Tamper-Resistant Narcotics Are Good News for Pain Patients

Pharmaceutical companies are coming up with novel ways to outwit street dealers. In the wake of the OxyContin scandal, drug companies are in a race to make it more difficult to tamper with prescription narcotics. In August, the Food and Drug Administration (FDA) decided to give priority review to a version of oxycodone (the active compound in OxyContin) called Remoxy, which resists crushing, injecting, and dissolving in alcohol—all techniques used by street addicts to get a rapid high from what is supposed to be a slow-release drug. That followed an FDA rejection in May of a new version of OxyContin that was supposed to do the same thing.

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Getting tamper-resistant drugs to market will be a cash cow for the pharmaceutical industry, but it's not just companies who will benefit. If the drugs can cut the dangers and stigma of possessing legitimate-use narcotics in high-risk cities, the real beneficiaries will be patients in pain, says one expert in Baltimore, a city battling an entrenched drug problem.

In her work there, Kathryn Walker, PharmD, an assistant professor at the University of Maryland School of Pharmacy and a clinical specialist in palliative medicine, often sees doctors and terminal cancer patients who are afraid of narcotics in the home, in part because they fear the drugs will be stolen by addicted relatives. (A 2007 study found that 70% of illicitly used prescription drugs were obtained from friends or relatives.) Drug abuse also has gravely distorted the perception of these drugs to the people who need them most.

"You're talking about a patient with end-stage cancer who is afraid to use opioids because she's seen what addiction has done to her family," Walker says. "She's seen her cousin, brother, and mother hooked on these agents. Anything we can do to ameliorate that would be helpful."

New ideas to foil street dealers

Remoxy and the rejected new version of OxyContin both make the basic pill harder to crush, dissolve, snort, and inject. But Walker says several more novel anti-tampering formulas are working their way through the FDA approval process, and she's optimistic some will make it. In one, tiny spheres of an active drug are commingled in a capsule with identical-looking spheres of an antagonist—a substance that neutralizes the narcotic effect if the capsule is crushed. (Taken orally, as prescribed, the neutralization doesn't happen, but the high isn't immediate either).

In another formula, the active drug is mixed with capsaicin, the substance that gives chili peppers heat: Injecting or snorting results in fierce burning "at both ends," Walker says.

In the third option, called the "pro-drug" approach, a drug is only activated by the metabolic process that takes place inside the human gut, turning your body into a chemist's lab.

None of these measures prevent the simplest narcotic abuse—taking too much of a drug in its original form—but they make tampering tricky, and the street puts a premium on fast, intense highs. If the drug is too hard to jimmy, dealers will move on.