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Oxycontin Tweak Helped Turn Addicts to Heroin

heroin addicts on skid row

Lawmakers trying to combat the epidemic of opioid addiction might want to take note of the law of unintended consequences.

It can lead to the most unfortunate results.

A case in point is getting prescription painkillers off the streets might not have the effect of reducing addiction deaths. It might instead merely move the problem. At least that's the finding of some recently published research from the National Bureau of Economic Research.

Take, for instance, last week’s announcement of a bipartisan effort to combat the prescription drug scourge. Sens. Joni Ernst (R-Iowa), Chuck Grassley (R-Iowa), and Richard Blumenthal (D-Conn.) are pushing to make it easier to dispose of unused opioid pain relievers by alleviating the cost for pharmacies to collect the pills and destroy them. The senators are introducing the Access to Increased Drug Disposal (AIDD) Act of 2018 to make it happen.

It all sounds good. With fewer pills available, then surely there will be fewer drugs deaths, right? Wrong, at least based on the evidence of history.

Take a look at what happened after the 2010 reformulation of the uber-successful opioid painkiller OxyContin by the pharmaceutical company Purdue Pharma. The rejigged pills were cleverly designed so that they couldn’t and therefore wouldn’t be abused by addicts looking for an illicit high. At the same time, the medicine could still be useful for its prescribed use of combating pain. Just like with this month’s bipartisan push to stop opioid addiction, it sounded great.

Also similar to now, the problem facing the U.S. was that deaths from so-called semi-synthetic opioids, such as oxycodone (the drug in OxyContin) and hydrocodone, ballooned to more than 10,000 in 2010 -- up from fewer than 3,000 a decade before, according to data from the Kaiser Family Foundation.

The part of the plan to get addicts off OxyContin worked reasonably well, at least initially. Many addicts no longer abused the reformulated medication.

But it didn’t necessarily result in a happily-ever-after scenario.

Instead, the junkies quickly switched to heroin, according to the NBER research.

“The reformulation did not generate a reduction in combined heroin and opioid mortality — each prevented opioid death was replaced with a heroin death,” states an April-dated paper titled “How the Reformulation of Oxycontin Ignited the Heroin Epidemic.”

“We attribute the recent quadrupling of heroin death rates to the August 2010 reformulation of an oft-abused prescription opioid, OxyContin,” continues the report, authored by William Evans and Ethan Lieber, both from the University of Notre Dame, and Patrick Power from Boston University.

Deaths from heroin jumped to more than 15,000 in 2016, up from around 3,000 in 2010, according to the KFF data. And the fatalities from semisynthetic opioids stayed relatively flat for a few years and then grew, but much more slowly than previously.