Oxycodone Formula Change Blamed for Rise in Heroin Use

Caroline Cassels

July 12, 2012

July 12, 2012 — A 2010 change in a controlled-release formulation of oxycodone (OxyContin, Purdue Pharma) that was intended to prevent abuse of the widely prescribed opioid has had the unintended consequence of causing many abusers to switch to heroin, new research shows.

Data from 2566 opioid-dependent patients at 150 treatment centers in the United States show that 21 months after the new formulation was introduced, OxyContin use in the study population dropped from 47.4% to 30%, but heroin use nearly doubled.

"Our data show that OxyContin use by inhalation or intravenous administration has dropped significantly since that abuse deterrent formulation came onto the market. So in that sense, the new formulation was very successful," principal investigator Theodore J. Cicero, PhD, Washington University in St. Louis, Missouri, said in a statement.

Unintended Consequence

However, he added, there was an unintended consequence.

"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, which is like OxyContin in that it also is inhaled or injected," said Dr. Cicero.

The new report appears in a letter to the editor in the July 12 issue of the New England Journal of Medicine.

In 2010, the US Food and Drug Administration approved the new formulation to mitigate the risk for overdose. Instead of turning to a powder that can be injected, chewed, or snorted, the new formulation turns into a gummy gel when crushed.

To examine the impact of the new formulation on the abuse of OxyContin and other opioids, the investigators collected quarterly data from July 1, 2009, through March 1, 2012.

The data were derived from self-administered surveys completed by 2566 opioid-dependent patients entering treatment programs and for whom a prescription opioid was the primary drug of abuse.

No Magic Bullet

The abuse of OxyContin as a primary drug of abuse decreased from 35.6% before the release of the new formulation to 12.8% 21 months later (P < .001). At the same time, the researchers report that use of hydrocodone and other oxycodone agents increased "slightly." However, use of other opioids, including high-potency fentanyl and hydromorphone, increased "markedly" — from 20.1% to 32.3% (P = .005).

"Although 24% found a way to defeat the tamper-resistant properties of the abuse-deterrent formulation, 66% indicated a switch to another opioid, with 'heroin' the most common response," the researchers write.

This unanticipated outcome of increased use of heroin and other opioids indicates that "abuse-deterrent formulations may not be the 'magic bullets' that many hoped they would be in solving the growing problem of opioid abuse."

Dr. Cicero said the findings may explain why so many law enforcement officials around the United States are reporting increases in heroin use.

"This trend toward increases in heroin use is important enough that we want to get the word out to physicians, regulatory officials, and the public, so they can be aware of what's happening.

"Heroin is a very dangerous drug, and dealers always cut the drug with something, with the result that some users will overdose. As users switch to heroin, overdoses may be more common," he said.

The study was funded by the Denver Health and Hospital Authority.

New Engl J Med. 2012;367:187-189. Full article


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