A decade after the pain reliever Oxycontin was linked to an increasing number of fatal overdoses, a new form of the pill — designed to keep addicts from snorting or injecting the drug — is making its way into Kentucky.
The impact of the new formula on prescription drug abuse is unclear. But experts agree it isn't likely to end the opiate addiction that is ravaging parts of Kentucky. Drug abusers are likely to switch to the substance that will produce the most similar high: heroin.
Drug maker Purdue Pharma has long maintained Oxycontin is safe if used correctly. But, as law enforcement agencies across the country, including Kentucky, began blaming the drug for a rise in prescription pill addiction and fatal overdoses in 2001, the company began talking of creating a new formula.
Oxycontin — which was formulated to treat the severe pain of cancer patients — was designed to work on time release, dispensing an equal dose of pain relieving medicine over a 12-hour period. But addicts quickly discovered the pills could be ground up and injected or snorted to provide the full power of the narcotic in one, addictive rush.
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The company has worked with the FDA to produce a tablet that couldn't be easily ground up to hamper abuse. The new pill looks similar to the old one but is slightly larger.
"Purdue is very aware that the abuse of painkillers and prescription drugs is a very serious public health problem," said Libby Holmen, associate director of public affairs for the drug maker. "We are committed to being part of the solution to that problem."
While the company hopes it has found a tamper-proof product, there is no data to back up that claim — yet, Holmen said.
"It was developed in a way that hopefully it will be," she said, adding that the company will be working with the FDA to test the new formula.
"We are anxious to know that we are having a positive impact," she said.
The new formula has made the tablets difficult to manipulate, said Dr. Sharon Walsh, director of the Center on Drug and Alcohol Research at the University of Kentucky. The pill won't become powdery when crushed, but instead it breaks into chunks that can't be snorted or injected. If addicts try to melt the pills, they become gummy, she said.
If the new formula is successful it could prove an important template for safeguarding the abuse of other potentially addictive drugs, she said.
After years of research and getting FDA approval last April, the company began shipping the new formula to pharmacies and distributors in August. The pills have been appearing on the streets in Kentucky in the last two months, said Jennifer Havens, a University of Kentucky researcher who is studying drug addiction in Eastern Kentucky.
Havens' team interviews 503 addicts every six months. So far, she said, the addicts don't seem to like the new version of their preferred drug.
"They are not able with the new formulation to snort and inject," she said. "That seems to be changing the drug-use patterns.
"We may see a big change in the next year or two," she said, adding that she expects the drug abusers to seek a similar high from another form of opiate, most likely heroin.
"If you still got that monkey on your back at that point you are going to go to heroin," said Frank Rapier, director of Appalachia High Intensity Drug Trafficking Areas, which coordinates drug control efforts between local, state and federal agencies.
Right now, he said, "it's pills, pills, pills" in much of Kentucky, and Oxycontin is "eating everybody's lunch." Statistics Rapier has from the FBI show that about 70 people in Kentucky are dying each month as a result of prescription drugs overdose, he said.
The number of Oxycontin addicts is not likely to decrease because of the new formula because the addiction is so strong, he said. But as addicts switch to heroin a whole slew of new problems will come to Kentucky towns.
Based on Rapier's experience in the field, most people involved in selling Oxycontin in Kentucky are doing it to fund their own drug habits. "Most of them don't even have a criminal record," he said.
But the heroin trade is dominated by gangs and organized crime, he said. The level of violence associated with its distribution would change the character of drug wars in Kentucky for the worse, he said, adding his peers in other states have reported in recent months that there's an increase in heroin sales in Ohio and West Virginia.
Karen Kelly, director of Operation Unite, said the new formula may have some impact but she is skeptical as to how much.
"Addicts are always going to find a way," she said.