In 2010, the formula for OxyContin, a slow-release form of the powerfully addictive painkiller oxycodone, was changed to make it harder to abuse. It became almost impossible to grind up and dissolve effectively, making it mostly useless to addicts who would snort, smoke, or inject the drug to get an instant high. It was supposed to stem the tide of abuse — which, researchers say, it did. But at what cost?
"Our data show that OxyContin use by inhalation or intravenous administration has dropped significantly since that abuse-deterrent formulation came onto the market," says Theodore Cicero, a Washington University researcher who investigated its effects. "[But] 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."
Cicero's study, published July 12 in the New England Journal of Medicine, says that investigators surveyed more than 2,500 drug-treatment patients in 39 states and found that new forms of OxyContin prompted drug users to switch from Oxy to other drugs.
When their research started, they found that almost 36 percent of patients admitted to drug treatment centers said Oxy was their drug; it's down to 12.8 percent now.
"When we asked if they had stopped using OxyContin, the normal response was 'yes,' " Cicero says in a release. "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.' "
It's a finding that was affirmed by Kandy Burris, who says she was "a suburban mom with two kids and two dogs and two cars" before getting addicted to painkillers in 1997. She entered treatment in February 2009 and now works at the Delray Recovery Center. She says the new Oxy formulation made abuse of the drug come to a "screeching halt." But that meant other drugs entered the fray.
"That's definitely what's been seen," she says. "What are they going to do? They're hooked... These clients have ridiculous tolerance. Without treatment, without a detox, something has to compensate for that."
But, she adds, people were making the switch from Oxy and other opioid painkillers to heroin long before anybody changed the formula of the pill: "It also has a lot to do with the cost of it," she says. "It's a whole lot cheaper to go out and get a bag of heroin than it is to get a pill."
She says it was a switch she made around 2002, after she'd progressed up the "ladder" from orally ingesting the pills, through snorting and smoking, and into injecting the dissolved medication directly into her veins. Once she couldn't doctor-shop for prescriptions anymore and couldn't afford to buy the pain pills on the street, she says she made the switch to heroin.
"[A pain pill], it's 30 bucks. But I could afford a $20 bag of heroin and get a couple of shots out of it," she says. "A lot of times, we go into the addiction being prescribed the medication, and once the prescription runs out or the financial resources aren't there, that's when we have to turn to the street drugs. Because they're cheaper and they're available."
She also says intravenous drug users without access to Oxy can't just find a different way of taking drugs — the "love of the needle" drives them to need something injectable. Some people, she says, unable to find IV drugs, will simply shoot ice water into themselves.
"There's something about crossing that line to becoming an IV user; there's nowhere else to go after that," she says. "So yes, if you're using a drug a certain way and I'm not able to because it's not dissolving anymore, then yeah, I'm going to find something that will dissolve."