Oxycontin abuse drops with new tamper-resistant drug but addicts seek morphine and fentanyl instead (ABC)

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The ABC has obtained the first evidence of a decline in oxycontin abuse in Australia after the introduction of a new tamper-resistant formula three months ago.

The new formula is difficult to dissolve and inject and has been designed to stop opioid addicts shooting up so-called hillbilly heroin.

Data obtained from the Medically Supervised Injecting Centre in Sydney's Kings Cross shows a sudden decline in visits to the centre, from 800 oxycontin injections per week down to just 50.

An opioid addict who wished to remain anonymous told Lateline: "On one occasion I've tried to prepare it for injection and it didn't work."

"The product I ended up with was completely unfit to be injected and for that reason I didn't inject it."

The makers of the new oxycontin formula say the tamper-resistant brand was released in the United States four years ago and has reduced overdose deaths.

"We know that the rates of abuse have dropped by about 50 per cent," Dr Christine Smith from MundiPharma said of its effects in the US.

"The reports of death to the company have dropped by 82 per cent. Reports of law enforcement incidents have dropped by 75 per cent and doctor shopping has halved, so there's clear evidence that there are benefits in the United States."

Switch to other drugs and rise in overdoses

But drug user groups are questioning whether Australian oxycontin addicts will now switch to other drugs.

Data from the Sydney injecting centre shows a rise in heroin, morphine and fentanyl use since the tamper-resistant oxycontin formula was released in Australia in April.

Before the new oxycontin formula was released the injecting centre received an average of 236 heroin injections per week.

Since then, heroin injections increased to 324 per week, morphine injections increased from 48 to 146 per week and fentanyl increased from four to 13.

Despite the dramatic drop in oxycontin injection, overdoses have slightly increased at the centre from eight to 10 per week. All overdoses were successfully treated onsite.

"Given our reduction in the number of visits, you would expect to see a corresponding decrease in numbers of overdoses treated onsite," the injecting centre's medical director, Dr Marianne Jauncey said.

"Instead, we have actually seen an increase. This is because of the increased overdose risk associated with both heroin and fentanyl injection when compared to oxycontin injection."

Fentanyl more powerful and more dangerous

Earlier this year Lateline reported on an increase in fentanyl overdoses in Australian country towns where drugs like heroin are scarce.

Drug user groups are concerned that the change to the new oxycontin formula will see a major shift in opioid use in small towns, with some users switching to the painkiller fentanyl.

Fentanyl is about 100 times stronger than morphine and far more dangerous than oxycontin.

"We are certainly hearing anecdotally that some people are using other substances like fentanyl," said Annie Madden from the Australian Injecting and Illicit Drug Users League.

"Fentanyl patches, in particular, which is a significantly stronger opioid known as a super agonist."

An opioid addict who asked not to be identified told Lateline: "Oxycontin just doesn't do what you could get it to do before."

"We want to get what we need from it, and if the new formulation isn't working they've got to find something else, and they will."

Another drug user said: "Fentanyl has become among some circles the first go to after oxys ... and they are extremely dangerous.

"It's so hard to get the dosage right because it's such a powerful drug."

Dr Jauncey said these types of comments are worrying.

"Given we are already seeing an increase in fentanyl-related deaths in Australia, anything that could drive this number higher would clearly be disturbing," she said.

Tamper-resistant oxycontin patent about to end

MundiPharma owns the patent on the new oxycontin formula in Australia. The patent runs out later this month.

From late July, generic brands of oxycodone may be available in Australia. These include the crushable, injectable forms of oxycodone.

The makers of the new drug want the federal Health Department to block the sale of injectable oxycodone in Australia.

"I think that any benefit that we have already seen from the introduction of the abuse-deterrent formulation will be negated," Dr Smith said.

"The community cannot benefit if there are these other formulations there that don't meet the same standards of abuse deterrents."

Dr Jauncey said she wanted more research before conclusions could be made about the impact of the tamper-resistant formula in Australia.

"I think our early data showing a significant decrease in injection of oxycontin is encouraging, however I would really caution that we need to clearly be looking at population impacts," she said.

A spokeswoman for the federal Department of Health said there was a need for a variety of oxycodone drugs in Australia, and not just the tamper-resistant formula.

"In deciding on the availability of medicines in Australia, the needs of very sick patients is given priority over deterring drug addicts from illegally misusing prescription medicines."

http://au.news.yahoo.com/a/-/latest/24458239/oxycontin-abuse-drops-with-new-tamper-resistant-drug-but-addicts-seek-morphine-and-fentanyl-instead/