The Cato Institute

“Abusedeterrent” Opioids Aren’t the Cure for Overdose Deaths

Could an “abusedeterrent” formulation of OxyContin, introduced in 1996, be to blame for rising overdose deaths?

Deaths from drug overdoses have steadily increased over the past 15 years — the national death rate (deaths/100,000) for drug poisonings doubled from 1999 to 2014 — and are now at epidemic levels.

Between 1999 and 2009, opioid death rates were rising rapidly, but heroin death rates were much lower and were increasing slowly. In 2010, this changed; over the next four years, heroin death rates increased by a factor of four while opioid death rates remained fairly flat.

The rise in deaths involving heroin or opioids can account for 75% of the overall increase in deaths from drug poisonings.

Opioids are narcotic pain relievers and are available, legally, only by prescription. When used as directed, they are an important element of fighting acute and chronic pain. However, when taken in large quantities, opioids shut down the respiratory system and can lead to death. 

Starting in the mid-1990s, medical groups argued that there was an epidemic of untreated pain, and they urged greater use of opioid pain medicines, especially for those with chronic conditions. The efforts changed prescribing practices considerably. Between 1991 and 2013, opioid prescriptions increased threefold. Opioids are addictive, and as their everyday use increased, so did abuse rates. 

OxyContin became popular for recreational use and abuse because the drug offered much more of the active ingredient, oxycodone, than other prescription opioids, and because the pills could easily be manipulated to access the entire store of the active ingredient. In early August 2010, the makers of OxyContin, Purdue Pharma, took the existing drug off the market and replaced it with an abusedeterrent formulation (ADF) that made it difficult to abuse the drug in this fashion.

OxyContin prescriptions, deaths from opioids, fatalities reported to the makers of OxyContin, calls to poison control centers for opioids, and entrance into opioid treatment programs all have flatlined since the third quarter of 2010. 

However, this change made the drug far less appealing to opioid abusers and led many to shift to a readily available and cheaper substitute, heroin.

The Food and Drug Administration has promoted the development of abuse-deterrent opioids, like the one created for OxyContin, to pharmaceutical companies and has worked with manufacturers to bring these products to market as quickly as possible. Most recently, the Food and Drug Administration listed the development of ADFs as a national policy priority, 5 states have adopted laws requiring insurance companies to cover ADFs, and similar laws have been proposed in 15 other states. 

However, the evidence is clear that these policies don’t work. 

For example, in the case of the OxyContin reformulation, opioid death rates were increasing rapidly across all groups before reformulation, but were flat afterward. That might seem like a success, but when heroin and opioid death rates are combined, there’s no evidence that total heroin and opioid deaths fell at all after the reformulation. Instead, there appears to have been one-for-one substitution of heroin deaths for opioid deaths.

Thus, it appears that the intent behind the abuse-deterrent reformulation of OxyContin was completely undone by changes in consumer behavior.

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