Taking the Fun Out of Popping Pain Pills

By chillinwill · Sep 20, 2009 · ·
  1. chillinwill
    HOW can you get a faster high from sustained-release pain pills like OxyContin? Let me count some of the ways.

    People have crushed them using bookends, hammers, mortars and pestles, and then snorted the powder, according to doctors who study addiction. They’ve chewed and swallowed fistfuls of pills. They’ve minced the pills in blenders, pulverized them in coffee grinders, dissolved them in water and then injected the liquid.

    Even for those of us who don’t inhale, the misuse and abuse of prescription painkillers called opioids should matter because, putting moral and ethics aside for the moment, it’s costing us billions of dollars.

    In a 2008 federal survey, an estimated 4.7 million Americans were found to have used prescription pain relievers for nonmedical reasons in the previous month. The abuse of opioids now costs at least $11 billion annually in excess medical care including overdoses by adults and accidental ingestion by children, said Howard G. Birnbaum, a health economist with the Analysis Group in Boston.

    Corporate America loves a void, and now some pharmaceutical companies are developing innovative opioids intended to deter tampering and meet the market’s need.

    Some pills under development are rubberlike and harder to crush. Others contain ingredients that cause unpleasant reactions in the body, like flushing or itching, if the pill is adulterated. Taking a cue from exploding ink packets that can render stolen money unusable, some pills have an outer opioid layer and an inner core that, if tampered with, releases a drug that counters the high of the pain reliever.

    Embeda, made by King Pharmaceuticals in Bristol, Tenn., uses the last of these strategies. Scheduled to arrive in drug stores this weekend, Embeda is the first of the new so-called abuse-deterrent opioids to reach the market. But, the Food and Drug Administration has approved Embeda only as a pain reliever, not as an abuse-deterrent drug, an agency spokeswoman said.

    In a clinical study of Embeda, a majority of volunteers experienced less euphoria when they took a crushed form of the drug compared to immediate-release morphine. But the company has not yet established the real-world significance of the results.

    The hope for abuser-unfriendly pills is that they might eventually decrease abuse. The drawback is that the pills represent (bad pun alert!) a fix for only one part of a very complex problem.

    In a sense, the new opioids reflect the ups and downs of broader efforts to overhaul health care: addressing cosmetic aspects of the problem without thoroughly grappling with systemic causes.

    While legislators are diligently trying to figure out how to get medical coverage for millions of uninsured people, the insurance gap is just one symptom of an ailing, inefficient medical system inclined toward reactive rather than preventive care.

    Likewise, the new pain relievers are intended to deter an important cause of opioid abuse: tampering. But, for people who simply ingest too many whole, intact pills, tamper-resistant opioids still don’t reduce overdose risks, said Dr. Nathaniel P. Katz, the chief executive of Analgesic Research, a research and consulting firm in Boston that specializes in the development of pain treatments.

    (Dr. Katz and every other expert quoted here say they have worked as paid consultants for King Pharmaceuticals or conducted research sponsored by the company).

    Drug companies have promoted novel opioids as nonaddictive on other occasions and failed, said Dr. Katz, who is also a neurologist and adjunct faculty member at Tufts University medical school. He cited heroin, introduced by Bayer as a branded drug in 1898, and OxyContin, introduced by Purdue Pharma in 1995. Moreover, according to Steven D. Passik, a clinical psychologist at Memorial Sloan-Kettering Cancer Center in Manhattan, the advent of so-called abuse-deterrent opioids also doesn’t solve another, larger problem: uneven state and physician monitoring of the legal circulation of opioids.

    “It does not obviate the need to put together a strategy to teach every prescriber to do Addiction Medicine 101,” Dr. Passik said.

    A more complete strategy to combat opioid abuse, he said, would involve asking busy primary care doctors to routinely assess how vulnerable to addiction a patient might be and to closely track patients taking opioids for chronic pain. That, of course, means some health insurers would have to step up and cover more frequent urine tests and doctor visits for those patients.

