THURSDAY, Jan. 11, 2018 -- Tamper-resistant opioid pills -- one attempt to curb prescription painkiller abuse -- aren't stopping overuse and overdosing, at least in Australia, new research shows.
"This formulation was developed with the specific aim of reducing tampering, targeting behaviors such as injection or snorting," said the study's lead author, Briony Larance.
But there was also the hope that tamper-resistant formulations of oxycodone might reduce opioid-related harms -- such as overdose -- more broadly, she said. Larance is a senior research fellow at the National Drug and Alcohol Research Centre at the University of New South Wales in Sydney.
"Until this study, it wasn't clear whether or not they would do this," Larance said.
Tamper-resistant oxycodone did, however, reduce oxycodone use and injection by people who injected drugs, the study found.
Australia is in the midst of an opioid epidemic similar to the one in the United States. From 1992 to 2012, the rate of opioid use went up 15-fold in Australia, according to the researchers. Seventy percent of opioid overdose deaths in Australia are linked to prescription opioids, such as oxycodone (OxyContin) and morphine.
In the United States, 2 million people were dependent on prescription opioids in 2015. And more than 33,000 Americans overdosed on opioids in 2015, with close to half of those deaths attributed to prescription pain relievers, the U.S. Department of Health and Human Services reports.
A controlled-release version of oxycodone has been introduced in the United States. The pills are hard and like plastic. If crushed, they break into large pieces instead of a fine powder. And if water is added to the pill, a thick gel-like substance forms, making intravenous use or snorting up the nose difficult.
But because other government-led efforts to reduce opioid misuse were launched at the same time, it's not possible to study the effects of the controlled-release strategy in the United States.
A tamper-resistant form of oxycodone became available in Australia in 2014. The researchers collected data from 17 data sources there, including opioid sales data, health datasets, surveys of people who inject drugs, and a group of more than 600 people who admitted to tampering with pharmaceutical opioids, Larance said.
"We did not find any impacts on population-level opioid use, overdose or help or treatment seeking," she said.
"The vast majority of people exposed to pharmaceutical opioids in Australia are prescribed them and do not inject drugs. This appears to limit the effectiveness of tamper-resistant formulations as a strategy to address population-level issues such as overprescribing, overuse and harm of opioids," Larance explained.
Dr. Daniel Cucco is a psychiatrist at NYU Winthrop Hospital in Mineola, N.Y.
"Tamper-resistant drugs are just one part of a multifaceted strategy we need against the opioid epidemic," he said. "And when you look at any one intervention on its own, it may seem underwhelming. There won't be one miracle intervention."
Also, it can be difficult to compare people using drugs from one country to another. There are large differences even from one region of the United States to another, he added.
So, if tamper-resistant drugs aren't an answer to the opioid epidemic, what can be done?
The author of an editorial accompanying the report, Nabarun Dasgupta, said there's "a great need to find more creative solutions."
Dasgupta is a senior scientist at the University of North Carolina at Chapel Hill's School of Global Public Health.
"In the United States, as we progress into the third decade of the opioid epidemic, we're starting to understand some of the root causes," he said. Things like poverty and lack of job opportunities can fuel "problematic drug use," Dasgupta noted.
One such solution, he said, may be found in Tennessee, a state with an opioid overdose epidemic. The state has made vocational schools and community colleges free to its residents. This strategy's effectiveness remains to be seen. But Dasgupta said it may be more promising than other solutions tried in the past.
The Australia study was published online Jan. 11 in The Lancet Psychiatry.
Learn more about the opioid epidemic from the U.S. Department of Health and Human Services.
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