Friday, July 13, 2012

The Law of Unintended Consequences Confirmed

After reformulation in 2010, OxyContin use dropped from 47.4% to 30%, but heroin use nearly doubled.
From the article "Effect of Abuse-Deterrent Formulation of OxyContin," published in the current issue of the New England Journal of Medicine:  

"In August 2010, an abuse-deterrent formulation of the widely abused prescription opioid OxyContin was introduced. The intent was to make OxyContin more difficult to solubilize or crush, thus discouraging abuse through injection and inhalation. We examined the effect of the abuse-deterrent formulation on the abuse of OxyContin and other opioids.
      
Data were collected quarterly from July 1, 2009, through March 31, 2012, with the use of self-administered surveys that were completed anonymously by independent cohorts of 2,566 patients with opioid dependence. 

The selection of OxyContin as a primary drug of abuse decreased from 35.6% of respondents before the release of the abuse-deterrent formulation to just 12.8% 21 months later.  

Of all opioids used to “get high in the past 30 days at least once," OxyContin fell from 47.4% of respondents to 30.0%, whereas heroin use nearly doubled (see chart above, click to enlarge).

Our data show that an abuse-deterrent formulation successfully reduced abuse of a specific drug but also generated an unanticipated outcome: replacement of the abuse-deterrent formulation with alternative opioid medications and heroin, a drug that may pose a much greater overall risk to public health than OxyContin. Thus, abuse-deterrent formulations may not be the “magic bullets” that many hoped they would be in solving the growing problem of opioid abuse.

MP: That's why the law of unintended consequences is called a "law."  It also confirms the reality that the "stronger the drug laws, the stronger and more dangerous the drugs."

HT: Morgan Frank

17 Comments:

At 7/13/2012 10:57 AM, Blogger morganovich said...

the first line of the study says it all:

"July 12, 2012 — A 2010 change in a controlled-release formulation of oxycodone (OxyContin, Purdue Pharma) that was intended to prevent abuse of the widely prescribed opioid has had the unintended consequence of causing many abusers to switch to heroin, new research shows."

this is precisely the same thing we saw with wood alcohol during prohibition and really dangerous stuff like bath salts now.

the demand does no go away, it just shifts to more dangerous stuff.

 
At 7/13/2012 11:05 AM, Blogger Moe said...

Is this really a case of "unintended consequences"?

The controlled-release formulation was intended to get abusers off Oxycontin - not off of any addiction they suffer from - and it worked. As Morganovich points out - the demand remains - they were going to go somewhere...

 
At 7/13/2012 11:09 AM, Blogger Mark J. Perry said...

But heroin is more dangerous, so the situation is now worse, not better.

 
At 7/13/2012 11:11 AM, Blogger Moe said...

Hello Mr. Perry,

Agreed, but keeping people away from heroin was never the intention of the reformulation - it was get them off Oxycontin - so it was successful in its intention...no? (I've gone without coffee this a.m., so maybe I'm missin g it)

 
At 7/13/2012 11:21 AM, Blogger Jon Murphy said...

Moe-

If I may answer for Dr. Perry (and please correct me if I am wrong):

The idea was oxycontin was dangerous and get people off the dangerous drug. So, it was sucessfull in getting people off oxycontin. However, the unintended consequence was the rise in heroin. When this was reformulated, they did not intended to drive people to heroin. But that is what happened.

Remember Newton's Law of Physics? "Every Action has an equal and opposite reaction." The Law of Unintended Consequences is similar: every intended consequence has an equal and opposite unintended consequence.

make sense? I am pretty hopped up on painkillers right now (irony, I know), so I could be making no sense.

 
At 7/13/2012 11:27 AM, Blogger morganovich said...

moe-

to simplify what jon said a bit, the goal was to make the world "safer". the purported route was to do so by reducing oxy abuse.

instead, it made it more dangerous because the route that emerged led to heroin.

i do not think anyone would argue that mexican black tar bought from callie in da alley is safer than pharmaceutical grade oxy.

i'd be very interested to see what happened to overall opiod ODs and health crises as a result of this.

there is nothing inherently wrong with trying to make a product safer, but, in this case, it looks like a loss not a win.

getting people to switch from johhy walker to wood alcohol is hard to see as a positive.

