Pharmavixen

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Context: I've been preparing methadone in a jail for the past 15 years, and also worked part-time in a methadone clinic for four of those (lots of customer overlap between the two work places). For the past several years, the most popular opioid of abuse in Canada has been Oxycontin. The number of people on methadone has been steadily climbing for the past ten or so years.

Then on March 1st, Oxycontin was discontinued in Canada and replaced with OxyNeo. Most of the provincial government insurance plans aren't covering OxyNeo. Bottom line: enormous reduction in oxycodone-containing products on the streets.

I emailed my bosses and various folks in the methadone business, saying we need to prepare ourselves for a deluge of new clientele as Oxycontin addicts run through the remaining supply.

What's happened? The opposite. I've got fewer guys on methadone since 1999. One of the methadone inmates told me today that some people were switching to heroin or other opioids, but then he said, "They're not the same as Oxycontin. So people are kicking."

Is this too good to be true?
 

rxlea

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Well with the oxycontin, they know what's in it. It's regulated and has purity. People don't always know what's in heroin. I've had patients in the past say they would rather use oxycontin because it's safer. Plus, you don't necessarily have to use needles which reduces the risk for HIV. Then you deal with street drug dealers and that's a whole other issue.
 

psychoandy

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Is buprenorphine/naloxone being used instead? Is it approved for use in Canada? Maybe use of regular oxycodone or other opiates is on the rise to compensate?
 
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Socrates25

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Is buprenorphine/naloxone being used instead? Is it approved for use in Canada? Maybe use of regular oxycodone or other opiates is on the rise to compensate?


Does buprenoprhine require a special prescriber's license in Canada like it does for the U.S.? If so, I dont think it would be a replacement for oxy because not very many docs in teh US bother with the hassle of getting that special license whereas anybody with a DEA can write for oxy.
 

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Is buprenorphine/naloxone being used instead? Is it approved for use in Canada? Maybe use of regular oxycodone or other opiates is on the rise to compensate?

Maybe buprenorphine alone...Suboxone doesn't have a very high abuse potential due to the naloxone blocking a lot of the effect.
 

psychoandy

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I mean for harm reduction, not as a "pain" medication. As in maybe methadone isn't cool anymore and mixed opioid/antagonist therapy is the new black...I don't really keep up with the psych/detox lit.
 

Pharmavixen

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Suboxone isn't covered by provincial insurers, so I haven't seen a rise in its use, though I thought I would, alongside a rise in methadone use when Oxycontin was discontinued. Suboxone doesn't require a special licence, but methadone does, and the physician colleges are strongly recommending that methadone drs, or drs otherwise well-versed in addiction medicine, prescribe Suboxone.

A couple of nurses from a jail in Australia came to visit the jail recently. They said Suboxone is hugely abused in that country, which seems counter-intuitive, given its agonist-antagonist properties and ceiling effect. But IV abuse of buprenorphine in Europe and Australia is why they put the naloxone in Suboxone.

Well with the oxycontin, they know what's in it. It's regulated and has purity. People don't always know what's in heroin. I've had patients in the past say they would rather use oxycontin because it's safer. Plus, you don't necessarily have to use needles which reduces the risk for HIV. Then you deal with street drug dealers and that's a whole other issue.

Yes, that's what they've always told me.

But yesterday, when I asked the methadone patient, "Won't people just switch from Oxycontin to heroin or other narcotics?" and he replied, "Yes but they're not the same," I was gobsmacked.

It's early days, but maybe oxycodone is extra special in terms of abuse liability.

Maybe use of regular oxycodone or other opiates is on the rise to compensate?

Maybe. Though we got rid of Oxycontin at the jail in 2008, replacing it with MS Contin for people with legitimate pain. Since then, we've had fewer people on the morphine than we had on the oxycodone. (We still carry Percocet, with its measly 5mg oxycodone/tab. And we're totally miserly, reserving it for fractures.)
 

rxlea

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Suboxone isn't covered by provincial insurers, so I haven't seen a rise in its use, though I thought I would, alongside a rise in methadone use when Oxycontin was discontinued. Suboxone doesn't require a special licence, but methadone does, and the physician colleges are strongly recommending that methadone drs, or drs otherwise well-versed in addiction medicine, prescribe Suboxone.

A couple of nurses from a jail in Australia came to visit the jail recently. They said Suboxone is hugely abused in that country, which seems counter-intuitive, given its agonist-antagonist properties and ceiling effect. But IV abuse of buprenorphine in Europe and Australia is why they put the naloxone in Suboxone.



Yes, that's what they've always told me.

But yesterday, when I asked the methadone patient, "Won't people just switch from Oxycontin to heroin or other narcotics?" and he replied, "Yes but they're not the same," I was gobsmacked.

It's early days, but maybe oxycodone is extra special in terms of abuse liability.



Maybe. Though we got rid of Oxycontin at the jail in 2008, replacing it with MS Contin for people with legitimate pain. Since then, we've had fewer people on the morphine than we had on the oxycodone. (We still carry Percocet, with its measly 5mg oxycodone/tab. And we're totally miserly, reserving it for fractures.)

