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.
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.
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.
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.
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.