One Solution to Prescription Drug Overdoses: Make Oxycontin and Similar Drugs Safer

Alison Bass
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In my previous blogs about West Virginia’s shockingly high rate of prescription drug overdoses — the Mountain State has the second highest rate of overdoses in the nation — I focused on “the culture of disability” that created this problem and what should be done to curb the over-prescribing of addictive painkillers by doctors — see here and here. I also talked about how the state’s inadequate health care system tends to feed into the problem, making it difficult for addicts in Appalachia to get the help they need when they want it. But I overlooked one very important solution to this crisis: making the drugs themselves safer.

Opiate painkillers like Oxycontin and Vicodin not only dull pain but when taken in high doses, they produce a high that can become quite addictive. Addicts often have to consume larger and larger quantities of the drug to keep that high coming. The problem is that when taken in such large quantities, such drugs also cause respiratory failure, which is why prescription drug overdoses now kill more West Virginians each year than car accidents do.

The drug companies that make these potent painkillers now have the technology to reduce this abuse and save lives, says Dr. Jeffrey Coben, professor of emergency medicine and director of the Injury Control Research Center at West Virginia University. These companies have already developed pain killers that contain an antidote to the ingredient in the drug that causes respiratory failure (as well as the high), and this antidote is released whenever the drugs are crushed. (Many addicts like to crush the pills to enhance their effects; once crushed, they can be snorted or injected directly into the bloodstream).

With the new technology, the antidote would be released if the drug is crushed and addicts would not get the same high or respiratory effect, Coben says. These drugs are called agonist-antagonist medications, and in some cases, they are already on the market. Other companies are developing tamper-proof prescription dispensers that are timed to release a pill only every eight hours so that dangerous drugs like methadone (which is prescribed to help people wean themselves off of heroin addiction) could only be consumed every eight hours, as prescribed. (Methadone is frequently abused in West Virginia and also causes overdose fatalities).

So why are these new drugs and devices not being marketed and prescribed in place of the older more dangerous painkillers ? The reason is simple: money. They are more expensive to produce and drug companies make tons of money from the addictive painkillers like Oxycontin and Vicodin, so they’re in no rush to provide a solution. The higher costs have also kept many of these drugs from being approved for use by health care insurance providers. Coben says the only way drug companies will market these new drugs is if they are forced to.

“That’s what happened with the car companies,” Coben says.

Coben says airbags and other safety mechanisms that prevent fatalities in car accidents were available long before car companies began installing them in vehicles. It wasn’t until the companies began to get sued by families who had lost loved ones in car accidents that airbags were installed as a matter of course. And the number of fatalities from drunk driving and other car accidents nosedived.

“It was the tort system at work,” Coben says. “The same thing has to happen to the drug companies.”

It’s too bad, of course, that our state and federal regulators can’t seem to muster the political will to require the marketing and prescribing of safer opiate painkillers. Indeed, the federal Department of Health and Human Services could ensure that Medicare and Medicaid include agonist-antagonist drugs in their drug formularies and save many lives in one bold sweep. But until the feds get their act together — are you listening,  President Obama? — it’s up to the families who have lost loves ones to prescription drug overdoses to sue the drug makers and force change.

This blog was originally posted on alison-bass.com.

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Alison Bass
A former medical and science writer for The Boston Globe, Alison Bass writes  about conflicts of interest in medicine and flaws in the way drugs are tested and marketed. She is a Pulitzer Prize nominee and author of Side Effects: A Prosecutor, a Whistleblower and a Bestselling Antidepressant on Trial.

3 COMMENTS

  1. Hello. I understand this article is about addicts, addiction and the drugs that addicts manage to get their hands on, whether through a doctor’s prescription or on the black market. I believe people have been getting drugs on the black market since it began, and many times, the dealers did not get tons of pills for sale from a doctor, but instead, through other means. Doctors don’t give out a thousand pain pills at once, which can be found in the dealers’ possession.

