Article Body 2010 
 
 A reformulation of OxyContin that makes it harder to abuse has curtailed the drug’s illicit use. But some 25 percent of drug abusers entering rehab said they still abused the prescription painkiller despite package labeling that emphasizes its abuse-deterrent properties, new research indicates. 
 
 The study, by researchers at Washington University School of Medicine in St. Louis, is published March 11 in JAMA Psychiatry. 
 
 Surveying almost 11,000 drug users at 150 drug-treatment facilities in 48 states, the researchers found that an abuse-deterrent formulation of the prescription drug OxyContin was successful in getting abusers and addicts to stop using the drug, but only to a point. 
 
 
 
 “We found that the abuse-deterrent formulation was useful as a first line of defense,” said senior investigator Theodore J. Cicero, PhD, a professor of neuropharmacology in psychiatry. “OxyContin abuse in people seeking treatment declined, but that decline slowed after a while. And during that same time period, heroin use increased dramatically.” 
 
 The original formulation of OxyContin contained high levels of the pain-killing drug oxycodone. It was designed so that small amounts of the drug were released over a long period of time. However, abusers in pursuit of an intense high found they could crush the pills and snort the powder, or dissolve the pills in liquid and then inject the drug. 
 
 To discourage abuse, the newer formulation of OxyContin was designed to make it harder to crush or dissolve the pills. 
 
 The abuse-deterrent formulation was introduced in 2010 at a time when 45 percent of study participants entering drug treatment reported they had used OxyContin to get high at least once in the previous 30 days. Two years later, the percentage of those who got high with the abuse-deterrent form of the drug in the month before entering a treatment center had fallen to 26 percent. 
 
 These abusers continued to use OxyContin to get high by either taking the drug orally or finding new ways to snort or inject it. 
 
 Perhaps even more worrisome, almost half of the drug abusers surveyed in 2014 reported they had used heroin in the 30 days before they entered treatment. 
 
 “Some people found ways to get around the abuse-deterrent formulation so that they could snort or inject it, and others simply swallowed the pills,” Cicero explained. “But many people switched to heroin, and that’s a major concern.” 
 
 Robert Boston Theodore J. Cicero, PhD, professor of neuropharmacology in psychiatry at Washington University School of Medicine in St. Louis, reviews drug-abuse data. 
 
 Cicero, also vice chairman for research in the Department of Psychiatry, explained that of those who had stopped using OxyContin and switched to another drug, 70 percent started using heroin instead. Many said they made that switch for economic reasons. 
 
 “A few years ago when we did interviews with people in treatment, many would tell us that although they were addicts, at least they weren’t using heroin,” he said. “But now, many tell us that a prescription opioid might run $20 to $30 per tablet while heroin might only cost about $10.” 
 
 In addition, he said, many of the people who sell heroin aren’t quite as frightening as they once seemed. Addicts no longer have to find dealers in dark alleys in rough neighborhoods. It has become easy to find heroin virtually anywhere, including suburban and rural areas. 
 
 “Some people have come to see it as a cost-effective method of getting high,” Cicero said. “If they can tolerate the intravenous injection and overcome their reluctance to give themselves a shot, many of the people in our study said it was a fairly simple decision and that heroin now represents a cheaper, more attractive alternative.” 
 
 Limiting access to a prescription drug by making it harder to abuse does not change the demand side of the drug abuse equation, he said. People who want to get high find ways to continue doing so. 
 
 “The newer formulations are less attractive to abusers, but the reality is — and our data demonstrate this quite clearly — it’s naïve to think that by making an abuse-deterrent pill we can eliminate drug abuse,” he said. “There are people who will continue to use, no matter what the drug makers do, and until we focus more on why people use these drugs, we won’t be able to solve this problem.” 
 
 The data were collected as part of the SKIP (Survey of Key Informants’ Patients) program, a component of the RADARS (Researched Abuse, Diversion and Addiction-Related Surveillance) system, funded through an unrestricted research grant sponsored by the Denver Health and Hospital Authority, which collects subscription fees from 14 pharmaceutical firms. The researchers also were supported by private university funds. 
 
 Cicero TJ, Ellis MS. Abuse-deterrent formulations and the prescription opioid abuse epidemic in the United States. JAMA Psychiatry, published online March 11, 2015. doi:10.1001/jamapsychiatry.2014.3043 ||||| (CNN) In an attempt to reduce opioid use amid a nationwide abuse epidemic , insurance giant Cigna will no longer cover most OxyContin prescriptions in its group plans beginning January 1. 
 
 "Our focus is on helping customers get the most value from their medications -- this means obtaining effective pain relief while also guarding against opioid misuse," Cigna Chief Pharmacy Officer Jon Maesner said in a statement Wednesday. 
 
