Pubdate: Wed, 11 Jul 2012
Source: Los Angeles Times (CA)
Copyright: 2012 Los Angeles Times
Contact:  http://www.latimes.com/
Details: http://www.mapinc.org/media/248
Author: Melissa Healy

ANTI-DRUG ABUSE MEASURE DRIVES MANY ADDICTS TO HEROIN

In the record book of unintended consequences, this one's sure to be a
groan-worthy entry: A frightening rise in addiction to the drug
OxyContin prompts a reformulation that makes the prescription pain
medication harder to abuse. So addicts switch to heroin instead.

Clearly, not the hoped-for effect. But according to a letter published
Wednesday in the New England Journal of Medicine, it's a switch that
appears to be happening across the country -- especially in rural and
suburban communities, where OxyContin abuse and addiction had gained a
firm foothold.

In August 2010, the makers of the opioid pain reliever OxyContin,
Purdue Pharma LP, rolled out a new version of OxyContin designed to
thwart efforts to crush, split, grind or dissolve the tablet in water.
Those abusing the drug had routinely broken the original slow-release
version of the tablet and snorted or injected it -- actions which
afforded an intense high.

While the U.S. Drug Enforcement Administration applauded the new
tamper-proof formulation, officials there did warn that emergency
departments might see an uptick in drug-abuse-related visits, as
OxyContin abusers endured withdrawal or embraced new ways to get high.

Between July 2010 and March 31, 2012, three researchers -- two from
Washington University in St. Louis, Mo., and one from Nova
Southeastern University in Coral Gables, Fla., surveyed 2,566 people
seeking treatment for abuse of or dependence on opioid drugs. Their
aim was to gauge how their habits had changed. They further
interviewed 103 of those who filled out surveys anonymously to flesh
out their findings.

Those surveyed came from 150 different treatment centers in 39
states.

The reformulation of OxyContin, the researchers found, had fulfilled
its mission, in a sense: Almost two years after the new OxyContin was
rolled out and the old discontinued, only 12.8% of those surveyed --
down from 35.6% at the start -- considered OxyContin their drug of
choice. Among the smaller group interviewed, 24% of the
treatment-seekers reported they had found a way around the measures
designed to reduce OxyContin's abuse. But 66% reported they had moved
on to a new drug -- and the most common choice was heroin.

The number of those who reported having taken heroin in the last 30
days to get high doubled.

"Most people that I know don't use OxyContin to get high anymore," one
interviewee told the researchers. "They have moved on to heroin
[because] it is easier to use, much cheaper, and easily available."

In addition to nudging many drug users toward more dangerous drugs of
abuse, the OxyContin reformulation appeared to have shifted the
demographics of heroin use a bit as well, the researchers reported.

"We're now seeing reports from across the country of large quantities
of heroin appearing in rural and suburban areas," said Theodore J.
Cicero, vice chair of research at Washington University's department
of psychiatry. "Unable to use OxyContin easily, which was a very
popular drug in rural and suburban areas, drug abusers who prefer
snorting or IV drug administration now have shifted to more potent
opioids if they can find them, or to heroin."

In the bid to stem the rise of prescription opioid abuse and
dependence, wrote the authors, reformulating popular drugs of abuse
"may not be the 'magic bullets' that many hoped."
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