    You say that all pain pills are dangerous. I agree to some extent, but Tylenol is also a very dangerous drug. NSAID’s cause heart disease, bleeding ulcers, and other serious health problems that can and do lead to death. Opioid medications are dangerous to an addict who has obtained them, uses and abuses them, and then dies as a result.

    A pain pill to a pain patient is often the only way that patient can live. This article doesn’t mention pain patients (unless I missed that part). Oxycontin has been changed to a form that isn’t as easily crushed. I am not sure if “addicts” have figured out a way to crush this new form.

    You mention Methadone, and say it is “prescribed to help people wean themselves off of heroin,” which is true, but it is also one of the most widely used pain medications for severe chronic pain. One of the reasons it is widely used is because it works well for severe pain, and it is cheap. Most people who live with chronic severe pain can’t take Methadone because it is too sedating and most pain patients are looking for a quality of life, and not, I might add, a way to get high.

    To talk about suing doctors who prescribe pain medication, and getting the “feds” and “Obama” involved in telling doctors what they can and cannot do, without ever mentioning the reason the pain medications are prescribed and to whom, is such a lack of respect and concern for pain patients.

    A good doctor will do the best he or she can to know his or her patient, which would include investigating if the patient has a history of addiction. Pain and Addiction are not the same thing. They are very different subjects.

    Personally, I think articles and attitudes like I hear in this article are ignorant. Talking about pain medication to discuss addicts and addiction, while leaving out important facts, such as pain medication saves lives every single day, offers life to people who would probably commit suicide if they had to live in severe chronic pain without proper medication, and dismisses the good medical doctors who are really trying to help their patients.

    Pain patients should be educated about medications. The eight hour dispensing tool is a good idea, esp., for elderly people or those who for whatever reason may not be able to follow a medication regime.

    Suing doctors will only make life harder for people who really need pain medication. Why would anyone want to do that? Focusing on Medicaid and Medicare recipients (by getting the government more involved in what medicines they can or can’t get), will make life harder for pain patient’s who are also in poverty.

    People in pain may well become ‘dependent’ on medications after using them long-term, but most pain patients do not use their medications to get high. I say most, and maybe I shouldn’t, but I’ve communicated with so many pain patients over the years, and I do not know one who gets ‘high’ on their medications.

    People in severe pain find relief and most want to live their lives to the fullest degree possible. Most of them do not want to be zombies. If pain medication is used correctly, people don’t have to keep going up on the dose, at least not nearly as often as people would assume. I think people do a lot of assuming when it comes to pain medication, such as assuming that Methadone is only used to help heroine addicts and that medical doctors only prescribe pain medication for monetary gain.

  2. While decriminalization/legalization is necessary, it needs to be backed up with public health announcements explaining exactly why it is needed. Its not in any way condoning the abuse of addictors, it is done bc the alternative, the drug war, has made things infinitely worse on almost every level, to include making all drugs abundantly available to any & all that wants them. We need to pull LE out of the drug biz & that will free up a lot of resources currently chasing their collective tails. When the laws create more harm and cause more damage than they prevent, its time to change the laws. The $1 TRILLION so-called war on drugs is a massive big government failure – on nearly every single level. Its way past time to put the cartels & black market drug dealers out of business. Mass incarceration has failed. We need the science of addiction causation to guide prevention, treatment, recovery & public policies. Otherwise, things will inexorably just continue to worsen & no progress will be made. The war on drugs is an apotheosis of the largest & longest war failure in history. It actually exposes our children to more harm & risk and does not protect them whatsoever. In all actuality, the war on drugs is nothing more than an international projection of a domestic psychosis, it is not the “great child protection act,” its actually the complete opposite. We need common sense harm reduction approaches desperately. MAT (medication assisted treatment) and HAT (heroin assisted treatment) must be available options. Of course, MJ should not be a sched drug at all.