In 2010, Purdue Pharma changed the unique model of OxyContin, an extended-release oxycodone tablet, with a reformulated product that was a lot more durable to crush for snorting or injection. The thought was to discourage nonmedical use, and the hope was that the reformulation would cut back dependancy and opioid-related deaths. That isn’t how issues labored out.
The reformulation of OxyContin was as an alternative related to a rise in deaths involving illicit opioids and, finally, an general enhance in deadly drug overdoses. Researchers recognized that sample by trying on the relationship between pre-2010 charges of OxyContin misuse, as measured by surveys, and subsequent overdose developments. They discovered that demise charges rose quickest in states the place reformulation would have had the most important impression. A brand new research by RAND Company senior economist David Powell extends these findings by exhibiting that the reformulation of OxyContin additionally was related to rising suicides amongst youngsters and youngsters.
The basis explanation for such perverse results was the substitution that occurred after the previous model of OxyContin was retired. Nonmedical customers turned to black-market alternate options that have been extra harmful as a result of their efficiency was extremely variable and unpredictable—a hazard that was compounded by the emergence of illicit fentanyl as a heroin booster and substitute. The fallout from the reformulation of OxyContin is one instance of a broader tendency: Interventions geared toward decreasing the hurt brought on by substance abuse often have the other impact.
From 1988 to 2010, Powell notes within the journal Demography, the suicide charge amongst 10-to-17-year-olds fell by 36 %. That drop was “followed by eight consecutive years of increases—resulting in an 83% increase in child suicide rates.” Primarily based on interstate variations in nonmedical use of OxyContin previous to 2010, Powell estimates that “the reformulation of OxyContin can explain 49% of the rise in child suicides.”
Since “the evidence suggests that children’s illicit opioid use did not increase,” Powell says, it seems to be like “the illicit opioid crisis engendered higher suicide propensities by increasing suicidal risk factors for children,” equivalent to baby neglect and “alter[ed] household living arrangements.” He notes a previous research that discovered “states more
affected by reformulation experienced faster growth in rates of child physical abuse
and neglect starting in 2011.” And he suggests the suicide charge may have been boosted by “parental death and incarceration” related to the shift from legally produced prescribed drugs to illicit medication.
“Areas more impacted by the transition to illicit opioids due to higher rates of previous OxyContin misuse showed sharper growth in child suicide rates,” Powell stated in a press launch. “The results are consistent with the growth in illicit opioid use among the adult population generating worsening conditions for children by increasing rates of child neglect.”
This research is certainly one of a number of documenting the unintended results of OxyContin’s reformulation. In a 2021 American Journal of Well being Economics article, Powell and College of Southern California economist Rosalie Liccardo Pacula famous that the intervention was instantly adopted by a rise in heroin-related deaths, a development that was particularly pronounced in states with comparatively excessive pre-2010 charges of OxyContin misuse. In subsequent years, they discovered, “reformulation stimulated illicit drug markets to grow and evolve,” finally leading to extra fentanyl-related deaths.
“More exposed areas experienced disproportionate increases in fatal overdoses involving synthetic opioids (fentanyl) and nonopioid substances like cocaine, suggesting that these new epidemics are related to the same factors driving the rise in heroin deaths,” Powell and Pacula wrote. “Instead of just short-term substitution from prescription opioid to heroin overdoses, the transition to illicit markets spurred by reformulation led to growth in the overall overdose rate to unprecedented levels.”
The eventual impression of that transition was dramatic. “We estimate that reformulation increased the 2013 overdose rate by 1.7 overdoses per 100,000 people, a 14 percent increase relative to the counterfactual,” Powell and Pacula wrote. “However, by 2017, our estimates imply that reformulation increased overdose rates by over 11.6 overdoses per 100,000 people, more than a 100 percent increase relative to our counterfactual.”
What in regards to the expectation that reformulating OxyContin would finally cut back opioid abuse? “The potential benefits of reformulation include reductions in the propensity of beginning to misuse opioids,” Powell and Pacula famous. “However, there is little empirical evidence that such reductions are having a meaningful impact on overdose rates. The relationship between exposure to reformulation and overdose rates has strengthened over time. In addition, initial substance use treatment admissions are also increasing faster in states more exposed to reformulation, suggesting that initiation rates are still not declining in response.”