Prescription drugs are simply part of modern life. People who go to the doctor for some type of illness usually expect to walk away with a prescription in return, and they might feel cheated if they don’t get the pills they think they need. At the same time, experts have come to believe that certain types of prescriptions are associated with addiction, and they’ve responded by tightening restrictions and making those drugs just a little harder to get. Manufacturers have done the same.
It might seem like great news, as steps like this have the capability to reduce the suffering of people who might be tempted to abuse prescription drugs. However, the evidence suggests that the link between restrictions and addiction isn’t always straightforward. In fact, tightening restrictions sometimes has completely unexpected, and unwelcome, consequences in terms of addiction.
While the regulation of any class of prescription drug could help to illustrate this concept, prescription painkillers provide the clearest example of the dangers of shifting regulations. That story begins with a sea change in terms of the number of prescriptions written for this class of drugs.
Between the years of 1997 and 2007, the milligram-per-person rate for this type of drug rose by 402 percent. In addition, pharmacies filled out 48 percent more prescriptions for these painkillers in the same time period. It seems that people developed a love for these medications during this time period, and that love was accompanied by a rising awareness that people were getting these drugs in order to abuse them.
In the early 2000s, the U.S. Food and Drug Administration became aware that the rates of overdose and death that were attributed to prescription painkillers were on the rise. Administrators there held meetings, conducted studies, and otherwise tried to determine just why these drugs had become targets of abuse, and they looked at what they could do to make that problem disappear.
The obvious solution seemed to involve regulation. If the drugs were harder for people to access for illicit purposes, experts reasoned, then the rates of addiction and death would quickly fall. By 2013, some of those restrictions were in place. At this point, doctors were required to jump through some serious hoops in order to supply painkillers to clients, as these drugs were reclassified as Schedule II drugs.
Clients were required to:
- Obtain smaller amounts at a time
- See a doctor regularly to obtain refills
- Get refills only from doctors, not nurse practitioners, in some states
- Get the medications from pharmacies that comply with strict storage and classification requirements
Some states enacted their own laws that were designed to reduce abuse rates. In New York, for example, legislators developed a tracking system for patients, which ensured that the same person didn’t visit multiple doctors for the same drug. This switch cut so-called “doctor shopping” rates by 75 percent in the first year, which was considered a victory in the fight against addiction.
Manufacturers Join the Fight
While legislators were working hard to make drugs less accessible, drug manufacturers decided to join in by reformulating some types of prescription painkillers. These changes made the pills harder to crush, so users couldn’t inject or snort the contents, and it was seen as a move that would dramatically reduce addiction suffering. When the new pills were approved by the Food and Drug Administration in 2010, experts said that the pills could still be abused orally but that other forms of abuse would be more difficult, and that addiction rates should fall as a result.
Turns out, they were about half right. In a study released in the New England Journal of Medicine in 2012, researchers found that the number of people enrolling in treatment programs due to the painkiller OxyContin went way down once the new pills hit the streets. Prior to that change, 35.6 percent enrolled in treatment due to these painkiller pills. After the change, only 12.8 percent did so.
It’s possible that some users who faced an unappetizing pill that was hard to get chose to get clean as a result. But as an expert quoted in an article produced by Washington University in St. Louis points out, trying to curb addiction is sometimes akin to building a levee in order to stop a flood. The step might be meaningful, but it might not be enough on its own.
Switching to Heroin
For people who were once addicted to painkillers, there’s another drug that seems like an excellent replacement: heroin. It works on the same receptors that come alive in response to painkillers, and even though heroin is illegal, it’s still considered remarkably easy to get.
Many people who were addicted to painkillers like OxyContin seem to have made the switch to heroin, experts say. While the number of people who admitted to abusing OxyContin dropped from 47.4 percent to 30 percent due to the medication formulation change, the number of people who admitted to heroin use almost doubled at the same time.
It’s become almost commonplace, say some experts, for people to use prescription painkillers first and then transition to heroin later. As a representative of the Massachusetts State Police said in an interview:
I don’t think I have met anybody under the age of 30 that’s a heroin addict that did not start out using oxycodone or OxyContin.
It’s not a surprise, really, as legislation changes and formulation changes don’t do anything to address addiction itself. These changes might make specific drugs harder to get, but they don’t address the chemical imbalances inside the mind of an addicted person, and that’s the element that can lead people to abuse substances, no matter what the consequences might be.
While legislation might make some drugs harder for addicts to obtain and abuse, the changes also make it hard for other people to access, including people who might need those drugs to assist with:
- Chronic back pain
- Cancer pain
- Post-surgical pain
- Dental pain
These people may have no plans at all to abuse the drug, but they still might find it hard to get the medications they need due to legislative changes that were made to target addicts.
For example, in 2013, Walgreens pharmacy executives reported that pharmacists working for the company would be required to take a number of steps to verify prescriptions before they could be filled. These pharmacists had to call the patient’s doctor to ensure that the drug was prescribed for a real condition, and they had to find out about the other therapies the doctor tried before the painkillers hit the market. In some cases, this meant that patients couldn’t get their drugs.
Similarly, equating long-term drug use with addiction could, in theory, mean that people who had real pain conditions wouldn’t even attempt to fill their prescriptions, as they wouldn’t want to be aligned with addiction. It’s a form of stigma, and it could lead to suffering.
If regulations and reformatting drugs don’t work, as they just push addicts to other drugs and makes the substances hard for needy people to get, the more reasonable solution would involve better addiction care. People who have addictions don’t need barriers to attaining drugs. They need to develop inner skills that can help them to resist the call of drugs, whether or not those substances are available.
People who are abusing prescription painkillers may desperately need this help, but they may be reluctant to enter a treatment program. Families can help by holding an intervention, in which they outline the addiction symptoms they’ve seen and the reasons that they’d like the person to get help. If you’re ready to hold a talk like this and you need someone to help you to prepare for the conversation, please contact us. We have a number of experts who can help you, and we can connect you to the right interventionist or family mediator for you today.
”Prescription Drug Abuse.” (n.d.). The White House Office of National Drug Control Policy. Accessed May 16, 2014.
”Timeline of Selected FDA Activities and Significant Events Addressing Opioid Misuse and Abuse.” (April 14, 2014). U.S. Food and Drug Administration. Accessed May 16, 2014.
Meier, B. (Oct. 24, 2013). “FDA Urging a Tighter Rein on Painkillers.” The New York Times. Accessed May 16, 2014.
”New York’s Strengthened PMP Helped Cut ‘Doctor Shopping’ by 75 Percent.” (Feb. 12, 2014). National Association of Boards of Pharmacy. Accessed May 16, 2014.
”FDA Approves New Formulation for OxyContin.” (April 5, 2010). U.S. Food and Drug Administration. Accessed May 16, 2014.
Cicero, T. & Surratt, H. (July 12, 2012). “Effect of Abuse-Deterrent Formulation of OxyContin.” The New England Journal of Medicine. Accessed May 16, 2014.
Dryden, J. (July 11, 2012). “OxyContin Formula Change Has Many Abusers Switching to Heroin.” Washington University in St. Louis. Accessed May 16, 2014.
Crees, A. (July 12, 2012). “OxyContin Users Switching to Heroin After Drug is Redesigned.” Fox. Accessed May 16, 2014.
Van Zeller, M. (June 23, 2011). “Painkillers Are a Gateway to Heroin.” CNN. Accessed May 16, 2014.
Foreman, J. (Aug. 12, 2013). “Backlash Against Walgreen’s New Painkiller Crackdown.” WBR’s Common Health. Accessed May 16, 2014.