In April this year, a new tamper-proof form of the prescription drug Oxycontin was rolled out in Australia to combat the decade-long rise of intravenous use of the drug that’s commonly called “hillbilly heroin”. While the uncrushable pills were meant to act as a deterrent against illicit drug use, many injectors have instead turned to more dangerous prescription drug options. And with the patent for Oxycontin about to expire this Wednesday, July 23—and a slew of generic versions of the drug ready to go on sale—questions have been raised as to why its producer, MundiPharma, released the new formula so close to this date.
Tom is a 35-year-old residing in Sydney, who’s been injecting opioids for close to 16 years. He told VICE that despite the production of the tamper-proof pills, people are still extracting oxycodone—the opioid ingredient in Oxycontin—with sometimes fatal results. “It's a tamper-proof formulation, which turns gelatinous when you add water. They've also found a way of binding the active ingredient with an inactive ingredient, which basically means that unless you use a solvent extraction over a long period of time, it's very hard to inject. If you do manage to get it into a barrel and inject it, from anecdotal evidence that I've seen on the streets, it's caused at least a couple of fatalities,” he said.
The greater concern, according to Tom, is the many drug users turning to drugs like fentanyl (a surgical anaesthetic) and MS Contin (a potent painkiller) which carry more potential for harm. “Fentanyl is about 100 times stronger than morphine and therefore the chances of overdose are extremely high. Personally, I've had four friends overdose and die from fentanyl injections.”
On June 2 this year, at a meeting of the Australian Senate Community Affairs Legislation committee Professor John Skerritt, national manager of the Therapeutic Goods Administration (TGA), stated that evidence shows people are diverting to alternative opioids in response to the tamper-proof pills. When Senator Jan McLucas asked if the TGA was considering banning non-tamper proof oxycodone, a move carried out in the US, Skerritt said it was not a simple matter under the Australian system.
At the same meeting Professor Chris Baggoley, chief medical officer at the Department of Health, said that figures provided by the Sydney Medically Supervised Injecting Centre (MSIC) in Kings Cross showed that in May there’d been 25 fentanyl self-administrations per week compared with 5 to 6 in February and March. The figures also showed a rise in the rates of heroin and morphine use.
Baggoley stated: “What they are finding is that, while there has been a move away from oxycodone, there has been a move towards these other drugs, and they have gone on to say, 'As expected, the rates of overdose… have increased from an average of six per 1,000 injections up to eight per 1,000'. So there has been an increase in overdose as a direct result.”
The MSIC also noted an increase in the number of people attending the centre saying they were now able to successfully inject the tamper-proof pills.
Annie Madden, executive officer of the Australian Injecting and Illicit Drug Users League (AIVL), said the appearance of the tamper-proof pills has led injecting drug users to take drastic measures to extract the oxycodone. “People actually have been finding ways to break them down but the problem is they've often been doing it with really harmful solvents, like household solvents,” she said. “What we're seeing is people trying to make something that isn't meant to be injected, injectable. And then there's the harms associated with that.”
A spokesperson for the NSW Police Force said while Oxycontin and drugs like it have a legitimate pharmaceutical use: “the bottom line is that those using pharmaceutical drugs without prescriptions are not only committing criminal offences, they're taking serious health risks.”
Andrew, who’d prefer to keep his last name private, is a pharmacist living in Sydney, who used to run methadone programs. He believes the reason Mundipharma began producing the tamper-proof pills months before their patent runs out is more to do business than preventing intravenous drug use.
“They released that form of the drug in April this year, the idea behind that was to protect their market share before the generic brands become available on patent expiry in July. They present a new form of the drug, which has the benefit of being more difficult to abuse, and because that's available, prior to the generics becoming available, it enables you to get your patients onto this new formulation and then less willing to change,” Andrew said.
“The general tone of pharmacists is that, I'm not going to be supporting the new generic option, now that a difficult to divert formulation is available. There's a professional obligation to minimise misuse of the medication, so a pharmacist is going to prefer to stock the anti-diversion formula.”
A spokesperson for MundiPharma said they could not “discuss a prescription medicine where the audience is not primarily healthcare professionals,” nor could they comment on the entry of other generic versions of oxycodone entering the Australian market.
Targin is another opioid analgesic produced by MundiPharma, it combines naloxone with oxycodone. Naloxone is added to Targin to counteract opioid-induced constipation. It’s also a drug used in the treatment of opioid overdoses. When Targin is crushed and injected it actually works in reverse, becoming an opioid antagonist that blocks opioid receptors and sends drug users into precipitated withdrawal.
Will Tregoning, a director of Sydney harm reduction group, Unharm, posed the question: “If MundiPharma are committed to reducing Oxycontin injecting, couldn't Targin replace Oxycontin in more or all prescribing situations?”
Tregoning thinks the way to deal with the intravenous drug use situation is not to address it on the supply side, but to initiate harm reduction programs. “Things like supervised injecting facilities, needle and syringe programs, good access to treatment and opiate substitution therapies, like methadone. Those are the things that we should be using.”
Follow Paul on Twitter: @paulrgregoire