Heroin instead?

The maker of OxyContin released an abuse-resistant formulation of the drug to deter addicts from crushing it and inhaling or injecting it.  As abuse of OxyContin fell, other opioids moved in to fill the gap: drug users choosing high-potency fentanyl and hydromorphone rose.  A new abuse-resistant version of Opana hit the U.S. 

[A]n 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.

The dirty secret is that prescription drug misuse is safer than heroin use  not because the inherent overdose or addiction risk is any lower with prescription opioids, but because these drugs come in known doses with specific ingredients and often involve contact with a medical doctor.

The most effective known treatment for opioid addiction is maintenance treatment with another opioid, typically methadone or buprenorphine (Suboxone, Subutex). Such treatment reduces the spread of blood-borne disease, cuts crime and saves lives better than any other known method. It may be that the maintenance opioids help treat depression or act as a salve for some other underlying problem, allowing some people to function better on the drugs than off.

Whatever the case, people can and do lead full, productive loving lives of recovery while taking these medications. Add appropriate counseling, job training and psychiatric medication where needed and you can sometimes see even better results.

Rather than driving prescription opioid misusers to the illegal heroin market, then, we should be pushing them in the other direction: trying to get as many opioid addicts as possible into the medical system and using opioids themselves in treatment when necessary. It may seem counterintuitive, but effective strategies often are.

Just a thought.