 OxyContin is a brand name for an extended-release version of oxycodone, a commonly prescribed opioid painkiller. 
 
 Long-acting or extended-release medications like OxyContin contain a higher dosage of the active ingredients in the pill itself, which is chemically released over a long period of time. The advantage for patients is that they don't have to take pills as frequently. However, the higher dosage of long-acting pills can make them more attractive for abuse. Crushing or melting some versions of extended-release pills, a user can get a day's dosage in just one pill. 
 
 According to Cigna, "Xtampza ER's abuse-deterrent platform allows the product to maintain its extended release profile even when cut, crushed, chewed or otherwise manipulated." OxyContin likewise has some abuse-deterrent properties, such as being more difficult to crush. And although one study appeared to find that Xtampza was harder to abuse than OxyContin, it was conducted by the medication's manufacturer, Collegium. 
 
 The difficulty of abuse shouldn't be confused with how addictive a drug may be, said Dr. Caleb Alexander, director of the Johns Hopkins Center for Drug Safety and Effectiveness. "People don't recognize that just because they are harder to tamper with doesn't make them any less addictive or any more effective in chronic non-cancer pain," he said. 
 
 Despite any advantages Xtampza may have, "people still get addicted to oral pills. They can still take too much. They can still overdose," said Dr. Walid Gellad , co-director of the University of Pittsburgh's Center for Pharmaceutical Policy and Prescribing. 
 
 Purdue Pharma, maker of OxyContin, said in a statement Thursday that "Cigna's decision limits the tools prescribers can use to help address the opioid crisis as both products are formulated with properties designed to deter abuse. Unfortunately, this decision appears to be more about pharmaceutical rebates." 
 
 Gellad and Alexander also believe that there was more to Cigna's decision than a desire to combat the opioid crisis. "I think it's important to recognize that insurers are trying to find the sweet spot between finding the right spot clinically and the right thing to do for their business," Alexander said. 
 
 In its statement, the insurance company said that "Collegium is financially accountable if the average daily dosage strengths of Xtampza ER prescribed for Cigna customers exceed a specific threshold. If the threshold is exceeded, Collegium will reduce the cost of the medication for many of Cigna's benefit plans." 
 
 When asked for further details of the financial agreement, including what the threshold was and the how cost reduction would be distributed, Cigna said that "specific terms of the contract are proprietary." 
 
 Dr. Charles E. Argoff, president of the American Academy of Pain Medicine Foundation, said "we are going down a very bad slippery slope if we allow payers to only make decisions solely on financial grounds and don't have any checks and balances on the insurance world's ability to basically dictate what happens to them medically." 
 
 Cigna said OxyContin will still be considered for patients if a doctor believes it medically necessary. 
 
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 According to the US Centers for Disease Control and Prevention , over 90 Americans die every day from opioid overdoses, including legally prescribed drugs like oxycodone as well as illicit drugs like heroin. Since 1999, the number of opioid overdose deaths has quadrupled, as has the number of opioid prescriptions. However, there hasn't been a change in the amount of pain reported by Americans. 
 
 Drug overdoses overall are killing more Americans than guns or car accidents. 
 
 But Gellad said that targeting prescriptions alone will not be enough to help turn the tide on the opioid overdose epidemic. "If you really want to address the opioid epidemic, it's about about increasing access to non-opioid treament for chronic pain patients."
– When an "abuse-deterrent" version of OxyContin was introduced in 2010, the intent was clear: "to make OxyContin more difficult to solubilize or crush, thus discouraging abuse through injection and inhalation," the New England Journal of Medicine noted in 2012. Made with special binders, the revamped pills would turn into a gooey substance instead of powder or liquid if someone tried to crush or dissolve them, making the drug extremely difficult to snort or inject, CBS News notes. But a new study published in JAMA Psychiatry that examined surveys of 11,000 drug users at 150 treatment facilities across 48 states found that hardcore addicts will either find novel ways to circumvent the pill's properties or, just as bad, turn to a cheaper street drug: heroin. Washington University School of Medicine researchers discovered that although the percentage of addicts entering rehab who had used OxyContin within the past 30 days declined since the abuse-deterrent pill was introduced (45% in 2010; 26% in 2012), addicts "have figured out how to circumvent" it, Theodore Cicero, the study's lead author, tells CBS. He adds that users go online to trade techniques on "cooking" the pill to get a stronger high, and when that doesn't work, they often turn to heroin, which is often cheaper and easier to get than prescription drugs: Almost 50% of addicts entering rehab said they had used heroin within the past 30 days. "There are people who will continue to use, no matter what the drug makers do," Cicero says. "Until we focus more on why people use these drugs, we won't be able to solve this problem." (The new face of heroin may not be what you expect.)