How OxyContin Kicked Off the Heroin Epidemic

April 13, 2018

The FDA was trying to make OxyContin safer. Instead, it accidentally launched a national crisis.

Purdue Pharma’s attempt to stem a mushrooming opioid crisis by reformulating OxyContin is the reason why heroin replaced it and took off, causing the crisis to explode into a full-blown epidemic, according to a new working paper.

Not only that, the paper’s authors—economists William N. Evans and Ethan Lieber of the University of Notre Dame, and Patrick Power of Boston University—narrow down the switch to August and September 2010. Once OxyContin’s formula changed, it became too expensive to get high off the drug, making heroin the obvious choice as its replacement, they write in the paper, published online with the National Bureau of Economic Research.

It’s not necessarily the first paper to come to this conclusion—another NBER paper from January 2017 cites similar results—but the new paper manages to pinpoint down to the month when the dramatic change occurred. Perhaps more important, as the paper states in its abstract, the “reformulation did not generate a reduction in combined heroin and opioid mortality—each opioid death was replaced with a heroin death.”

And then some, it appears from data.

Lieber, an assistant professor of economics at the University of Notre Dame, said it’s clear a substitution effect of sorts was occurring. “What we were doing when we came across this data was asking two questions: Is something changing somewhere in this time line? And if so, when is it changing?”

The substitution effect will likely be a familiar term for anyone who’s ever taken an Economics 101 course. It’s a pretty simple concept: When the price of a good rises, the consumer will redirect their purchase of said product toward a cheaper alternative. If, for example, the price of name brand, gourmet string cheese goes up, consumers will veer towards the generic, less fancy but cheaper mozzarella stick as a substitute.

Lieber and his colleagues found evidence of the substitution effect with OxyContin and heroin.

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Indeed, Lieber said it came down to a single month. “In August 2010, something is changing in opioid use,” he pointed out. “And in September 2010, something is changing for heroin use.”

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