    Meanwhile, on a regulatory level, some states should devote greater resources to online prescription monitoring systems, Dr. Katz said. These are databases used by pharmacists and doctors to check whether a patient already has multiple opioid prescriptions, a phenomenon called “doctor shopping” that is a red flag for drug abuse.

    On a federal level, the F.D.A. is developing a comprehensive risk management system for sustained-release opioids, an agency spokeswoman said. The program may include a certification requirement for doctors who prescribe and pharmacies that dispense those kinds of painkillers.

    But the F.D.A. could solve another slice of the problem — people who share legally prescribed opioids with friends and family members — if it required a patient training program, Dr. Katz said.

    If doctors verbally warned patients, “‘Don’t share, it’s a felony, and you will kill your neighbors, friends and family,’ you’d have a lot less sharing,” he said.

    Finally, opioid abuse might be diminished if there were national standards on how to dispose of unused pills, said Sandra Comer, a professor of clinical neurobiology in the psychiatry department at Columbia University medical school.

    Often, Dr. Comer said, patients are prescribed an opioid for a month or more, but their pain subsides after a week or two. Then they have leftover pills in their medicine cabinets which are open to pilfering by, for example, college-age children or visitors.

    But nobody knows what to do with unused pills because pharmacies won’t take them back. Flushing them down the toilet is a bad idea because the chemicals can pollute the water system. Some experts recommend mixing the pills with used kitty litter or coffee grounds and throwing them in the garbage.

    September 19, 2009
    NY Times

    Perhaps, in addition to patient training, the F.D.A. might institute a give-back program — akin to government buy-back deals for guns — for anybody housing an inventory of unused prescription painkillers.

    Share This Article


  1. missparkles
    People are always gonna look for ways to take prescribed meds that give more bang for their buck. Adding anything that prevents this is just gonna cause more damage.
    People who know not to, don't do it now, people who don't know are still gonna try.
    Sparkles remembers Temazepam, when they first came out, they were gel filled eggs.
    Everyone knew they were risking possible limb amputation injecting them, but still did it, hoping they would get away with it.
    Nothings changed, so why make it dangerous?
    Yeah...pharma meds are supposed to be taken as directed, but people don't use meds as prescribed, drug companies know this. It seems quite a spiteful, punishing thing to do.
    Just my opinion.
  2. Motorhead
    The pharmies have been attempting stuff like this for some time now. It is a futile attempt at dealing with drug abuse from the supply side of the issue. Its the same mode of thinking that allows a militant approach to drug trafficking-arresting and jailing dealers, spraying coca crops and the like.

    Perhaps someday we will have forward thinking prevail in our institutions that will make an effort to really deal with abuse from the demand side, such as legalizion and regulation, more research and funds directed at the nature and treatment of addiction, and promoting information on harm reduction rather than abstinence.

    For now it is the same old song and dance.

    lol I really don't understand this statement. How does putting anything in our sewers pollute the water supply?
  3. g666d
    Swim agrees. Can't help thinking the money which would have gone to pharma, will go to afghanistan or whoever can produce comparable illicit analgesics. If they successful at making painkillers 'abuse-proof'.
    And if body can extract active ingredients, chances are home chemist can too.
    But maybe will be good side, with 'abuse-proof' pills maybe docs will script them easier :)
  4. missparkles
    I'm not sure, but I remember reading somewhere that fish have changed, due to the amounts of hormones in rivers.
    Found this site, hope it's ok to post it here. It does give some explanation.
    That might be what's meant about flushing these meds down the toilet. But if you use them for cat littler, then throw them, eventually they get into the soil...don't they?

    There's lots of stuff on the net about it.
  5. g666d
    I understood was that was initially blamed on birth control pill, but later found to be a result of effluent from all the female sows/cows from farming flooding rivers with estrogen. Just what read somewhere.
    Have a bit trouble understanding that article, couple of chemical names i don't understand.
    Junkie fish?? suppose we'd catch them swimming around the toilet bowl, hanging for their next fix...
To make a comment simply sign up and become a member!