Pharmaceuticals Public Health

The unintended consequences of abuse-deterrent opioids

FDA is encouraging the development of abuse-deterrent formulations of opioids. What are abuse-deterrent formulations (ADF)? FDA explains:

Abuse-deterrent formulations target the known or expected routes of abuse, such as crushing in order to snort or dissolving in order to inject, for the specific opioid drug substance.

The good news is that ADF opioids reduce the abuse of opioids. However, do lead drug addicts to abuse other drugs, noteably heroin? According to a paper by Behesti (2019), the answer is likely ‘yes’.

Exploiting variation across states in OxyContin misuse prior to the reformulation, I find relative increases in the spread of hepatitis B and C in states most likely to be affected by the reformulation. In aggregate, the estimates suggest that absent the reformulation, we would have observed approximately 76% fewer cases of hepatitis C and 53% fewer cases of hepatitis B from 2011 to 2015. I find some suggestive evidence that the reformulation also lead to increases in HIV and hepatitis A, although these findings are less robust.

So should we get rid of ADF formulations? Likely the answer is no. Probably ADF formulations help prevent new opioid users from becoming abusers. Among those already addicted to opioids, however, they likely will find a way to get high and thus ADF may induce these users to switch to heroin. The net health and economic impacts is not yet known, but futher study in this area is needed.

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