Pubdate: Tue, 20 Apr 2004 Source: Charlotte Observer (NC) Copyright: 2004 The Charlotte Observer Contact: http://www.charlotte.com/mld/observer/ Details: http://www.mapinc.org/media/78 Author: Sandra Blakeslee, New York Times Bookmark: http://www.mapinc.org/oxycontin.htm (Oxycontin/Oxycodone) DRUG MAKERS TAKE AIM AT OPIATE ABUSE Education efforts, reformulated pills could curb recreational use Worried that millions of Americans are using prescription opiate painkillers to get high rather than to ease severe chronic pain, drug makers are working on ways to prevent such abuse. Cooperating closely with government officials and pain specialists, the companies are educating doctors, rewriting warning labels and tracking pills as they move from pharmacy to patient. They are also reformulating pills with added ingredients. One combination blocks euphoria. Another produces a nasty burning sensation. "The problem of prescription painkiller abuse is much bigger than people realize," said Dr. Clifford Woolf, director of the neural plasticity group and professor of anesthesia research at Massachusetts General Hospital in Boston and Harvard Medical School. According to the Substance Abuse and Mental Health Services Administration, more Americans abuse prescription opiates than cocaine and the abusers far outnumber those who misuse tranquilizers, stimulants, hallucinogens, heroin, inhalants or sedatives. After marijuana, pain pills are the drug of choice for America's teenagers and young adults. In recent decades, doctors stopped prescribing opiates because 5 percent to 10 percent of people who took them became addicted. But the 50 million Americans with chronic pain needed help. It arrived five or six years ago with slow-release formulations of opiates. A person who swallows such a pill feels no euphoria but is relieved of pain for up to 24 hours. Unfortunately, addicts found they could grind the pills, swallow or snort the powder and get a high dose of opiates delivered directly into their bloodstreams. Now drug makers are developing ways to reformulate prescription painkillers. Purdue Pharma in Stamford, Conn., which makes OxyContin, is thinking of adding a second drug, called an opiate antagonist, that neutralizes the effects of the opiate. The antagonist would be walled off using a sequestering technique, said Dr. David Haddox, the company's vice president of health policy. A patient who swallowed the drug would get full pain relief. But if someone tampered with the pills, the antagonist would be released. Then, Haddox said, "If you are a recreational drug user, you feel nothing. The effect is canceled out." A second approach is to mix in a chemical irritant like capsaicin, the main ingredient of hot chili peppers, said Woolf. Because the esophagus and stomach don't have many receptors for hot peppers, patients could take the pills as prescribed and find relief, he said. But the lining of the nose and cheeks are loaded with pepper receptors, and anyone who ground up such a pill would get a burning feeling in the chest, face, rectum and extremities. In another effort to address the problem, drug manufacturers are providing doctors with tamperproof prescription pads that make forgeries difficult. When a prescription is photocopied, the copies say "void." - --- MAP posted-by: Jackl