Article Body 2010 
 
 A reformulation of OxyContin that makes it harder to abuse has curtailed the drug’s illicit use. But some 25 percent of drug abusers entering rehab said they still abused the prescription painkiller despite package labeling that emphasizes its abuse-deterrent properties, new research indicates. 
 
 The study, by researchers at Washington University School of Medicine in St. Louis, is published March 11 in JAMA Psychiatry. 
 
 Surveying almost 11,000 drug users at 150 drug-treatment facilities in 48 states, the researchers found that an abuse-deterrent formulation of the prescription drug OxyContin was successful in getting abusers and addicts to stop using the drug, but only to a point. 
 
 
 
 “We found that the abuse-deterrent formulation was useful as a first line of defense,” said senior investigator Theodore J. Cicero, PhD, a professor of neuropharmacology in psychiatry. “OxyContin abuse in people seeking treatment declined, but that decline slowed after a while. And during that same time period, heroin use increased dramatically.” 
 
 The original formulation of OxyContin contained high levels of the pain-killing drug oxycodone. It was designed so that small amounts of the drug were released over a long period of time. However, abusers in pursuit of an intense high found they could crush the pills and snort the powder, or dissolve the pills in liquid and then inject the drug. 
 
 To discourage abuse, the newer formulation of OxyContin was designed to make it harder to crush or dissolve the pills. 
 
 The abuse-deterrent formulation was introduced in 2010 at a time when 45 percent of study participants entering drug treatment reported they had used OxyContin to get high at least once in the previous 30 days. Two years later, the percentage of those who got high with the abuse-deterrent form of the drug in the month before entering a treatment center had fallen to 26 percent. 
 
 These abusers continued to use OxyContin to get high by either taking the drug orally or finding new ways to snort or inject it. 
 
 Perhaps even more worrisome, almost half of the drug abusers surveyed in 2014 reported they had used heroin in the 30 days before they entered treatment. 
 
 “Some people found ways to get around the abuse-deterrent formulation so that they could snort or inject it, and others simply swallowed the pills,” Cicero explained. “But many people switched to heroin, and that’s a major concern.” 
 
 Robert Boston Theodore J. Cicero, PhD, professor of neuropharmacology in psychiatry at Washington University School of Medicine in St. Louis, reviews drug-abuse data. 
 
 Cicero, also vice chairman for research in the Department of Psychiatry, explained that of those who had stopped using OxyContin and switched to another drug, 70 percent started using heroin instead. Many said they made that switch for economic reasons. 
 
 “A few years ago when we did interviews with people in treatment, many would tell us that although they were addicts, at least they weren’t using heroin,” he said. “But now, many tell us that a prescription opioid might run $20 to $30 per tablet while heroin might only cost about $10.” 
 
 In addition, he said, many of the people who sell heroin aren’t quite as frightening as they once seemed. Addicts no longer have to find dealers in dark alleys in rough neighborhoods. It has become easy to find heroin virtually anywhere, including suburban and rural areas. 
 
 “Some people have come to see it as a cost-effective method of getting high,” Cicero said. “If they can tolerate the intravenous injection and overcome their reluctance to give themselves a shot, many of the people in our study said it was a fairly simple decision and that heroin now represents a cheaper, more attractive alternative.” 
 
 Limiting access to a prescription drug by making it harder to abuse does not change the demand side of the drug abuse equation, he said. People who want to get high find ways to continue doing so. 
 
 “The newer formulations are less attractive to abusers, but the reality is — and our data demonstrate this quite clearly — it’s naïve to think that by making an abuse-deterrent pill we can eliminate drug abuse,” he said. “There are people who will continue to use, no matter what the drug makers do, and until we focus more on why people use these drugs, we won’t be able to solve this problem.” 
 
 The data were collected as part of the SKIP (Survey of Key Informants’ Patients) program, a component of the RADARS (Researched Abuse, Diversion and Addiction-Related Surveillance) system, funded through an unrestricted research grant sponsored by the Denver Health and Hospital Authority, which collects subscription fees from 14 pharmaceutical firms. The researchers also were supported by private university funds. 
 
