New England Journal of Medicine: New OxyContin Abuse-Deterrent Formulation Drove Surge in Heroin Use

LOS ANGELES–Today, the New England Journal of Medicine released research showing that the recent introduction of the reformulated, abuse-deterrent version of OxyContin is linked to increases in heroin use.

In a letter-to-the-editor appearing in the Journal, Theodore Cicero, Ph.D., Matthew Ellis, M.P.E., and Hilary Surratt, Ph.D., wrote, “Our data show that an abuse-deterrent formulation successfully reduced abuse of a specific drug but also generated an unanticipated outcome: replacement of the abuse-deterrent formulation with alternative opioid medications and heroin, a drug that may pose a much greater overall risk to public health than OxyContin.”

Harm reduction advocates were disheartened, but not surprised at the findings.

“We’ve long known that simply making OxyContin more difficult to crush or inject would simply lead people to the next easiest drug to abuse, namely heroin. So while we’re disheartened to have our beliefs proved true, none of us are surprised,” said Meghan Ralston, harm reduction coordinator the Drug Policy Alliance. “No one thought to radically expand access to free drug treatment or free methadone when the new Oxy formula hit the market. There’s a bit of a frenzy in the U.S. to radically reduce prescription opioid abuse, but caution is needed. We urge all states attempting to ‘crack down’ on prescription opioid abuse to first plan for the unintended consequences, like those revealed in this research.”

Cicero, Ellis and Surratt collected data quarterly from over 2,500 opioid users entering drug treatment programs across the country from July 2009 through March 2012. While the selection of OxyContin as the primary drug of abuse did indeed decrease during that time, selection of high-potency fentanyl and hydromorphone “rose markedly,” according to Cicero, Ellis and Suratt. Their research indicates that heroin use nearly doubled.

“Abuse-deterrent formulations may not be the ‘magic bullets’ that many hoped they would be in solving the growing problem of opioid abuse,” said the researchers.