Last 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.
VP and Clinical Director,
Phoenix Houses of Florida