Tag: abuse-proof pills

The Frightening Truth about Abuse-Deterrent Painkillers

These Pills are Still Dangerous!

I recently read a New York Times article that sent chills down my spine. It focused on many of the new abuse-deterrent painkillers and how, despite extensive testing and precautions, they’re still being abused.

opioid epidemic
image via Flickr user mattza

What this means in practical terms is that America’s opioid epidemic is far from being over. Despite numerous claims that abuse-deterrent pills will herald a new era, this doesn’t seem to be the case.

The Time’s article briefly profiled Anthony DiTullio. He continued to abuse OxyContin even after the pills became abuse-deterrent in 2010. His solution to the pill’s so called “abuse-proof” measures? Chew and grind the pills between his teeth for a half hour.

DiTullio isn’t alone in his methods either. Addicts across the country continue to get high from Oxys and other abuse-deterrent painkillers. There’s no hard data on the prevalence of this yet. Remember, it’s only been since the late aughts that pharmaceutical companies began making their pills difficult to abuse.

There are various studies out there that confirm abuse-deterrent measures have in fact decreased abuse. Still, these same studies point out that many addicts simply switched to heroin or other, easier to abuse pills.

Overall, many health officials are worried that these abuse-deterrent drugs are simply lulling the public into a false sense of security. They’re worried that pharmaceutical companies have only placed a Band-Aid over the wound and an ineffective Band-Aid at that.

Let’s explore some of the larger points the Times article raises and see if things are really as bleak as they seem.

Do painkillers make someone more likely to “snap?”

The Limits of Abuse-Deterrent Pills

First and foremost, abuse-deterrent versions of popular painkillers like OxyContin and Vicodin are a step in the right direction. Still, there’s a limit to just how well these formulations work.

Take, for example, the recent HIV outbreak in Indiana. This was triggered by a number of individuals crushing and injecting the powerful painkiller Opana (hydromorphone).

Seems tragic though fairly normal, right? It is, until you consider that until recently Opana was marketed as difficult, if not downright impossible, to abuse via injection. In fact, the FDA ruled in 2013 that Endo Pharmaceuticals, the manufacturer of Opana, had to remove the abuse-deterrent label from its packaging.

When asked about whether these abuse-deterrent formulas really worked, Anthony DiTullio had the following to say,

“I would definitely say that OxyContin is harder to abuse than it used to be — it was a pain in the neck…No matter what they [pharmaceutical companies] do, there’s always going to be a way for people to get whatever they want in their system” (The New York Times).

When you consider the size of the opioid market, DiTullio’s claim becomes downright terrifying. Upwards of 210 million opioid prescriptions were written in 2014. According to Express Scripts, a minuscule 1.4% of these were filled for abuse-deterrent versions.

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Other Limits of “Safe” Pills

Many abuse-deterrent formulas are designed to make crushing, sniffing, and injecting painkillers difficult. They’re not aimed at reducing rates of oral abuse.

Well, according to a study cited in the Times, most painkiller abuse occurs via oral administration. That means these “safe” pills aren’t even safe for the majority of abusers!

Add into the equation the fact that many health care professionals simply don’t understand trends in drug abuse or what abuse-deterrent means. In fact, a 2014 study from John Hopkins found that around 33% of doctors believed most opioid abuse occurs via non-oral routes.

Even worse is that almost 50% of primary care doctors thought abuse-deterrent painkillers were less addictive. While they certainly present less risk of addiction, the pills themselves aren’t any less addictive.

This level of ignorance from medical professionals isn’t acceptable. Lest I sound too harsh, it’s understandable that a general practitioner may not have received the same training as, say, a thoracic surgeon. Still, in the midst of a country-wide opioid rampage, GPs should have some knowledge of how painkillers work.

Did you know patients can now sue doctors for overprescribing opioids?

Do We Have a Solution?

So, having examined the main points the New York Time’s article addressed – seriously, it’s a great article that you should go read now – what’s the solution? How can we, as a country, put an end to our collective painkiller addiction?

The solution lies somewhere between regulation, education, and increased access to treatment. What I mean is – while regulation and abuse-deterrent formulas work well as a short-term fix, they do nothing to address the overall problem.

abuse deterrent painkillers dont work
image via Flickr user AJC

Holding doctors and pharmacies accountable for prescribing and dispensing dangerous medication is important, but it simply isn’t enough. Look at our current situation. We have prescription monitoring programs in place in numerous states. There are abuse-deterrent meds on the market. Record numbers of people are still becoming addicted and dying as a result of painkiller abuse.

That’s where education and increased access to treatment becomes the necessary next step. Increasing education to adolescents, adults, and medical professionals will lead to both fewer prescriptions being written and more knowledge about the risks of each prescription that is written.

