In the new formulation of OxyContin, abusers could no longer crush the pills into a powder and snort the drug, or liquefy and inject it. (Photo: Shutterstock)
When OxyContin was reformulated in 2010 to make it harder to abuse, opioid addicts swiftly switched to a cheaper and readily available alternative: heroin. A new study by three economists finds that the uptake of heroin was so complete that no lives were saved at all. Every death from OxyContin that was prevented was replaced with an additional death from heroin.
The results "call into question" whether reformulating drugs to make them harder to abuse "is an effective policy to reduce drug abuse and poisonings in the presence of close substitutes," write the authors in a National Bureau of Economic Research working paper, "How the Reformulation of Oxycontin Ignited the Heroin Epidemic."
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While it's long been known that many OxyContin abusers switched to heroin, the economists performed a statistical test that found an abrupt change in August 2010, the month Purdue Pharma changed OxyContin's formulation. "Over the next four years," they write, "heroin death rates increased by a factor of four while opioid death rates remained fairly flat."
In the new formulation of OxyContin, abusers could no longer crush the pills into a powder and snort the drug, or liquefy and inject it. The new pills, when crushed, turn into a sticky substance that's hard to ingest rapidly. There was no change in law enforcement or other external factor that could reasonably account for the "structural break" that happened in August 2010, the authors found. The jump in heroin deaths was biggest in states where heroin was common before the OxyContin reformulation.
The authors link their findings to a landmark paper by Sam Peltzman, which found that requiring more safety devices in cars didn't save many lives because people compensated by driving more recklessly. "It appears that the intent behind the abuse-deterrent reformulation of OxyContin was completely undone by changes in consumer behavior, reminiscent of the unintended consequences phenomenon pointed out in Peltzman (1975)," they write.
The authors are William Evans and Ethan Lieber of the University of Notre Dame and Patrick Power of Boston University.
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