The Evolving Consequences of OxyContin Reformulation on Drug Overdoses

Powell, David; Pacula, Rosalie Liccardo

doi:10.1086/711723

Cited by 47 publications

(31 citation statements)

References 38 publications

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“…Although our participants do not represent the majority who were prescribed opioids for pain, most of whom take them only as prescribed and do not switch to heroin, the increasing rates of overdose deaths due to heroin and fentanyl suggests that the number of people who switched to heroin is not trivial. The existing market for POs on the street was replaced with heroin when POs became less available [64]. Trend theory is a useful framework for understanding these changes over time [59].…”

Section: Discussionmentioning

confidence: 99%

The effects of opioid policy changes on transitions from prescription opioids to heroin, fentanyl and injection drug use: a qualitative analysis

Dickson‐Gómez

Krechel

Spector

et al. 2022

Subst Abuse Treat Prev Policy

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Background Beginning in the 1990s, nonmedical use of prescription opioids (POs) became a major public health crisis. In response to rising rates of opioid dependence and fatal poisonings, measures were instituted to decrease the prescription, diversion, and nonmedical use of POs including prescription drug monitoring programs (PDMPs), pain clinic laws, prescription duration limits, disciplining doctors who prescribed an excessive number of POs, and the advent of abuse deterrent formulations of POs. This paper explores the unintended effects of these policies in the descriptions of why people who use opioids transitioned from PO to injection or heroin/fentanyl use. Methods We conducted 148 in-depth-interviews with people who use prescription opioids nonmedically, fentanyl or heroin from a rural, urban and suburban area in three states, Connecticut, Kentucky and Wisconsin. Interviews with people who use opioids (PWUO) focused on how they initiated their opioid use and any transitions they made from PO use to heroin, fentanyl or injection drug use. Results The majority of participants reported initiating use with POs, which they used for medical or nonmedical purposes. They described needing to take more POs or switched to heroin or fentanyl as their tolerance increased. As more policies were passed to limit opioid prescribing, participants noticed that doctors were less likely to prescribe or refill POs. This led to scarcity of POs on the street which accelerated the switch to heroin or fentanyl. These transitions likely increased risk of overdose and HIV/HCV infection. Conclusions A careful analysis of how and why people say they transitioned from PO to heroin or fentanyl reveals many unintended harms of policy changes to prevent overprescribing and diversion. Results highlight the importance of mitigating harms that resulted from policy changes.

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Section: Discussionmentioning

confidence: 99%

The effects of opioid policy changes on transitions from prescription opioids to heroin, fentanyl and injection drug use: a qualitative analysis

Dickson‐Gómez

Krechel

Spector

et al. 2022

Subst Abuse Treat Prev Policy

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“…Purdue also reformulated OxyContin into an abuse-deterrent version in 2010. Collectively, these changes stimulated the growth of a "thick market" for heroin (a cheaper and more potent opiate), ushering in the second wave of the overdose crisis (early-to-mid 2010s) (Alpert et al 2018;Cicero et al 2012;Pitt et al, 2018;Powell and Pacula 2021). Heroin is pharmacologically similar to, though more potent (in terms of morphine milligram equivalents) than, prescription opioids.…”

Section: Wave 2: Heroinmentioning

confidence: 99%

Demographic and Geographic Variation in Fatal Drug Overdose Rates in the United States, 1999-2020

Monnat¹

2022

Preprint

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The U.S. drug overdose crisis has been described as a national crisis affecting all communities. However, overdose rates are higher and have increased more in some sub-populations and places than others. This paper describes demographic (sex, racial/ethnic, age) and geographic variation in fatal drug overdose rates, 1999 to 2020. Throughout most of the period, rates were highest among young and middle-age (25-54) White and American Indian males and middle-age and older (45+) Black males. Rates have been consistently high in Appalachia, but in recent years have spread throughout several regions along the urban-rural continuum. Although opioids have been the main contributor, the contributions of cocaine and psychostimulants have increased dramatically in recent years, demonstrating that our problem is bigger than opioids. Supply-side interventions are unlikely to be effective in reducing overdoses. Instead, the U.S. must invest in policies that address the upstream structural drivers of the crisis.

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“…Purdue also reformulated OxyContin into an abuse-deterrent version in 2010. Collectively, these changes stimulated the growth of a “thick market” for heroin (a cheaper and more potent opiate), ushering in the second wave of the overdose crisis (early to mid-2010s) (Alpert et al 2018; Cicero and Surratt 2012; Pitt, Humphreys, and Brandeau 2018; Powell and Pacula 2021). Heroin is pharmacologically similar to, though more potent than (in terms of morphine milligram equivalents), prescription opioids.…”

Section: Factors Driving the Contemporary Drug Overdose Crisismentioning

confidence: 99%

Demographic and Geographic Variation in Fatal Drug Overdoses in the United States, 1999–2020

Monnat¹

2022

The ANNALS of the American Academy of Political and Social Scie

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The U.S. drug overdose crisis has been described as a national disaster that has affected all communities. But overdose rates are higher among some subpopulations and in some places than they are in others. This article describes demographic (sex, racial/ethnic, age) and geographic variation in fatal drug overdose rates in the United States from 1999 to 2020. Across most of that timespan, rates were highest among young and middle-age (25–54 years) White and American Indian males and middle-age and older (45+ years) Black males. Rates have been consistently high in Appalachia, but the crisis has spread to several other regions in recent years, and rates are high across the urban-rural continuum. Opioids have been the main contributor, but overdoses involving cocaine and psychostimulants have also increased dramatically in recent years, demonstrating that our problem is bigger than opioids. Evidence suggests that supply-side interventions are unlikely to be effective in reducing overdoses. I argue that the U.S. should invest in policies that address the upstream structural drivers of the crisis.

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The Evolving Consequences of OxyContin Reformulation on Drug Overdoses

Cited by 47 publications

References 38 publications

The effects of opioid policy changes on transitions from prescription opioids to heroin, fentanyl and injection drug use: a qualitative analysis

The effects of opioid policy changes on transitions from prescription opioids to heroin, fentanyl and injection drug use: a qualitative analysis

Demographic and Geographic Variation in Fatal Drug Overdose Rates in the United States, 1999-2020

Demographic and Geographic Variation in Fatal Drug Overdoses in the United States, 1999–2020

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