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In the past, the most effective pain drugs were the most commonly diverted, but this trend may be changing.
If you accept the definition of drug diversion as “any crime involving a prescription drug,” then the interesting question becomes, “What drives these crimes and what makes one prescription drug more desirable or abused than another?”
Something I learned a long time ago is that the best drugs for pain relief are the best drugs for getting “high.” This is simple but true. When a prescription drug is introduced and does what it says it will do—in this case, provide pain relief—it becomes popular. Patients report positive results, which causes prescribers to write more prescriptions for the drug.
Of course, this also puts a very large amount of pharmaceuticals in a tremendous number of homes in America. A percentage of those dosage units will end up being diverted and in the hands of abusers, addicts, and traffickers. As the pill seekers discover that the drug gives them the intense feeling they enjoy or crave, the demand skyrockets. We all know what happens when any commodity is in demand in our country—the price is driven up. The demand also means that more product is made available for diversion on the streets.
OxyContin (oxycodone) is probably one of the best examples of this concept. Purdue Pharma introduced it as an extended-release oxycodone product to provide pain relief to legitimate patients for up to 12 hours when taken as directed. Prescribers and patients quickly found that OxyContin is an incredible pain management drug, allowing patients many more hours of relief while taking far fewer pills than the conventional pain drugs, and without the concerns of acetaminophen or aspirin ceiling levels.
This favorable result meant a considerable amount of OxyContin started being prescribed and used in the United States. No one really knows who first discovered that if you crush it, you can effectively force up to 80 mg of oxycodone into the body by chewing, snorting, or injecting it, which causes the high.
I remember attending a meeting of Purdue Pharma sales representatives in the Cincinnati area. They were interested in knowing what drugs were being abused on the street, and specifically if OxyContin was part of the problem. At that time, OxyContin was not being abused and I gave them an honest response. Regardless of when individuals or agencies say that they could foresee the abuse and diversion of OxyContin, it just isn’t true. No one was able to predict it.
Now back to the math. Purdue Pharma launched their OxyContin reformulation in August 2010, and all of us who deal with drug diversion watched intently, as this was the first real opportunity to make a definitive comparison between the old “OC” and new “OP” pills. Because the OP pills contain the exact same active ingredient as before, and the only change is the addition of a tamper-resistant shell that makes crushing them for quick abuse difficult, we would know fairly quickly whether the reformulation was effective.
I have tentatively reported before, and continue to report in the first part of November 2011, that the reformulation is working. I know this in part from what has happened in my own drug task force because the street prices of the new formulation plummeted and in many cases the demand for the new OxyContin was almost nonexistent.
This was one anecdotal report, of course, so I asked the 1000 or more subscribers to the National Association of Drug Diversion Investigators (NADDI) list server what they were seeing with the reformulation. We also asked hundreds of diversion investigators from across the country when we provided more than a dozen training sessions nationwide. Finally, I monitored the Rx Patrol, which provides pharmacy robbery reports to see if the addicts who were robbing pharmacies still wanted OxyContin more than 70% of the time, which had been the norm in the past.
The answer in all areas was that the new formulation had significantly reduced the abuse and diversion of OxyContin. The final piece of evidence was announced at the 22nd annual NADDI conference in Jacksonville, Florida. The Researched Abuse, Diversion and AddictionRe l a t e d S u r v e i l l a n c e (RADARS) System reported a considerable reduction in the abuse and diversion of reformulated OxyContin as determined by their drug diversion surveys of more than 300 law enforcement agencies.
My understanding is that the new formulation of OxyContin is still selling quite well in our country, making me wonder if I need to eat my words when I said, “The best drugs for pain relief are the best drugs for getting ‘high.’” These are words I would be glad to retract as I see the possibility of more new pain drugs on the horizon that provide effective pain management with similar abuse deterrence. PT
Cmdr Burke is a 40-year veteran of law enforcement and the current president of the National Association of Drug Diversion Investigators. He can be reached by e-mail at firstname.lastname@example.org, via the Web site www .rxdiversion.com, or by phone at 513-336-0070. Cmdr Burke is commander of the Warren County, Ohio, drug task force and retired commander of the Cincinnati Police Pharmaceutical Diversion Squad.