Barring Generic OxyContin: A Small Win

Monday, April 29th, 2013

Pharmacist Filling a PrescriptionLast week on Mad Men, advertising guru Don Draper had some choice words for his wife Megan: “I can tolerate this, but I won’t encourage it.” I might have said the same thing when I found out about the FDA’s recent decision to bar generic OxyContin.

On the one hand, I agree with the FDA’s ruling.  A few years ago, Purdue Pharma LP, the makers of OxyContin, introduced a tamper-resistant form of the pill in an effort to curb abuse.  The company pulled the original formulation—which could be crushed and injected—from shelves.  Last Tuesday, Purdue’s patent for the drug ended, which would normally create the possibility for generic versions.  The FDA’s decision, however, extends the company’s patent, meaning drug-makers won’t be able to market crushable Oxy pills.

To me, this is a win-win situation.  It’s a big win for Purdue, which had obvious profit motivations for extending its patent.  It’s also a small win for those of us who are interested in seeing less abuse of prescription drugs, which are now responsible for more overdose deaths than heroin and cocaine combined.  Obviously, there are patients who use OxyContin for legitimate medical reasons and who would benefit from a less expensive generic pill.  However, a huge number of people are taking this drug in a manner that’s problematic rather than therapeutic.

I say this is a small win because I don’t believe the decision will make a significant dent in rates of painkiller addiction.  Since tamper-resistant OxyContin was introduced and Florida enacted regulations to curb pill mills, some addicts have moved on to other drugs.  Here in Florida, just in the last few weeks, we’ve seen a drastic upturn in the number of people abusing the pain medication hydromorphone, the generic equivalent of Dilaudid.  We discovered that folks who were injecting or snorting OxyContin had switched to hydromorphone when the abuse-resistant Oxy came out and its general availability was reduced.  Others have developed home recipes to get around the pill’s tamper resistance, making abuse of the drug even less safe.  Also, as Andrew Kolodny, head of psychiatry at Maimonides Medical Center in Brooklyn noted, “a pill that’s harder to snort or inject isn’t necessarily less addictive.”  It’s still possible to become addicted to swallowing these medications.

People who are dependent on drugs will always find a way—which is why focusing on supply alone won’t fix substance abuse.  Those who snort or inject drugs like OxyContin are often abusing multiple pills, and they typically cause damage to themselves and society before they receive help.  By getting these folks into treatment and reducing drug demand, the cost to the individual and society goes down. That’s why I go to work every day.

Here’s an idea: It’s a huge financial bonus for Purdue to have this extended patent.  What if they were to put their extra earnings back into medications that help lower drug demand, such as Vivitrol, which reduces cravings?  Another example we’ve discussed recently is an “addiction vaccine” that numbs the effects of a particular drug.  There are certainly risks to weigh, but research on these types of medications should absolutely move forward.

There was a clear pattern of advertising with extended-release pills like OxyContin.  That’s when use—and abuse—of these “super pills” went up.  Now, the pharmaceutical industry has an opportunity to invest in medications that would help stop the vicious cycle of addiction, rather than simply putting a Band-Aid over it.

That’s an idea I can not only tolerate, but support.

Jack Feinberg,
VP and Clinical Director,
Phoenix Houses of Florida

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2 Comments

  • razsey

    I would love to see just how are you going to get the addict to line up for this shot ? Oh and the vivitrex how are you going to pass this out? Is the govn’t going to make everyone sign up as it has for the healthcare? You mention people that are dependent on rx , which is exactly what happens if a preson is on them for any length of time. I totaly understand the problem of kids using and getting hooked on someting they thought might be a fun thing to try ,Never thinking thed have a problem. How do they get them in the first place? There was a time , yes, when a dr who was compassionate would prescribe these type of drugs to those they thought needed it, and with the govnt not putting pressure as now , they could freely prescribe. Now drs who fear losing their livelyhood, will not give out anything stronger than ibuprphen. So let me ask here, and if anyone can answer this for me , what now does a person that is in pain every day , who cant get the rx they need to function, work takecare of their children, and cant get out of bed without some type of medication , going to continue to be a giving part of society supposed to do that without them? As a chronic pain patient who is one of those paople, I am upst at the fact that it has gotten so out of hand that people like myself have to suffer due to the addicts abuse of someting so precious . We do not take them for granted or abuse them. We who have gotten this far have done everything possible to fix what life has done to us, and that failing, turn to our last resort, pills, that may even hasten our death. We makes choices, and we choose to live , not be in so much pain we lay and give up. We are fighters that want to be a giving part of society.jmo. sorry


  • kschmier

    Dear hysister19: You brought up a lot of compelling issues in your post but the one that resonates the most, if I understand correctly, is that you’re in pain and are feeling frustrated that your medical provider will not prescribe the medication you feel you need to function. First off, I want to express compassion. Because nobody deserves to be in pain. While I feel strongly that opioid medications ought to be taken with great care and only under the appropriate circumstances, those circumstances are between you and your doctor.

    At Phoenix House, we’ve seen many patients who have inappropriately used, abused and became addicted to opioid medications, often with devastating consequences. Frequently, these medications were originally prescribed by physicians, who while well meaning, lacked training in addictions or even possibly exhibited malfeasance in the interest of greed or some other incentive. This, along with intense marketing and product development by some in the pharmaceutical industry, coupled with modern mankind seemingly wanting everything cured by a pill bottle, leaves us with an crisis of epidemic proportions.

    Sincerely,
    Jack Feinberg



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