As the opioid crisis rages across the United States, a new analysis contends there is a lack of evidence that pills designed to deter abuse are truly effective in reducing overall opioid abuse and, moreover, the cost to prevent a single case of abuse or an overdose death may appear prohibitive.
After reviewing available studies, a panel of experts concluded data to support most of the so-called abuse deterrent formulations is “promising, but inconclusive,” given that some pills are new to the market or not yet available. And while studies indicated OxyContin, specifically, is harder to abuse, all of the drugs may shift people to other forms of opioids, notably heroin or fentanyl.
“This is the big conundrum. These medicines may reduce abuse of the specific drug, but may cause people to switch into other drugs more easily ground up or injected,” said Dr. Steven Pearson, who heads the Institute for Clinical and Economic Review, a nonprofit that assesses the value of medicines. “Unfortunately, there is simply inadequate evidence to judge the overall balance of their health impact.”
About the Author Reprints
The abuse-deterrent forumlation of Oxycontin in 2010 is directly responsible for an explosion of deaths due to heroin. In the three years immediately following that ill-considered action, prescriptions for Oxycontin dropped by 60%, and the number of overdose deaths involving heroin more than doubled. See http://www.acsh.org/news/2015/04/22/abuse-deterrent-narcotics-a-good-idea-with-unintended-consequences
I’m currently on Hysingla 30mg.
I’m awaiting implant of pain pump.
Oh and I can’t walk and am partially paralyzed.
Any info on Hysingla or the pain pump
In general, the extended release formulations are a massive ripoff. Hydrocodone is simply an effective pain medication among many. Which one works for you depends on your body chemistry. They all have problems of refractoriness. You’ll build up resistance.
Your very brief description sounds like the intrathecal pump has good potential, maybe very good. The pump is, in essence, a way to deliver the meds directly to the spinal fluid and spinal cord without needing the blood stream to take it there. Makes each milligram or microgram 1-300 times as potent with less systemic effect. Your success will all depend on the results of a trial (never implant a pump without a positive result from a trial dose). Your success will even more depend on your doctor’s experience and ability to find the best combination of meds that work for you.
Do you think Purdue would really reduce the brand cost of OxyContin to that of generics? If state legislation required abuse-deterrent formulation (ADF) formulations to generic immediate-release, Purdue loses. If Purdue really cares about abuse, they will lower their OxyContin. I’m not holding my breathe though. The difference in paying out brand vs generic, can be redirected toward addiction treatment.
“The panel noted the average price per day for an ADF pill was $11.60, compared with $5.82 for an opioid without abuse-deterrent features. ADF prices would have to drop by 41 percent to be considered worthwhile.”
Ed, plugging the panel’s assumptions into a clinical trial model, in order to detect a reduction of 23 abuse deterrences per 1000 patients per five years you would need a control group of equal size. That’s 2000 patients completing five years. Since this study is likely to have a high dropout rate you would have to enroll 10,000 to wind up with 2000 to show a difference of 23, assuming that your sample size calculation would show that difference to be statistically significant at P= 0.05. Such a study would cost between $50 and $100 million. If NIH wants to spend that kind of money they’re welcome to do so.