Thursday, March 24, 2011

Could New Opioid Regs Lead to Tsunami of Heroin?

Briefly NotedVarious states in the U.S. and federal agencies seem justifiably determined to stem the rising tide of opioid-analgesic abuse, addiction, and diversion. However, an unintended consequence of new approaches for ameliorating these problems might be a powerful resurgence of heroin overdoses and deaths.

As noted in a recent UPDATES article [here], Washington state has forged new and restrictive rules governing the management of chronic noncancer pain with opioid analgesics. Along with that, some manufacturers have introduced new, abuse-deterrent formulations of prescription opioids. Expectedly, such measures would avert the misuse and abuse of such products.

Now, a recent news report from a rural county just north of Seattle, Washington, comments, “Police say a string of heroin overdoses in Snohomish in the past weeks is tied to OxyContin abusers switching to heroin as their drug of choice. …they expect overdoses will continue because users switching from OxyContin to heroin are likely to misjudge how much heroin is too much for their bodies to handle” [see Snohomish County Tribune News here].

Several heroin overdoses were reported during early March in this one rural county and it is part of a regional spike in such adverse events during just this year, according to police sources. Part of the reason for the switch to heroin was introduction of a new formulation of OxyContin® — a long acting version of oxycodone — making the pills more difficult to abuse, and possibly a lack of access to alternative prescription opioids. The news report continues, “More than half of the [police] department’s drug arrests these days are tied to heroin, and about 90 percent of the department’s drug investigations are for heroin.”

COMMENT: Despite the emphasis in government reports on escalating abuses of prescription-opioids, heroin is still very much present and accessible throughout America. As we have emphasized in prior UPDATES, abuse deterrent formulations of opioid analgesics and laws or regulations restricting opioid prescribing could negatively impact patients with pain while doing little to dissuade persons determined to abuse some form of opioid for nonmedical purposes. Apparently, heroin dealers may be benefitting from the new formulations and regulations.

Could reports from Washington state of heroin’s comeback represent the first warning waves of a deluge coming toward us from over the horizon? As usual, reader opinions are welcome — comment below.