Why Abuse-Resistant Versions of Addictive Drugs Don’t Work

Addiction can have a strong grip on your mental health and wellbeing, which is why manufacturers of addictive prescription painkillers work hard to find an alternative medication that won’t get users so hooked. This was the case in August 2010, when makers of the prescription painkiller OxyContin released a abuse-resistant form of the drug that deterred drug addicts from crushing the substance and inhaling or injecting it. According to a letter published this month in the New England Journal of Medicine (NEJM), it worked; OxyContin went from being the primary drug of abuse for 36% of prescription-drug misusers to just 13% about 21 months later. Unfortunately, however, this isn’t the end of the story.


Instead of drug users quitting when they stopped getting high on OxyContin, they simply switched drugs. Other opioids moved in to fill the gap left by OxyContin, with drug users choice of high-potency fentanyl and hydromorphone rising from 20% to 32%, the NEJM survey showed. Even though, when drug users were asked about the substances they used to “get high in the past 30 days at least once,” OxyContin fell from 47% of respondents to 30%, the use of heroin nearly doubled. The survey authors quoted one respondent who said, “Most people that I know don’t use OxyContin to get high anymore. They have moved on to heroin [because] it is easier to use, much cheaper and easily available.”


For the study, the scientists researched almost 2,600 people who had been involved in treatment programmes throughout the US for prescription opioid addiction between July 2009 and March 2012. When they gathered their data, the authors were forced to conclude, “[A]n 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. Thus, abuse-deterrent formulations may not be the ‘magic bullets’ that many hoped they would be in solving the growing problem of opioid abuse.”


If you know anything about how addiction affects your wellness, you won’t be too surprised by the findings. There’s something to be said for how reducing the supply of particular drugs can help to prevent some new cases of addiction, but the strategy doesn’t do anything for existing addicts, and just replaces one object of addiction with another, potentially more harmful, one. This is due to the fact that addiction doesn’t lie in the drug itself, but rather in a dysfunctional coping strategy for the widespread human desire to manage emotions. On a more superficial level, it’s like taking cupcakes away from someone who’s trying to lose weight, but has a problem with emotional eating. That person wasn’t addicted to the cupcakes, they were relying on the dysfunctional coping strategy – the emotional eating – and so will simply switch to chocolate or ice-cream.


Therefore, doctors who simply cut off addicted patients’ supply of prescription drugs, or pharmaceutical companies who introduce abuse-deterrent formulas, do not address the underlying need that drives the addiction. In fact, it just pushes these people into the market for street drugs, which makes the situation so much worse. They lose contact with the medical system, purchase drugs that are more likely to be adulterated or even poisonous, and don’t know the exact dose they’re getting, which increases overdose risk. Though it may seem counterintuitive, we should be bringing as many opioid addicts as possible into the medical system and using opioids themselves in treatment when necessary, instead of driving them out and into the hands of the illegal heroin market.

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