Prescription painkiller abuse is rampant in the U.S. According to the American Society of Addiction Medicine, 2.1 million Americans live with opioid addiction. As the problem grew out of control in recent years, lawmakers, health officials and drug companies sought ways to curb illicit use of these medications, and one promising solution was to change the way the pills were made.
Nearly five years ago, the Food and Drug Administration approved an abuse-deterrent version of OxyContin from Purdue Pharma L.P. The newer version of the powerful drug has binders that make the drug difficult to crush for the purpose of snorting or using intravenously for a quick high.
But it turns out that change hasn't deterred drug abusers as effectively as officials might have hoped.
A new study conducted by researchers at Washington University School of Medicine in St. Louis, Missouri, finds that up to 25 percent of drug users entering rehab programs say they were still abusing the newer formulation of OxyContin.
Their findings, based on surveys of 11,000 drug users at 150 drug treatment facilities in 48 states, were published Wednesday in JAMA Psychiatry.
The original formulation of OxyContin contained highly concentrated levels of oxycodone designed for extended release over a long period of time. Abusers would crush the pills into powder or dissolve into liquid and inject them intravenously to get an intense high.To combat that problem, the reformulated pills turn into a gooey gel if they're crushed, making them nearly impossible to snort or inject. However, determined addicts still find a way to get their fix.
"There are still some people who have figured out how to circumvent abuse-deterrent formulation," Theodore J. Cicero, PhD, a professor of neuropharmacology in psychiatry and lead author of the study, told CBS News. Some users have simply resorted to taking the pills orally, but others have become much more creative.
He said drug abusers visit online chat groups to share advice, and even provide step-by-step instructions, which essentially involve "cooking" the medication in order to make it possible to pulverize the pills.
However, Purdue Pharma says they never guaranteed that their reformulated drug would completely eliminate all illicit use. "The product's label states that OxyContin has physical and chemical properties expected to make abuse via injection difficult and to reduce abuse via snorting," Raul Damas, vice president of corporate affairs, told CBS News in a press statement. "The label also states that abuse of OxyContin by these routes, as well as the oral route, is still possible." Damas added that "the report parallels other studies that show reformulated OxyContin is associated with a reduction in abuse."
Because the newer version of OxyContin is harder to abuse many addicts are also simply turning to heroin, a street drug that's easier to come by and much cheaper. A prescription pain medication may cost $20 or $30 or more, whereas a hit of heroin can cost as little as $10. The street drug is also a last-ditch alternative for an addict who no longer has access to a doctor willing to write a prescription for OxyContin, Percocet, Demerol, codeine or other drugs.
"It used to be an inner city problem, heroin use involving poor minority groups," said Cicero. "That problem has now moved in to the suburbs and in rural areas, white middle class individuals who are basically now peddling heroin."
A paper published last May, also in JAMA Psychiatry, captured this grim reality. That study found nearly 90 percent of heroin users in the last decade were white, and more than 75 percent live outside of urban areas and were introduced to heroin through prescription opioids.
Cicero said that while changing OxyContin's compound is a step in the right direction for drug control, it's not a solution to this endemic problem. Addressing the problem of why people become addicted is the only way to stop widespread opioid abuse.
"We have to start dealing with this demand," said Cicero. "As long as there's a demand out there it will be met by some clever dealers."