19 percent and the rate of overdoses dropped 20 percent across the United States. However, the rate of heroin overdose increased by 23 percent during the same period, the researchers added.
"This is the first time in the last two decades that narcotic prescribing had dropped, rather than continued to increase," said lead researcher Dr. Marc Larochelle, an instructor at Boston University School of Medicine.
And painkiller overdoses also decreased, he added. "Some were sceptical that simply decreasing supply would lead to a decrease in overdoses, but we did find that," Larochelle said.
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However, since heroin overdoses increased, the overall rate of overdoses from narcotics didn't decline, he explained.
"Reducing supply may have led some people who are abusing these drugs to substitute an illicit narcotic like heroin, and it may partially explain why we have seen an explosion in heroin use across the country," Larochelle said.
Larochelle pointed out that when the tamper-resistant form of OxyContin was released, the prescriptions for this drug dropped 40 percent. Larochelle speculates that this drastic drop in prescriptions could be the result of fewer people abusing OxyContin or more of it being sold on the street. "Up to 40 percent of the product may have been abused or diverted to the street," he said.
Resistant to crushing and dissolving
The new abuse-deterrent OxyContin is resistant to crushing and dissolving, both ways to bypass the extended-release mechanism and get a quicker, more intense high, the researchers said.
"With the pill, you used to be able to crush it up and either snort it or dissolve it and inject it. Now if you try and crush it, it doesn't turn into a powder – it just kind of balls up, and if you try and dissolve it, it turns into a goo," Larochelle explained.
Changing the formulation will not by itself solve the drug abuse problem, he said. "But it shows supply could be one part of the issue. Abuse-resistant formulations will not cure people who are addicted to narcotics. It could, however, prevent or slow down the number of new people who become addicted, because many people who use heroin may have started with pills," he said.
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Larochelle believes better access to treatment is needed for those addicted to narcotics. "We still need to focus on identification, diagnosis and treatment of people who have an addiction, not only on the supply chain," he suggested.
The report was published online April 20 in the journal JAMA Internal Medicine.
Dr. Hillary Kunins, an assistant commissioner in the New York City Department of Health and Mental Hygiene and author of an accompanying journal editorial, said making these long-acting narcotic painkillers tamper-resistant reduces the dangers of these drugs.
Preventing unnecessary exposure
"However, this is only part of the response we need to make to the problem of narcotic misuse and overdose," she said. One way to prevent addiction in the first place, Kunins said, is by prescribing narcotic painkillers judicially.
"We seek to reduce or prevent the unnecessary exposure to narcotics and that's got to be part of the solution so people don't end up trying other narcotics like heroin or other prescription painkillers," she said. "We encourage the public to use narcotic painkillers only when needed and only for as long as needed, and if there are extra pills dispose of them safely."
In addition, people already addicted to narcotics need to have effective treatments available, Kunins said.
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Kunins said that although the rate of heroin overdoses increased, the increase was not significant. "We are not trading one problem for another," she added.
For the study, Larochelle and colleagues used data from a large health insurer with 31 million members. They looked at claims for narcotic painkillers from 2003 through 2012.
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