 Cicero TJ, Ellis MS. Abuse-deterrent formulations and the prescription opioid abuse epidemic in the United States. JAMA Psychiatry, published online March 11, 2015. doi:10.1001/jamapsychiatry.2014.3043 ||||| Importance In an effort to reduce wide-scale abuse of the proprietary oxycodone hydrochloride formulation OxyContin, an abuse-deterrent formulation (ADF) was introduced in 2010. Although the reformulation produced an immediate drop in abuse rates, a definite ceiling effect appeared over time, beyond which no further decrease was seen. 
 
 Objective To examine the factors that led to the initial steep decline in OxyContin abuse and the substantial levels of residual abuse that have remained relatively stable since 2012. 
 
 Design, Setting, and Participants We used data from the ongoing Survey of Key Informants’ Patients program, part of the Researched Abuse, Diversion and Addiction-Related Surveillance system that collects and analyzes postmarketing data on misuse and diversion of prescription opioid analgesics and heroin. For our survey study, patients with a DSM-V diagnosis of opioid use disorder and primary drug of abuse consisting of a prescription opioid or heroin (N = 10 784) at entry to 1 of 150 drug treatment programs in 48 states completed an anonymous structured survey of opioid abuse patterns (surveys completed from January 1, 2009, through June 30, 2014). A subset of these patients (n = 244) was interviewed to add context and expand on the structured survey. 
 
 Main Outcomes and Measures In addition to key demographic measures, past-month abuse of opioids was the primary measure in the structured surveys. In the interviews, the effect of the introduction of the ADF on drug-seeking behavior was examined. 
 
 Results Reformulated OxyContin was associated with a significant reduction of past-month abuse after its introduction (45.1% [95% CI, 41.2%-49.1%] in January to June 2009 to 26.0% [95% CI, 23.6%-28.4%] in July to December 2012; P < .001; χ2 = 230.83), apparently owing to a migration to other opioids, particularly heroin. However, this reduction leveled off, such that 25% to 30% of the sample persisted in endorsing past-month abuse from 2012 to 2014 (at study end [January to June 2014], 26.7% [95% CI, 23.7%-29.6%]). Among the 88 participants who indicated experience using pre-ADF and ADF OxyContin, this residual level of abuse reflects the following 3 phenomena: (1) a transition from nonoral routes of administration to oral use (38 participants [43%]); (2) successful efforts to defeat the ADF mechanism leading to a continuation of inhaled or injected use (30 participants [34%]); and (3) exclusive use of the oral route independent of formulation type (20 participants [23%]). 
 
 Conclusions and Relevance Abuse-deterrent formulations can have the intended purpose of curtailing abuse, but the extent of their effectiveness has clear limits, resulting in a significant level of residual abuse. Consequently, although drug abuse policy should focus on limiting supplies of prescription analgesics for abuse, including ADF technology, efforts to reduce supply alone will not mitigate the opioid abuse problem in this country.
– When an "abuse-deterrent" version of OxyContin was introduced in 2010, the intent was clear: "to make OxyContin more difficult to solubilize or crush, thus discouraging abuse through injection and inhalation," the New England Journal of Medicine noted in 2012. Made with special binders, the revamped pills would turn into a gooey substance instead of powder or liquid if someone tried to crush or dissolve them, making the drug extremely difficult to snort or inject, CBS News notes. But a new study published in JAMA Psychiatry that examined surveys of 11,000 drug users at 150 treatment facilities across 48 states found that hardcore addicts will either find novel ways to circumvent the pill's properties or, just as bad, turn to a cheaper street drug: heroin. Washington University School of Medicine researchers discovered that although the percentage of addicts entering rehab who had used OxyContin within the past 30 days declined since the abuse-deterrent pill was introduced (45% in 2010; 26% in 2012), addicts "have figured out how to circumvent" it, Theodore Cicero, the study's lead author, tells CBS. He adds that users go online to trade techniques on "cooking" the pill to get a stronger high, and when that doesn't work, they often turn to heroin, which is often cheaper and easier to get than prescription drugs: Almost 50% of addicts entering rehab said they had used heroin within the past 30 days. "There are people who will continue to use, no matter what the drug makers do," Cicero says. "Until we focus more on why people use these drugs, we won't be able to solve this problem." (The new face of heroin may not be what you expect.)