Monday, March 12, 2012

Let's See: You Ordered a Gummy Oxy, an Opana, and a Stiff Shot of Mexican Mud

If you will please take a few minutes to watch this public service announcement and read this blog entry, you may add important knowledge to your perspective of prescription drug abuse. It is imperative that you continue to learn about new efforts pharmaceutical companies are making to stifle abuse and new strategies addicts are developing to defeat these reformulations.

In 2010, Purdue Pharmaceuticals released Remoxy®, a gelatin capsule, which renders OxyContin resinous and difficult to crush for snorting or injection. The FDA has approved the new formulation of the controlled-release drug designed to be more difficult to manipulate by someone trying to misuse or abuse the medication. OxyContin tablets contain the opioid analgesic oxycodone.

Purdue evaluates the opiate problem and the product:

"Purdue is very aware that the abuse of painkillers and prescription drugs is a very serious public health problem," said Libby Holmen, associate director of public affairs for the drug maker. "We are committed to being part of the solution to that problem." (Mary Meehan, "Impact of New OxyContin Formula On Abusers Unclear,", Lexington Herald-Leader, January 16 2011)

But, while the company hopes it has found a tamper-proof product, there is no data to back up that claim.

"It was developed in a way that hopefully it will be," she said, adding that the company will be working with the FDA to test the new formula. "We are anxious to know that we are having a positive impact," she said.

"The new formula has made the tablets difficult to manipulate," said Dr. Sharon Walsh, director of the Center on Drug and Alcohol Research at the University of Kentucky. "The pill won't become powdery when crushed, but instead it breaks into chunks that can't be snorted or injected. If addicts try to melt the pills, they become gummy," she said.

The Aftermath

Though many addicts appear frustrated by the reformulation, Dr. Mark Publicker, an addiction medicine specialist at Mercy Recovery Center in Westbrook, Me., said he was “absolutely certain” that people would figure out how to abuse the new OxyContin.

“They call them gummies because when you chew them up they get stuck between your teeth,” he said. “They call them jellynoses because when you try to snort it up they get stuck. They cake in the nose.” (Abby Goodnough and Katie Zezima, "Drug Is Harder to Abuse, but Users Persevere," The New York Times, June 15 2011) Despite these problems, people still use ingenuity to defeat the safety measure.

Abusers of Remoxy have already discovered some very unusual ways to deal with the "tamper-proof claim." Various methods involve the use of rotary tools, foot callous removers, microwave ovens, cola, and Emergen-C Vitamin C powder. Some report the added efforts to increase the potency are well worth the experienced "high." Other abusers are switching drugs.

Drug abuse experts, law enforcement officials and addicts said the reformulation has only driven up interest for other narcotics. Demand appears especially high for pure oxycodone pills that come in a 30-milligram dose, often called “Perc 30s” or “Roxies” on the street.

Since the reformulation of OxyContin, many people have switched to prescriptions of Roxicodone, an opioid analgesic containing oxycodone distributed by Xanodyne Pharmaceuticals.

Still others now use Opana, a drug similar to morphine. Opana is a semi-synthetic opioid analgesic produced by Endo Pharmaceuticals. Recently, it has been blamed for a rash of overdose deaths. In Louisville, Kentucky, as of June, there had been at least 14 deaths in 2011 involving Opana, according to the Jefferson County coroner’s office.

Here is a testimony from a happy Opana abuser:

"I don't understand this (people missing the old form of OxyContin). If everyone who has a script for OxyContin switched to Opana, it wouldn't be hard to get. It's only like 30 dollars more than OC and you get a 25 dollar savings card. It tastes good. It lasts longer, and if someone who turned to heroin tries it, they'll like it because it feels like heroin, with some Oxy effects.

"Opana has the ability to save the OxyContin users that don't know where to turn. I was taking OC 40 and I didn't want to end up with the new formula, so I didn't wait for it to end up in my pill bottle and got switched to Opana 40. I'm much happier with oxymorphone (brand name Opana), and I like the morphine based effects. My pain went from 5.5 to 2.5."

And, as expected, with the pressure on pill mills and the greedy doctors prescribing opioids, heroin use is on the rise. Much of the supply enters the U.S. through Mexico. The Department of Justice has found that many prescription opioid abusers are switching to heroin in areas where it is cheaper and more available than prescription drugs.  Also, over time, some opioid abusers build up a tolerance to prescription drugs and turn to heroin for a more intense high.

The Chicago Sun-Times reported that the majority of heroin and opioid drug abusers are between the ages of 18 and 25. This new class of users has access to heroin that is much stronger and more pure than heroin of the past. While heroin in the 1970s was about 3 percent pure, today’s heroin has a purity level of 60 percent.

Unfortunately, because today’s heroin is more potent, there is a greater risk of overdose than in the past. In November of 2010, ABC News reported on the growing problem of teenage heroin addiction  and the increase in overdoses in Seattle, Washington and in small towns throughout the Midwest.

The Bottom Line

Purdue should have dealt with the devastating effects of OxyContin much earlier. And even now, the so-called "tamper-proof formula" Remoxy is contributing to the epidemic of prescription drug abuse. I am not blaming Purdue alone; as you can see, other manufacturers of opioids should take responsibility and institute tighter controls. Our nation is in the grips of a chemically created monster that possesses an insatiable appetite for human flesh.

Despite the slow movement of the FDA, the greed of Big Pharma, and the continuous wranglings of Congress, the public must step up immediately to squash a beast that, as of now, has roamed freely without proper restraints. Does it matter as to the cause of death? OxyContin, Remoxy, Roxicodone, Opana, or heroin -- we all must be responsible for helping stop drug abuse now. It is too late for thousands of victims, many of which became addicted under a doctor's care.

The scope and complexity of the drug problem is enormous. The effort it will take to correct a National illness this ingrained makes people throw up their hands in disgust and say silly things like, "Hell, let's just legalize drugs" or "Forget it -- nothing will ever work to stop drug abuse, anyway."

Then, please people, just look at the children who have known nothing but pills, pills, pills since they were born. We adults are responsible for the lax attitude of drug acceptance in our youth. The kids say and believe "It's (taking drugs) no big deal." Where do you think they learned this offhand mindset?

We, the people, ultimately control the policies set by those in positions of authority, and we, the people, can no longer have others act as if drug abuse is not the number one health priority. Our mass efforts can cause needed change. We must act and not just acknowledge the seriousness of the problem.

Let's assume that a shooter enters a high school in Ohio every four days this year and slaughters a student. As a matter of fact, in Ohio four people a day die of drug-related poisonings, and this toll includes one in four high school students using prescription drugs without a prescription. For many reasons, actual statistics on drug-related teen deaths are very hard to find.

So, with some speculation, one could say 91 Ohio teens a year (for many years now) die of drug abuse. Is this acceptable? Imagine if guns were killing teens in these numbers. Let's contrast: In 2004, 2,852 children and teens were killed by firearms in the entire United States or nearly eight kids and teens every day. Can you imagine how many U.S. teens are actually dying of drug abuse? How about a low estimate of 4,500 a year?

A school shooter scenario such as the one above would draw unprecedented state and national attention and would surely drive the public to demand instantaneous reform and action. Yet, the sad truth is that much of the populace chooses to remain indifferent to the fact that drugs, especially opioid prescription medications, are killing youth in unbelievable numbers.

We must intensify efforts to save people from drug abuse. Isn't that evident?

 “Before you can break out of prison,
you must realize you are locked up.” 
-- Author Unknown

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