We just talked about this in therapeutics. Our psych instructor works as a psychiatric pharmacist inpatient. She used to be a counselor prior to pharmacy school. She said that people abuse the suboxone despite the antagonist. Many patients would sooner do that than find heroin on the streets. Like I said, they do it because it's safer in terms of what's in it.
 

Pharmavixen

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They'll just find something else to abuse.

That's been the assumption. But like rxlea says, Oxycontin abusers generally prefer pharmaceuticals and aren't generally going over to heroin. And like the methadone patient told me, other pharmaceuticals aren't the same.

Today another patient told me there was still lots of Oxycontin around - people stocked up in anticipation of the d/c. So I may be jumping the gun ...
 

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Oxycontin (oxycodone controlled-release) is now in a new formulation that makes it much harder to abuse. The new tablets have the letters "OP". The old ones have the letters "OC". When you crush the new tablet, instead of breaking into small pieces, it forms one smashed piece. If you mix oxycontin with an acqeous solution, it forms a gel, making it unable to be snorted or injected.
 
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Ackj

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Oxycontin (oxycodone controlled-release) is now in a new formulation that makes it much harder to abuse. The new tablets have the letters "OP". The old ones have the letters "OC". When you crush the new tablet, instead of breaking into small pieces, it forms one smashed piece. If you mix oxycontin with an acqeous solution, it forms a gel, making it unable to be snorted or injected.
But I'm pretty sure there's also a way to circumvent that. Are they freezing them now? Maybe that's fentanyl patches. Can't keep up with those darn kids these days :smuggrin:
 

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rxlea

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I saw that. It happens at rehab centers a lot from what I hear.

Btw didn't take you for a huffington post kind of guy :smuggrin:
 

Pharmavixen

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But I'm pretty sure there's also a way to circumvent that. Are they freezing them now? Maybe that's fentanyl patches. Can't keep up with those darn kids these days :smuggrin:

Anecdotally speaking, my patients - heroin or Oxycontin addicts in jail - tell me street chemists have not yet cracked the OxyNeo formulation.

Freezing worked to foil an anti-abuse formulation of LA methylphenidate (Ritalin SR? I forget...) They don't need to freeze the fentanyl patches; they eat those, or extract the drug and inject it.
 

Ackj

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Anecdotally speaking, my patients - heroin or Oxycontin addicts in jail - tell me street chemists have not yet cracked the OxyNeo formulation.

Freezing worked to foil an anti-abuse formulation of LA methylphenidate (Ritalin SR? I forget...) They don't need to freeze the fentanyl patches; they eat those, or extract the drug and inject it.
Eh, a quick google search got many results about extraction with various solvents, some as simple as acetone, although not a great % yield. "When there's a will, there's a way" unfortunately.
 

JerryPharmD

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I emailed my bosses and various folks in the methadone business

I can't help but smile when I read that.

I read a Reuters article that mentioned pharmacy robberies were at an all-time high up there because the junkies wanted to get the last bit of original formula OC left in the pharmacies, and people were choking on the OxyNeo. Of course media sensationalizes things.

On a side note, I wanted to read the manufacturer monograph for OxyNeo. The damned Purdue Canada site wouldn't let me see it. I had to register myself as a fake Canadian provider to download it (simple manufacturer package insert), complete with Canadian postal code. Kinda silly:D
 

Pharmavixen

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Eh, a quick google search got many results about extraction with various solvents, some as simple as acetone, although not a great % yield. "When there's a will, there's a way" unfortunately.

It remains to be seen whether the extraction methods will be worth the bother.

My patients are telling me the prices for the remaining Oxycontin supply on the streets of Toronto are soaring. And the CBC was saying that they're going for a thousand bucks a pill on northern native reserves, where Oxycontin abuse was a huge endemic problem.

Some folks have been saying for months that Oxycontin addicts are just going to switch to heroin. But the Oxycontin addicts I have talked to have frequently said they aren't going to do that. Some will, but many have never used street drugs brewed up in somebody's bathtub sort of thing. Many Oxycontin addicts started out as pain patients with a script from their doctor. They like the purity and relative safety of pharmaceuticals.
 

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Did you see that article on kids distilling hand sanitizer and getting trashed on it and ending up in the ER?

Future chemists of America I tell ya...:smuggrin:

http://www.huffingtonpost.com/2012/...tail-teens-hospital-california_n_1447611.html

Not long ago, I saw a TV show about Prohibition (it wasn't the PBS series) and they said that there were people in Appalachia who fermented sawdust from furniture factories, which kinda sorta made sense, and poison ivy, which didn't.

Confession: I'm reading "Mustaine", the autobiography of the Megadeth lead singer, and anyone who thinks there's anything fun or glamorous about drug addiction won't think so after reading this. And it would make 99% plus of you appreciate the parents you had. :( I was never a Megadeth fan, but from what I did know about him even before reading the book, I'm surprised he lived to be 20, let alone 50.
 

rph3664

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Do any of you older pharmacists remember some proposals, ca. 1980, to put ipecac in abusable drugs so people who OD'd would throw them up and not die or get wasted? That's an idea that sounds good on the surface but is a very bad idea, if you think about it.

How do I know about it? I was involved in a debate tournament that was won by some people who used this as their topic.
 
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