The avalanche of drug deaths spurred a series of major reforms in 2022 to the way drug addiction is treated in the U.S., changes designed to reduce stigma and improve access to care. Data from the Centers for Disease Control and Prevention suggests the avalanche of overdose deaths — driven largely by the spread of illicit fentanyl –may have crested in March. Heroin overdose deaths increased five-fold between 2010 and 2017, from 3,036 deaths to 15,482.
C. CHANGES IN OVERDOSES VERSUS CHANGES IN CODING OF OVERDOSES
- The problem offers new insight into why so many people have become addicted to OxyContin, one of the most abused pharmaceuticals in U.S. history.
- Our analysis, therefore, focused on whether increasing buprenorphine capacity would allow more people to receive treatment, thereby reducing fatal opioid overdose and OUD prevalence.
For instance, increasing buprenorphine capacity might decrease wait times, thereby increasing accessibility. In the real world practice of medicine, some doctors turned away from OxyContin entirely. San Francisco public health clinics stopped dispensing the painkiller in 2005, based in part on feedback from patients who said it wore off after eight hours.
High Likeability and Incentive Salience of Oxycodone Assessed by Behavioral Studies in Humans
Similarly, we find strong evidence that synthetic opioid death rates rose disproportionately in areas more exposed to reformulation. It may be surprising that the relationship between reformulation and overdose deaths has continued to strengthen. One hypothesis was that reformulation may reduce initiation rates, leading to longer-term benefits including decreases in overdose death rates. People prescribed OxyContin could potentially be less likely to develop dependency issues when the drug is harder to abuse. We do not see convincing evidence of a downturn in the relationship between exposure to reformulation and overdoses, suggesting that the benefits—at least in terms of overdose deaths by 2017—of reduced initiation rates are small.
Drug Overdose Deaths in the United States, 2002–2022
- Earlier this year, a man posting to a chat board for pain patients said he got six to eight hours of relief from OxyContin, but hadn’t been able to convince his doctor to prescribe it more frequently.
- The TEDS, which is maintained by the Substance Abuse and Mental Health Services Administration (SAMHSA), includes admissions data from all treatment facilities receiving public funding, whether through federal block grants, Medicaid or Medicare insurance, or other state funding sources.
- The price of opioid treatment may vary due to different factors, but the cost of treatment can range from $6,000 to $15,000 a year.
First, it specifies OxyContin https://ecosoberhouse.com/ in the survey question, which is the exact drug product affected by the reformulation. Second, it specifies nonmedical use, the relevant dimension since reformulation did not affect the medical capabilities of OxyContin. “Opioids kill people by slowing the rate of breathing and the depth of breathing,” says medical toxicologist and emergency physician Andrew Stolbach of Johns Hopkins University School of Medicine. We only report those strategies with disproportionate outcomes at 10% effect sizes because it is a more realistic effect size than 50%. “Now that the pandemic has largely improved and people are able to go out again, they’re able to socialize. That part of the risk has, I think, lessened, and so I think that’s partly why we’re seeing a decrease,” says Magdalena Cerda, an epidemiologist and director of the Center for Opioid Epidemiology and Policy at the NYU Grossman School of Medicine.
Overdose Prevention
By 2004, Purdue was seeing “a trend away from prescribing OxyContin” more frequently than every 12 hours, according to a company filing with the FDA. Boosting the dosage could extend the duration to some degree, how addictive is oxycontin but it didn’t guarantee 12 hours of relief. Commissions and performance evaluations for the sales force were based in part on the proportion of sales from high-dose pills. After some physicians began prescribing OxyContin more frequently than every 12 hours, Purdue summoned its sales force to special seminars. As this 2001 presentation shows, company officials were concerned more frequent dosing would hurt business. If a doctor complained that OxyContin didn’t last, Purdue reps were to recommend increasing the strength of the dose rather than the frequency.
We estimate that reformulation increased the 2013 overdose rate by 1.7 overdoses per 100,000 people, a 14 percent increase relative to the counterfactual. Selecting on admissions for those without any prior treatment episodes is potentially problematic given that having a prior treatment is endogenous to exposure to reformulation. We find evidence that reformulation increased treatment admissions, suggesting that the population eligible for categorization as not having any prior episodes is endogenously declining more in areas more exposed to reformulation.
Speculative Actions of Oxycodone That May Influence Addiction Potential
The Biden administration has scrambled in recent months to try to slow the rate of drug deaths, in part by making medical treatment more widely available for people with addiction. After public health officials made some early progress in reducing drug deaths, researchers found overdoses began rising again after 2013 with a sharp increase in fatalities during the first year of the pandemic. In recent years, most overdose deaths have involved illicit fentanyl, a powerful synthetic opioid, as well as cocaine and methamphetamines. Operation SpecTor was a coordinated international effort spanning three continents to disrupt fentanyl and opioid trafficking on the darknet, or dark web. The operation was conducted across the United States, Europe, and South America, and was a result of the continued partnership between JCODE and foreign law enforcement against the illegal sale of drugs and other illicit goods and services on the darknet. Operation SpecTor builds on the successes of prior years’ operations and takedowns of marketplaces, which result in the seizure of darknet infrastructure providing investigators across the world with investigative leads and evidence.
Treatment for opioid use disorder was also disrupted, and if a person overdosed, it was less likely that someone would be there to intervene. What does the evidence in this paper tell us about reformulation’s long-term effects on illicit drug markets? The relationship between overdose deaths and exposure to reformulation has only grown over time. The duration of this increase through 2017—and the fact that its growth does not appear to be slowing—is suggestive that we are not simply observing those misusing OxyContin prior to 2010 gradually but increasingly dying from overdoses up to seven years later. Instead, we have suggestive evidence of market growth and new consumers entering into illicit drug markets.
Often, policies do not explicitly account for these endogenous responses, which can be difficult to anticipate and take years to manifest. Policies that worked in the past or that work now could become less effective in the future. Policies that until now have been less effective or infeasible could become more impactful as trends shift.