Sunday, September 20, 2009

Tinkering With Opioid Pain Pills to Stop Their Abuse -

How can you get a faster high from sustained-release pain pills like OxyContin? Let me count some of the ways.

People have crushed them using bookends, hammers, mortars and pestles, and then snorted the powder, according to doctors who study addiction. They've chewed and swallowed fistfuls of pills. They've minced the pills in blenders, pulverized them in coffee grinders, dissolved them in water and then injected the liquid.

Even for those of us who don't inhale, the misuse and abuse of prescription painkillers called opioids should matter because, putting moral and ethics aside for the moment, it's costing us billions of dollars.

In a 2008 federal survey, an estimated 4.7 million Americans were found to have used prescription pain relievers for nonmedical reasons in the previous month. The abuse of opioids now costs at least $11 billion annually in excess medical care including overdoses by adults and accidental ingestion by children, said Howard G. Birnbaum, a health economist with the Analysis Group in Boston.

Corporate America loves a void, and now some pharmaceutical companies are developing innovative opioids intended to deter tampering and meet the market's need.

Some pills under development are rubberlike and harder to crush. Others contain ingredients that cause unpleasant reactions in the body, like flushing or itching, if the pill is adulterated. Taking a cue from exploding ink packets that can render stolen money unusable, some pills have an outer opioid layer and an inner core that, if tampered with, releases a drug that counters the high of the pain reliever.

Embeda, made by King Pharmaceuticals in Bristol, Tenn., uses the last of these strategies. Scheduled to arrive in drug stores this weekend, Embeda is the first of the new so-called abuse-deterrent opioids to reach the market. But, the Food and Drug Administration has approved Embeda only as a pain reliever, not as an abuse-deterrent drug, an agency spokeswoman said.

In a clinical study of Embeda, a majority of volunteers experienced less euphoria when they took a crushed form of the drug compared to immediate-release morphine. But the company has not yet established the real-world significance of the results.

The hope for abuser-unfriendly pills is that they might eventually decrease abuse. The drawback is that the pills represent (bad pun alert!) a fix for only one part of a very complex problem.

In a sense, the new opioids reflect the ups and downs of broader efforts to overhaul health care: addressing cosmetic aspects of the problem without thoroughly grappling with systemic causes.

While legislators are diligently trying to figure out how to get medical coverage for millions of uninsured people, the insurance gap is just one symptom of an ailing, inefficient medical system inclined toward reactive rather than preventive care.

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