 
At 7/13/2012 11:31 AM, Blogger Moe said...

Hey Jon,

I guess I don't see it driving "new users" to heroin.

Oxycontin abusers were more than likely abusing something before it came along – it provides a similar high to heroin, so not a stretch to say they were probably on heroin? We've seen it go full circle. Heroin to Oxycontin to reformulated Oxycontin back to Heroin.

Disclaimer: I'm not an addict, and haven't even played one on TV, so what do I know???

 
At 7/13/2012 11:40 AM, Blogger morganovich said...

moe-

while what you describe is possible, it seem to me more likely that they just found themselves unable to get oxy that worked to get high and went looking for something else.

the chart has an interesting 1 quarter lag in it from when oxy started to drop and heroin started to pick up.

that would be consistent with people seeking out a new source. if they were already using heroin, one would expect the change to be more rapid.

 
At 7/13/2012 12:41 PM, Blogger M. Simon said...

The Definition of Anarchy is amusing and where I got a link to this post.

Laws were created to fight the scourge of drugs and what we got was Drugs and Anarchy. A bad bargain.

Funny how so many - still - wish to keep paying on this bad deal.

 
At 7/13/2012 12:46 PM, Blogger M. Simon said...

How about this possibility - way beyond my pay grade - the Drug Cartels promoted this - the Drug Companies look like heroes and the Cartels reap the profits.

During Alcohol Prohibition the Cartels of that era owned government. Why should this era be any different?

 
At 7/13/2012 2:06 PM, Blogger Moe said...

Morganovich.

You are more than likely correct. I see heroin addicts attracted to Oxy only because I assume the following: it has a similar effect, is cheaper, easier to procure and if you get caught with Oxy vs. heroin - big difference.

 
At 7/13/2012 2:30 PM, Blogger Ken said...

Mark,

How is heroin more dangerous that Oxycontin?

 
At 7/13/2012 2:44 PM, Blogger morganovich said...

ken-

for the same reason that bootleg hooch is more dangerous than johhny walker except more so.

pharmaceutical heroin (dilaudid) may well not be any more dangerous.

but that is not what is sold on the street.

street heroin is unpredictable in purity, cut with all sorts of harmful chemicals, made using primative and poorly controlled processes, and may ahve intensifiers in it as well.

this is a very big deal with heroin as it has a narrow therapeutic window.

that is to say, that the difference between the amount that will give you desired effect and the amount that will result in an OD is small.

it's difficult to accidentally drink 12 beers and be really drunk. you tend to notice that.

if you feel 3 and 10 is an issue, you have a wide window.

but imagine that 1 beer would make you buzzed and 1.3 would give you alcohol poisoning. that's how opiods work.

so, would you rather have a dosage and concentration created to pharma standards in a lab, or one that can vary by multiples and is unpredictable as street heroin does?

 
At 7/14/2012 2:00 AM, Blogger PeakTrader said...

All this means is if the liquor store a block away closes, the alcoholic will walk two blocks to the next liquor store.

 
At 7/14/2012 2:18 AM, Blogger PeakTrader said...

I've seen a lot of stores close. However, I don't recall ever seeing a liquor store close.

 
At 7/14/2012 5:37 PM, Blogger Hydra said...

Every action inolves certain trade offs. that does not mean the action is ALWAYS bad.

Even actions by individuals, made in their own best interests, may have unintended consequences that affect others negatively.

Proper recognition and enforcement of property rights could help insure that unintended consequnces are properly accounted and paid for.

 
At 7/14/2012 5:41 PM, Blogger Hydra said...

We've seen it go full circle. Heroin to Oxycontin to reformulated Oxycontin back to Heroin.

============================

That seems correct to me. If it is the case then you would seem to have a condition of circular unintended consequences (the inventor or discoveror of heroin did not intend to create a class of addicts)


Like many issues, this one is distorted by choosing a wrong system boundary.

 

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