Heroin deaths rose after 2010 OxyContin reformulation, study finds

Ohio overdose deaths by type of opioid, 1999-2016. Source: The Henry J. Kaiser Family Foundation

By Andrew Cass, The News-Herald

U.S. overdose deaths by type of opioid, 1999-2016. Source: The Henry J. Kaiser Family Foundation

Heroin deaths surged following the August 2010 reformulation of OxyContin, according to a recent study from University of Notre Dame and Boston University researchers.

While the reformulation made OxyContin harder to abuse, “each prevented opioid death was replaced with a heroin death,” according to the researchers who worked on the study.

“A key component of the federal government’s response to the opioid epidemic has been encouraging the development of abuse-deterrent formulations of drugs,” study co-author William N. Evans said in a statement. “Our work suggests that as long as there are readily available substitutes for prescription opioids, such as heroin, reformulating painkillers will do little to mitigate the effect of the crisis.”

Why OxyContin was reformulated

OxyContin was introduced to the market in 1996 and stood out from other opioid-based prescription painkillers like Vicodin because it would slowly release oxycodone over a 12-hour period. Its competitors’ drugs needed to be taken every three to six hours.

Those extended-release properties could be circumvented by crushing the pill into a fine powder. The powder could then be snorted, smoked, liquefied and injected, allowing the user to “gain access to the full milligram content of oxycodone all at once and rapidly achieve an intense high,” as the study put it.

The makers of OxyContin, Purdue Pharmaceutical, developed a new formula for the drug in an effort to combat abuse. With its new formulation, the pills did not turn into a fine powder when crushed. Instead it turned into a “gummy substance” that was more difficult to snort and inject.

The new formulation was approved by the Food and Drug Administration in April 2010, becoming the first drug allowed to claim, on its label, that it had abuse-deterrent properties. According to the researchers, Purdue Pharma ceased shipping their old OxyContin formulation on Aug. 5 of that year.

Heroin

“Unfortunately, at the time of the reformulation, there was a readily available and inexpensive substitute for OxyContin: heroin,” the study stated.

Over the past 30 years, there has been an increasing supply of heroin from Mexican gangs. According to the Drug Enforcement Administration, as of 2016, 79 percent of confiscated heroin is now from Mexico. The study also states that the average price of heroin has dropped significantly, from $3,000 per pure gram in 1981 to under $500 in 2012 (both figures in real 2012 dollars).

Also over that time frame, entry into heroin got easier because of the purity, according to the study. It was once mostly an injected drug, but because of its purity, it can now be smoked or inhaled.

“The available literature suggests that because of the easy availability of heroin, many OxyContin abusers switched to heroin after the product reformulation. Interrupted time series data indicates that outcomes such as deaths, poisonings, emergency room visits, and enrollments in treatment programs from heroin abuse all have increased since August 2010.

At the local level, 2010 is the year Lake County officials have typically said they started to notice heroin was becoming a problem. There were 39 total unintentional drug overdose deaths that year in Lake County, according to the Ohio Department of Health. That was a record high at the time, but there have been more than 40 unintentional drug deaths every year since then. Heroin deaths are now representing a smaller percentage of overdose deaths in Lake County as the crisis has shifted toward fentanyl. There were 86 overdose deaths in the county in 2016, according to the Lake County Coroner’s Office, and at least 79 last year.

Another study

The study from Notre Dame and Boston University researchers is not the only recent one to point to OxyContin’s reformulation as a turning point. Research by the American Action Forum found the same thing.

“While restrictions on prescription opioids appear to have slowed the growth in overdose fatalities involving those substances, the total number of opioid-involved overdose fatalities has accelerated due to staggering growth in overdose deaths involving heroin and synthetic opioids,” the American Action Forum researchers wrote.

In an interview with the Washington Post, Ben Gitis — one of the study’s authors — said that while policy makers need to address the flow of illicit opioids, they must do so while tackling the root problem of addiction.

“Say policymakers were to start turning more attention to the supply of illicit opioids, heroin and synthetic opioids, which is obviously something that needs to happen,” Gitis told the Washington Post. “Doing that without addressing dependency could turn users to other types of drugs to use in their addiction.”

Though the reformulation of OxyContin did not quell overall opioid abuse, a drug policy expert from Stanford University told Vox that it doesn’t mean it was a bad idea. It made OxyContin harder to abuse, meaning they prevent more people from getting addicted and over the longer term could prevent hundreds of thousands of overdose death.

That expert, Keith Humphreys, told Vox about the “stock” and “flow” of the opioid epidemic: There is a current stock of opioid users who need treatment or they will find other — and potentially deadlier — opioids to use if they lose access/or the ability to misuse prescription drugs. But, he said, you also have to stop new generations of people from accessing and misusing opioids. If not, then they too could get addicted and potentially die of an overdose.

The reformulation of OxyContin and other attempted crackdowns on opioid abuse — like efforts to shutdown pill mills — were not met with increased access to addiction treatment. According to a 2016 report by then-U.S. Surgeon General Vivek Murthy, only 10 percent of people with substance abuse disorders receive any type of treatment.

“Many factors contribute to this ‘treatment gap,’ including the inability to access or afford care, fear of shame and discrimination, and lack of screening for substance misuse and substance use disorders in general health care settings,” the Surgeon General’s report stated.

Lake County Alcohol, Drug Addiction and Mental Health Services Executive Director Kim Fraser said on “The Sound of Ideas” in April there is always a need for more treatment beds.

“We certainly need more beds,” Fraser said. “We’re working with our area providers to increase the number of treatment beds. We work very closely with our local impatient facility to help people who need withdrawal management.”

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