A New Drug of Choice?

My local paper carried an article this morning about the latest series of deaths from an overdose of heroin. It seems like that’s become the drug of choice for people of all stripes. It used to be that heroin was for the junkies, the losers, the lowest of the low. No more. Now it’s the go-to option for people looking to replace prescription opioid painkillers such as oxycodone.

All the opioids—drugs that act like opium, such morphine—are excellent at relieving mild-to-moderate pain for most people. But they also all create physical addiction and mental dependence in regular users. This creates a dilemma for physicians and for society: How do you provide access to these drugs for people who truly need them, while keeping them out of the hands of those who abuse the drug? And how do you tell the difference for sure? (One of my new favorite bloggers, Jen Gunter, has an excellent article about the dilemma physicians face.)

The term diversion refers to any use of a drug outside its purpose intended by the prescribing physician. (This definition may seem a little convoluted, and it is. But diversion has a very specific meaning.) In the case of opioids, they can be diverted by theft, by black-market sales to other people, or by what’s known as doctor-shopping—going from doctor to doctor looking to get a prescription without the others being aware.

From Savior to Satan In One Easy Step

Oxycodone had been available for many years as the brands Percodan (when combined with aspirin) and Percocet (with acetaminophen [Tylenol]). But these formulations called for taking the drug every 4–6 hours to maintain effectiveness—which played hell with the sleep pattern of someone in pain. When the time-release formulation Oxycontin was approved in 1995, it was seen as a godsend for people who suffer chronic pain. Now they could take the drug only twice a day for longer-lasting pain relief.

Oxycontin packs twice as much oxycodone into a single tablet, released over time. But if you crush the tablet the time-release mechanism is defeated and all the drug is available at once. This is what made Oxycontin so attractive to addicts. For a period in the late 1990s and early 2000s, pharmacy break-ins seemed like the crime du jour. Eventually pharmacists got smart and held only enough Oxycontin in stock for that day’s needs. Now the primary source of diversion is patients, who sell what they don’t use for up to $50 per pill.

Yes, Heroin Kills

As the supply of Oxycontin has dried up, people have been turning toward heroin instead. It’s relatively cheap and easily available (so I’m told), and increasingly socially acceptable. Except when it kills.

Street heroin is cut with anything from powdered milk to kitchen cleanser, and the user can’t tell the difference. Who knows what else they’re putting in their arm, or foot, or neck, or wherever else they can pop out a vein. And the cutting leaves the drug at an uncertain strength, which is how most overdose deaths happen—the user gets an unexpectedly potent dose. Not that I’m recommending the abuse of prescription drugs, but at least with Oxycontin you know what you’re getting.