OxyContin reformulation faulted in 222% spike in hepatitis C infections

HepatitisCInvestigators have teased out yet another damaging thread in the villainous web of harms of the opioid crisis. A spike in hepatitis C infections is a costly, long-term, and major health consequence of the hype and disastrous reformulation of OxyContin, the powerful painkiller made by Purdue Pharmaceuticals owned by the wealthy Sackler family.

Purdue, in the 1990s, promoted and sold OxyContin to doctors and hospitals in a relentless campaign that stressed how this drug was supposedly safer and longer acting, releasing its potent effects over as long as a 12-hour span instead of requiring many pills that needed to be taken more often.

Although those claims of the drug’s benefits were dubious to start, patients — especially those abusing the highly addictive prescription medication — found they could get around OxyContin’s delayed release, getting an immediate jolt or walloping high, by crushing their pills. They then snorted Oxy as a powder or mixed it with a liquid and injected it.

The company, under regulator pressure and after increasing public clamor to do so, made a fateful decision: Purdue reformulated OxyContin into a new pill that needed to be taken whole. If smashed, the drug turned into a gummy mess that was supposed to deter abuse.

The unintended result, however, was to send opioid abusers off to seek another similar high. This launched the next deadly and still-running phase of the drug and overdose crisis, as users turned to heroin and fentanyl, a super potent, synthetic opioid.

Overdoses, including of heroin and especially of fentanyl, killed more than 70,000 Americans in 2017 alone, and they have become a leading cause of death for Americans younger than 55.

Opioid and heroin injections also have added to the nation’s health toll by causing hepatitis C infections to increase, according to researchers from the independent, nonpartisan RAND Corp. As the think tank reported:

The hepatitis C virus causes liver disease and is responsible for more deaths in the United States than any other infectious disease, accounting for 20,000 deaths in 2015. While the rate of new hepatitis C had remained steady for several years, the infection rate began rising at an alarming rate beginning in 2010. Injection drug use has consistently been identified as a predominant risk factor for hepatitis C, leading experts to consider whether the opioid epidemic might be a driver of the recent rise in the infection … [S]tates with above-median OxyContin misuse prior to the reformulation experienced a 222 percent increase in hepatitis C infections after reformulation, while states with below-median misuse of OxyContin experienced a 75 percent increase in hepatitis C infections over the same period. Before the reformulation, there was almost no difference in hepatitis C infections rates across the two groups of states.

In my practice, I see not only the harms that patients suffer while seeking medical services, but also the damage that can be inflicted on them and their loved ones by prescription medications and their skyrocketing costs and by dangerous drugs, notably in recent times opioid painkillers. It took us a while — with plenty of blame to go around for Big Pharma, doctors, hospitals, insurers, and other providers — to crash into an opioid crisis. Medical advances, in the meantime, have created, in effect, a cure for hepatitis C.

But the anti-viral regimen to lower the infection to undetectable levels takes time and has been costly, with California officials at one point estimating they needed to set aside more than $1 billion just to cover the drugs to treat infected patients on Medi-Cal, the state’s Medicaid program. Drug makers recently have begun to sell “authorized generic” versions of the anti-hepatitis C medications. These have sent the treatment cost plunging from their highs of as much as $95,000 per patient to potential lows of $24,000.

Still, Rosalie Liccardo Pacula, a co-author of the RAND study on OxyContin and hepatitis C and co-director of the organization’s Opioid Policy Tools and Information Center and its Drug Policy Research Center, observed: “Even with recent advancements in the treatment for hepatitis C, the dramatic increase in infections represents a substantial public health concern that can have tremendous long-term costs if infected people are not identified and treated.”

This is unacceptable. We’ve got a lot of work to do, and all the parties responsible for plunging us into the mess — including the philanthropic Sacklers — need to stop their finger-pointing and denial, and get behind ways to attack this drug nightmare.

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