In an effort to reduce prescription drug abuse, many pharmaceutical companies introduced abuse-deterrent formulations that are designed to make product manipulation more difficult and abuse of the drugs less rewarding. In 2012, the Pharmacy and Therapeutics journal noted that opioid abuse concerns led many doctors to prescribe inadequate doses of drugs to relieve pain, and the deterrents allow medical professionals to prescribe certain drugs with fewer reservations. The tamperproof technology is relatively new and quickly evolving, but ongoing clinical studies are testing its effectiveness. For many medications, the deterrents currently have limited impact for substance abusers who swallow the pills whole, but they can limit the ways in which drugs are manipulated to achieve a powerful high.
Ways to Manipulate Prescription Drugs
In 2000, the Primary Care Companion to the Journal of Clinical Psychiatry noted that methylphenidate (Ritalin) and cocaine both increase synaptic dopamine, but the pharmacokinetics of the drugs are particularly similar when administered intravenously. This kind of drug use is the idea behind prescription drug manipulation: substance abusers manipulate prescription drugs to increase their potency and immediacy, and to make the effects more similar to illicit counterparts. People manipulate prescription drugs in the following ways:
- Crush and swallow
- Crush and snort
- Crush and smoke
- Crush, dissolve and inject
Crushing the pill or tablet can also remove the extended-release mechanisms in many drugs, which allows users more immediate access to the total higher dosage.
Types of Abuse-Deterrent Properties
In 2013, the Federal Drug Administration (FDA) issued a study on how pharmaceutical companies might make the opioid drugs more tamperproof; their suggestions included the following list:
- Create physical chemical barriers that prevent chewing, grating, crushing, grinding, dissolving or cutting the pills
- Formulate agonist/antagonist combinations that reduce or eliminate the narcotic euphoria
- Ideally make the antagonist agent active only if the product is manipulated or injected
- Promote abuse aversion that produces unpleasant effects when the drug is manipulated or taken in higher dosage
- Utilize delivery systems that resist abuse, like a sustained-release depot, injectable formulations or subcutaneous implants
- Develop pro-drugs whose opioid effects are only triggered in the gastrointestinal tract, thus limiting the effects from injection or snorting
Likewise, the FDA emphasized that clear labeling and public outreach were important to teach the public how many drugs cannot be abused.
The Effectiveness of Abuse Deterrents
The FDA highlighted some of the ways that drug companies can design and utilize abuse deterrents, and several clinical studies have examined the products currently in the marketplace. In 2013, the American Journal of Managed Care published a study that looked at OxyContin prescriptions in August 2009 and then again in August 2010 after the medication introduced deterrent properties. The study noted the following findings:
- 2.2% of the users in the 2009 survey decided to switch to another opioid
- 2.6% in the 2010 survey switched opioids after the deterrents were introduced
- The difference is statistically insignificant, so it calls into question the effectiveness of abuse deterrents
Alternatively, in 2012 The New England Journal of Medicine published a study that came to the opposite conclusion. Utilizing self-administered surveys of opioid addiction patients, the study looked at usage patterns between July 1, 2009 and March 31, 2012, which found the following key differences:
- 35.6% chose OxyContin as their preferred drug of abuse through August 2010
- Only 12.8% chose OxyContin 21 months later after the deterrents were introduced
- Hydrocodone and oxycodone product preferences increased slightly during that time
- High-potency fentanyl and hydromorphone rose significantly from 20.1% to 32.3%
After the deterrents were introduced, survey participants were asked what narcotic drugs they purposely used to get high in the previous 30 days, and OxyContin fell from 47.4% to 30%, while heroin use doubled. In regard to the abuse-deterrent OxyContin formulation, the study published the following additional findings:
- 24% of respondents found a way to get around the tamper-resistant properties
- 66% of the respondents simply switched to a different opioid
- Heroin was the opioid to which most respondents switched
- Everyone in the survey preferred the OxyContin formulation without deterrents
One participant’s response epitomized the deterrent risk, namely that most OxyContin addicts switched to heroin because it was cheaper and more easily available. Per the study’s conclusion, the deterrents may help reduce the abuse of a particular drug, but there was no evidence that the deterrents resulted in decreased substance abuse overall. Rather, the users simply switched to different drugs.
Prescription Drug Addiction Help
There are benefits to abuse deterrents – they create more hurdles for abuse, hinder first-time drug manipulations, reduce the abuse of a particular formulation and they limit more dangerous forms of abuse – but their benefits are limited by the addicts’ willingness to switch drugs. For this reason, professional rehab remains the most effective way to combat prescription drug abuse. Rehab centers can provide the following services to recovering drug addicts:
- Supervised detox with safety measures for drugs like benzodiazepines
- Integrated treatment for co-occurring mental health and personality disorders
- Motivational therapies that helps patients find personal catalysts to change
- Behavioral therapies that target unhealthy thought patterns and beliefs
- Relapse-prevention tools to recognize and resist cues that trigger cravings
- New coping skills to deal more effectively with stress, anger and conflict
If prescription drug abuse stems from a legitimate medical need, then a treatment center will find alternative ways to address the health concern if it is still an issue.
Free Addiction Help
Please call our toll-free helpline if you have questions about substance abuse, treatment, rehab centers, mental health or other related issues. Our admissions coordinators can provide answers and information 24 hours a day, and they can even check health insurance plans for treatment benefits. If you need help, please call now.