Increasing access to treatment is the second step of this one-two combo. People are always going to become addicted to opioids. It doesn’t matter if those opioids are medically prescribed (OxyContin, Percocet, Vicodin, etc.) or bought from the street (heroin).

Once an individual is addicted, what then? That’s where having greater access to treatment centers becomes invaluable. Allowing anybody and everybody who needs help to get that help is a must.

Things like money, insurance providers, and substance abuse benefits shouldn’t dictate whether someone can get to treatment. Unfortunately, in the current system, they do. We need to change that.

The combination of abuse-deterrent pills, stricter regulations on prescriptions, and increased education and access to treatment will end the opioid epidemic. It’s that simple.

Methadone is a lot more dangerous than it’s made out to be…

A Controversial New “Abuse-Proof” Painkiller

The FDA Approved WHAT?

In a bold and possibly rash move, the FDA approved a new “abuse-proof” form of a powerful opioid.

hysingla opioid painkiller

On November 20th, the FDA gave the green light to Hysingla ER, an extended release version of the popular opioid hydrocodone. Hydrocodone is the chemical name of the blockbuster drug Vicodin.

Okay, so the government approved a hard to abuse painkiller. What’s wrong with that? If anything, we should be singing Hysingla’s praises. I’m not so sure. A closer look into Hysingla and its development reveals a troubling history.

Learn the staggering effect of Vicodin on society

Not All It’s Cracked Up to Be

Hysingla is the latest form of extended release hydrocodone. Following Vicodin’s huge spike in popularity (it’s currently the most prescribed and abused painkiller in the U.S.), it became clear something had to be done.

Vicodin exposes its legitimate and recreational users to a host of negative side effects. These include liver damage, due to acetaminophen, and addiction. So, drug companies began working on a pure form of hydrocodone that was also “abuse-proof.”

Fast-forward to 2013. The FDA, despite numerous doubts about its safety, approved Zohydro ER. Legislators, police officers, addiction professional, and even the FDA’s own advisory board claimed Zohydro presented a danger to users due to its high levels of hydrocodone (the highest strength contains fifty milligrams of the opioid).

Once Zohydro hit the market, Massachusetts Governor Deval Patrick declared a public health emergency. It was reactions like these that prompted the pharmaceutical company Perdue to develop Hysingla.

Not everyone is so sure this new drug is safe, though. Jane Woodcock, the director of the FDA’s Center for Drug Evaluation and Research, wrote the following

“Prescription opioids with abuse-deterrent properties will not completely fix the prescription opioid abuse problem, but they can be part of a comprehensive approach to combat the epidemic.”

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How is Hysingla “Abuse-Proof?”

No matter what side of the Hysingla debate you’re on, we can all celebrate a drug that’s difficult for addicts to abuse. Surely we can all agree on that, right?

Well, it turns out Hysingla isn’t actually that abuse-proof. In fact, Hysingla is difficult to crush. That’s it. It doesn’t turn to gel when mixed with water. It isn’t impossible to inject. It’s simply difficult to crush.

Hysingla may need some better abuse-deterrent methods. Otherwise it’s destined to join the ranks of the many other “abuse-proof” drugs which aren’t too hard to abuse.

Is there an end in sight for prescription pill overdoses?

”Abuse-Proof” Pills Aren’t Abuse-Proof

Since the mid-2000’s there’s been a push to develop abuse-proof alternatives to popular opioid drugs like OxyContin, Percocet, Roxicodone, and you guessed it, Vicodin.

abuse proof opioids

These pills were simply too popular with addicts. People were overdosing left and right. A painkiller epidemic was born.

So, Perdue and other pharmaceutical companies began to develop “abuse-proof” forms of many opioids. The only drawback, though, was that these abuse-deterrent pills were still abusable.

OxyContin formulas started to turn to gel when mixed with water. Enterprising addicts figured out a way to extract the drug from the gel. Roxicodone pills were supposedly “un-crushable.” Once again, enterprising addicts learned how to crush them.

Not to mention, as a specific pill became harder to abuse, addicts would simply switch to one that wasn’t so hard. This is why, by the mid and late 2000’s, we saw people switching from oxy to Dilaudid.

This presents a powerful lesion. As long as opioid drugs are available, people will figure out ways to abuse them. It doesn’t matter if they’re “abuse-proof” or not.

So, what’s the answer? Well, there isn’t an easy answer. Knowledge of the destructive effects of addiction helps. Shifting the focus of addiction from a moral failing to a medical condition helps. Increased access to substance abuse treatment helps.

Now put all those things together and we can hope to see a real solution to American’s painkiller epidemic.

He went from pills to heroin and homelessness. Read the recovery story of Jesse Schenker, world famous chef!

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