New Opioids

I’ve blogged about states that have passed new laws addressing the prescribing of opioids, but the manufacturers of prescription opioids medications also have made changes to help reduce the potential for medication misuse. Of course, opioids will never be misuse-proof, but at least it’s a little harder to misuse some of the newer ones.

Oxecta is a new immediate-release brand of the drug oxycodone. It’s formulated so that it breaks into chunks when crushed, instead of a powder. When it’s mixed with water, it forms a gel so that it can’t be injected. This pill contains sodium laurel sulfate, a substance that irritates the nose if snorted.

Lazanda is a new delivery form of a very potent opioid, fentanyl. This brand is designed to be used as a nasal spray, which I would expect to be very addictive. The preparation itself has no anti-abuse features, but in order to distribute, dispense, prescribe, or be prescribed this medication, parties have to sign an agreement and be enrolled with the drug company. This extra scrutiny is hoped to deter diversion by distributor, pharmacy, doctor, or patient. Physicians must take a training program specific for this brand, and be enrolled with the drug company as a prescriber, or pharmacies can’t dispense to the patient.

Patients also need to complete a patient-prescriber agreement. Many people (like me) think doctors aren’t likely to jump through these extra hoops to prescribe this particular brand, when other brands of the same medication are already on the market, though not in the form of nasal spray.

Remoxy, another brand of oxycodone, hasn’t yet been FDA approved. Supposedly, it’s resistant to injection or snorting, and also has been formulated to be resistant to alcohol extraction.

Drug companies are now required by the FDA to have plans to evaluate and mitigate the risks associated with the opioid drugs they manufacture, particularly if they make sustained release or long-acting opioid preparations. This cooperation by drug manufacturers is a necessary part of turning the tide of opioid addiction in this country.

Last year, Purdue Pharma re-formulated OxyContin, making it more difficult to crush to snort or inject.  I noticed a sudden drop-off in patients entering treatment for pain pill addiction who said OxyContin was their drug of choice. During the years 2002 through 2007, nearly all of the opioid addicts I admitted to treatment said OxyContin was their preferred drug. It became obvious that the re-formulation made a big difference.

Addicts can and will still abuse these medications orally to get high, but the new formulations really do reduce abuse by making pills less likely to be snorted or injected.

5 responses to this post.

  1. Posted by dbc92912 on November 11, 2011 at 5:23 am

    What really upsets me is that due to drug seeking patients, legit doctors *assume* patients with pain are drug seeking in times when they aren’t. I remember when I was having severe panic attacks in College. I had never been through such a thing, and would mock them if I had not been through it myself. I was certain I was dying, certain. I hyperventilated so bad had to go to the ER as my muscles all contracted and I thought I was dying. Anyway, they gave me some ativan and referred me to a psychiatrist. I go to the psychiatrist, and she thinks I’m out to get xanax or something, continually probing me with accusatory questions. Needless to say, I wanted nothing of the sort, as I didn’t even thing I should have been referred to a psych doctor – I was sure I had a physical ailment.

    Whether physical or psychological, the pain that legitimate patients now experience goes untreated due to drug seeking patients, dollar seeking doctors, and general moral decay of society (all sectors, including medical).


    • Posted by dbc92912 on November 11, 2011 at 5:27 am

      As a side note, to this day I’m still not for sure I didn’t have a physical ailment, but sadly many doctors are quick to make assumptions, especially if they see no immediate signs of problems. Once those assumptions are made, they don’t like to back down from them, for like any human they don’t like being wrong — and there is nobody who less prefers being wrong than a doctor. Yes, you are sensing some strong anti-medical establishment feelings here. A lot is wrong with our medical system. A lot. And you can’t blame it on any one thing, it takes the confluence of the moral decay of many segments to result in the times we see today.


    • “What really upsets me is that due to drug seeking patients, legit doctors *assume* patients with pain are drug seeking in times when they aren’t. ”
      “there is nobody who less prefers being wrong than a doctor. ”

      It sounds like the doctors aren’t the only ones making assumptions.


  2. Posted by dbc92912 on November 11, 2011 at 5:42 am

    As for the actual topic here, new formulations of opiod medications. The number of your patients who preferred more easily abused medications should have told you how many were either reselling or abusing those medications (probably 50/50). Still, with modern chemistry knowledge readily available, and the wealth of information on the internet, you can bet that they will find a way to inject any drug — or literally die trying. And that’s what I fear, that one of these new formulations causes someone to die due to their attempted abuse of it.


    • Overdose deaths from OxyContin went down after the re-formulation.

      There will always be some addicts with what I call “malignant” addiction, meaning they are so deeply enmeshed in addiction that they go above & beyond to find ways to inject. These are the addicts who aren’t able to stop abusing even the medications that are meant to help. They even shoot and snort Suboxone, and they really need to get into a more intense treatment. I don’t think they can be safely treated as an outpatient.


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