Drug addicts are outraged by recent changes to the formula of frequently abused prescription painkiller OxyContin which makes it harder to inhale.

So they are taking their business to heroin.

For nearly three years, psychiatrists have been collecting information from patients entering treatment for drug abuse and more than 2,500 patients from 150 treatment centers in 39 states have answered survey questions about their drug use with a particular focus on the reformulation of OxyContin.

Surveys. Of drug addicts. Calibrate accordingly.

OxyContin was originally developed to be part of the solution to the abuse of opioid drugs because it releases into the system slowly, thus not contributing to an immediate “high.” Smart addicts found they could evade the slow-release mechanism by crushing the pills and inhaling the powder, or by dissolving the pills in water and injecting the solution, getting an immediate rush as large amounts of oxycodone entered the system all at once.

In 2010, a new formulation of the drug was introduced and the new pills were much more difficult to crush and dissolved more slowly. The idea was to make the drug less attractive to illicit users who wanted to experience an immediate high.

The new formulation of OxyContin has drug addicits dissatisfied because makes inhaling or injecting the drug more difficult, so they are turning instead to heroin. Credit: DEA

“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 J. Cicero, PhD, a professor of neuropharmacology in psychiatry at Washington University in St. Louis. “In that sense, the new formulation was very successful.”

So now they are worried drug addicts are migrating to other weak spots in the illegal drug market but, really, society has limits on how much hand-holding it needs to do for people determined to kill themselves. Criminals are selling to criminals so the quality assurance is not going to be great, we can't start doing heroin exchange programs.

Since the researchers started gathering data from patients admitted to drug treatment centers, the number of users who selected OxyContin as their primary drug of abuse has decreased from 35.6 percent of respondents before the release of the abuse-deterrent formulation to 12.8 percent now.

When users answered a question about which opioid they used to get high “in the past 30 days at least once,” OxyContin fell from 47.4 percent of respondents to 30 percent. During the same time period, reported use of heroin nearly doubled. In addition to answering a confidential questionnaire when admitted to a drug treatment program, more than 125 of the study subjects also agreed to longer phone interviews during which they discussed their drug use and the impact of the new OxyContin formulation on their individual choices.

“When we asked if they had stopped using OxyContin, the normal response was ‘yes,’” Cicero says. “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.’”

Cicero TJ, Ellis MS, Surrat HL. Effect of abuse-deterrent formulation of OxyContin. The New England Journal of Medicine, July 12, 2012.