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COMMENTARY: OxyContin formulation is good for workers comp, but bad for society


A new OxyContin formulation is providing relief for workers compensation payers strapped with paying for the illegal diversion of the prescription pain reliever.

But unfortunately for society overall, heroin and other narcotics are replacing OxyContin as a drug of choice among addicts because the new formulation contains polymers that make it harder to crush for snorting or melt for injecting.

Allow me to explain.

The abuse-deterrent OxyContin formulation was introduced in 2010. Then in 2012, a study in the New England Journal of Medicine found that abusers preferred to shift from the reformulated OxyContin to heroin and other high-potency opioids.

The study relied on surveys completed by 2,566 people entering treatment programs because of opioid dependency. It revealed that before the release of the abuse-deterrent formula, 35.6% favored OxyContin as their primary drug.

That dropped to 12.8% just 21 months later, after introduction of the new OxyContin formulation.

The survey also found that of all opioids used to get high at least once during the past 30 days, OxyContin fell from 47% to 30%. Heroin use nearly doubled during that time and was the most-used alternative, according to the survey relying on data collected from July 2009 through March 2012.

Meanwhile, pharmacy benefit managers said in their workers compensation drug-trend reports released in April that opioid prescribing dropped during 2012.

Westerville, Ohio-based Progressive Medical Inc., for instance, said a drop in opioid prescriptions resulted from changing government prescribing guidelines, urine drug testing and the introduction of abuse-deterrent formulations.

That means the new formulations affecting pharmaceutical payer efforts to eliminate the diversion of addictive narcotic opioids also are helping. Diversion refers to using drugs outside their intended purpose, such as helping people with legitimate pain-management needs, to selling them on the street illegally.

Payers have stepped up efforts to discourage diversion with measures such as urine testing to assure claimants are consuming prescribed opioids rather than diverting them.

This is good news for the workers comp industry.

But the authors of the New England Journal of Medicine study, titled “Effect of Abuse-Deterrent Formulation of OxyContin,” wrote, the new formula reduced the abuse of one drug, but replaced it with a “drug that may pose a much greater overall risk to public health.”

And Barry Lipton, practice leader and senior actuary for Boca Raton, Fla.-based NCCI Holdings Inc. said during the rating and research organization's recent 2013 Annual Issues Symposium, “It's not good news for society, but it is a big pressure release for workers comp.”