Researchers Link Oxycodone Abuse Deterrent Formulation to HCV Surge

FEBRUARY 06, 2019
Kenneth Bender, PharmD, MA
The 2010 remanufacturing of Purdue Pharma's OxyContin (oxycodone) into an "abuse-deterrent formulation" has been identified as a key contributing factor in opioid abusers switching to heroin injections and the corresponding surge in hepatitis C virus (HCV) infections, according to a new Rand Corporation study.

Although injection drug use has previously been identified as a predominant risk factor for HCV infection and the opioid epidemic has been suggested as a driver of the recent rise in infections, David Powell, PhD, Senior Economist at the Rand Corporation, Arlington Virginia, and colleagues noted that increased HCV infections appeared to coincide with the reformulation of OxyContin.

To test for a causal relation, the investigators analyzed differences in infection rates between states with different rates of OxyContin misuse prior to reformulation. They assumed that if the reformulation was a principle factor in the increased rate of infection, they would find a higher impact in the states with higher levels of OxyContin misuse prior to reformulation.

The investigators obtained the rate of new acute HCV infections in each state from the National Notifiable Diseases Surveillance System administered by the Centers for Disease Control and Prevention (CDC). Their measure of non-medical use of OxyContin and other analgesics was drawn from self-reported data of the public-use National Survey on Drug Use and Health.

Several measures were taken to validate the comparative analysis, including testing whether the nonmedical use of other analgesics such as hydrocodone, tramadol, and morphine predicted HCV infections following the OxyContin reformulation. In addition, their analysis controlled for contemporary changes in opioid use policies and enforcement practices, such as prescription drug monitoring programs, pain clinic regulations, and disruption of major "pill-mill" operations.

Powell and colleagues found that incidents of OxyContin misuse fell by more than 40% after reformulation, in data collected between 2010 and 2015, and that this coincided with sharp increases in both heroin-related mortality and HCV infections. 

A version of the article was orignally published by MD Magazine. View the full article at