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Oxycodone
Oxycodone is an opioid that is used to treat moderate to severe pain that was approved by the FDA in 2005. Oxycodone decreases pain by increasing one’s tolerance to pain, decreasing respiration, and sending the body into a state of sedation. Patients take oxycodone to ease the discomfort for an array of painful medical conditions such as surgery recovery, kidney stones, broken bones, ect. The main side effects of Oxycodone include dizziness, nausea, headache, constipation, itching, seizures, and agitation.

Changes in Abuse
In the early 2000s, Oxycodone overdoses and deaths began to spike and soon became one of the top three opioids for overdose and death in the United States. Overdoses became such a big concern that in 2003, the FDA wrote a letter to the manufacturing company about false advertisement on the bottle and told the drug company that they needed to add more warnings to the drug packaging due to the increasing amount of overdoses and deaths. After the drug company refused to listen to the FDA, eventually, the FDA went above the drug company and put a label on Oxycodone stating that it can lead to risk of addiction, overdose, and death. Unfortunately, a label has done very little to stop and prevent further abuse. With the number of abuse and overdoses increasing every year, it became apparent that a change needed to be made. In 2010, Oxycodone was reformulated into Oxycontin, which is an extended-release tablet version of Oxycodone, which is an immediate-release tablet. Oxycontin was created in hopes that it would lower the abuse rates of the drug and help with the opioid epidemic that the United States is currently facing. Since it is extended-release and not immediate-release, it does not give off as strong of a high when taken. In multiple studies, users reported that they prefer Oxycodone to Oxycontin

Oxycodone is supposed to be taken as a tablet that is swallowed but abusers will chew, crush, snort, or dissolve the tablets to get high. Snorting/injecting the tablets give off a stronger high that is similar to the opioid heroin. Another change that was made to Oxycodone to lower abuse rates is that Oxycontin was created with the intention that its reformulation would make the tablet crush-resistant and solubility-resistant to prevent users from snorting or injecting it. It has been reported that there was a massive decrease in abuse via injecting and snorting after reformulation. Oxycontin was created with physicochemical barriers to prevent people front crushing or dissolving it and has a polyethylene oxide matrix, which is supposed to make the tablet too hard to be able to inject. Modification is important because many abusers crush or dissolve the tablet in order to get a stronger high, which is more dangerous and leads to a higher risk of overdosing. Another benefit of a lower injection rate is that it correlates with a lower rate of diseases such as HIV and hepatitis C, because there are fewer users sharing needles.

There are many studies that have been conducted since 2010 that show that the reformulation into Oxycontin has reduced abuse rates of the drug. A study published by the National Bureau of Economic Research states that that Oxycodone reformulation was successful in reducing abuse. A study done shows the abuse rates of Oxycontin before and after its reformulation with abuse-deterrent properties. The results from surveys conducted on drug use and health portray that following the release of Oxycontin; there was an immediate decline in medical and non-medical use of Oxycontin. Oxycodone abuse incidences after its reformulation in 2010 were decreased by a reported number of 137,500 cases. In a different article by Severston et al., (2018) researchers compared the abuse rates of Oxycodone and Oxycontin. Their findings are that abuse of Oxycontin decreased as soon as the reformulation occurred, and continued to decrease for five more years

In a different study, participants in treatment programs across 33 states from 2008-2011 were asked questions about past 30-day abuse and changes in abuse pre and post Oxycontin introduction. The results show that there was an increase in Oxycodone abuse by 22% between 2009-2010, which leveled off after Oxycontin was released in 2010. In a study done by Cicero and Ellis (2015), individuals in drug treatment programs with a diagnosis of opioid abuse were asked questions about their abuse. The questions inquired about abuse within the past month, which formulation of Oxy they use, and what route of administration they use. The results showed that there was a significant decrease in the use of Oxy after its reformulation.

In the three years after the reformulation of Oxycodone into Oxycontin, there was a decrease in abuse rates, overdose, death, and misuse. In one study, rates of misuse of Oxycodone decreased by 43% after its reformulation and deaths by Oxycodone overdose reported to the FDA decreased by 65% in the first year and 80% by the third year. Another study reported that 2,835 of the participants were abusing Oxycodone before its reformulation and after its reformulation it was reported that only 786 participants were abusing Oxycontin. Abuse of Oxycodone declined by 49% within the first 11 months after Oxycontin was released among individuals who have been diagnosed with substance abuse problems.

Also, Poison center reports for Oxycodone abuse and misuse has declined by 25% in the two years following the reformulation. There was also a 25% decrease in prescriptions of Oxycontin in the 5 years after its reformulation. This shows that the demand for Oxycontin is less, which can be positively correlated with a lowering abuse rate. Each study evaluated different individuals from all across the United States with different demographics but they all showed the same results. Overall, all of the studies show that the reformulation of Oxycodone into Oxycontin has showed a significant decrease in abuse, misuse, and overdose of the drug. This data correlates with the claim that the reformulation would lower abuse rates.

Since the reformulation, Oxycodone is not injected or snorted nearly as often as it was before. This data correlates positively with the claim that the reformulation would deter users from injected and snorting the drug to get a stronger high. Despite seeing an improvement, the reformulation has not completely solved the problem of abuse and misuse of Oxycodone and other opioids. Unfortunately, some abusers are so dedicated to Oxycodone that they have figured out ways to abuse the reformulation, which the drug company tried to make impossible to do. A survey found that 30% of users are abusing the new formula. It is reported that some users have managed to get around the properties of Oxycontin that are supposed to make it impossible to crush or dissolve. In a study it was reported that 30 of the participants claimed to have beaten the reformulation and administer their Oxycontin by inhaling or injecting, which is not supposed to be possible.

Concerns
In addition to finding ways around Oxycontin’s abuse-deterrent properties, there is also an increasingly growing worry that the decrease in use of Oxycontin is steering users towards the abuse of other opioids. Following the reformulated of Oxycodone, it was reported that there was an increase in the opioid Oxymorphone abuse by 139%. Overall, there was a 7% increase in the prescription of other opioids. This data shows that not only are users turning to other opioids, but prescribers are as well. The main drug that former Oxycodone abusers are turning to is Heroin. This is due to the fact that snorting or injecting Oxycodone gives off a high similar to heroin and users are looking to reach the same type of high. Participants in a drug treatment program reported significant increase in the use of heroin after the reformulation of Oxycodone. Some research shows that the reformulation of Oxycodone has been the largest factor in the increase use of heroin by as much as 80% since 2010. During the same time that Oxycodone was reformulated, there was an increase in heroin overdoses. It has also been reported that there has been a very large and troubling increase in heroin overdose deaths since the reformulation in 2010 and now heroin kills more people annually than prescription painkillers.

One can assume that the reformulation of Oxycodone is directly linked to the increase in heroin use because research has found that the states that had the high Oxycodone abuse rates experienced the highest increase in heroin abuse rates following 2010. It is good to see a decrease in abuse of Oxycodone; however, this data shows this decrease is steering people towards the use of other opioids instead of stopping the abuse of opioids. This is problematic and defeats the main purpose of the reformulation.

Although progress is being made, there is still improvement that needs to be made in fighting the opioid epidemic that the United States has been facing. Although the abuse of Oxycodone may be declining, the abuse of other opioids is not. In order to help reduce the risk of abuse for oxycodone and other opioids, drug companies must educate physicians on the safe prescribing, mandated labeling about risks and drug companies now have to conduct longer-term and better studies to assess the long-term risks of using these medications. In addition, broader reduce strategies need to be implemented and more resources should be focused on treatment and prevention programs.