Tamper-proof prescription drugs may halt abuse

[Zeno Swijtink]

Tamper-proof prescription drugs may halt abuse
29 June 2008
NewScientist.com news service
Jim Giles

IT'S a class of drug abused by 1.5 million Americans. To quit, addicts have to go cold turkey: vomiting, diarrhoea, insomnia. Thousands die every year from overdoses. Add up the days lost from work and the money spent caring for addicts, and the toll reaches $10 billion annually.

You'd be forgiven for thinking that the drugs in question are crack cocaine or heroin. Instead, the culprits are prescription painkillers such as oxycodone and hydrocodone. By binding to and disrupting the activity of brain cells that control the experience of pain, they ease the suffering caused by a range of conditions from back problems to terminal cancer. When milder painkillers fail, opioids bring vital relief.

Around a decade ago, when medical organisations began encouraging doctors to do more to help patients in pain, opioids, which can be formulated to offer long-lasting relief, seemed to be the answer. But although pain management has improved, the huge rise in prescriptions is fuelling an epidemic of opioid abuse (see Graph), which is costing lives. In 2005, prescription opioids played a role in 8500 fatal overdoses, more than the figures for cocaine and heroin combined.

"Judged by any measure - person years of life lost, healthcare costs, self reports of drug abuse - the prescription drug problem is a crisis that is steadily worsening," said Leonard Paulozzi, an epidemiologist at the Centers for Disease Control and Prevention in Atlanta, Georgia, at a recent Senate hearing on unintentional drug overdoses. Studies have also shown that people are turning to the internet in droves to find ways to tamper with prescription drugs (New Scientist, 3 June 2006, p 6).

Now drug companies are fighting back with a solution of their own - tamper-resistant opioids. Even if some people find ways around these new pills, experts say that anything that makes abuse harder will help cut the numbers of addicts.

None of the new pills has yet been approved for sale. But earlier this month, Pain Therapeutics of San Mateo, California, and King Pharmaceuticals of Bristol, Tennessee, asked the US Food and Drug Administration (FDA) to approve Remoxy, a new form of OxyContin, one of the most widely prescribed opioid-based painkillers.


A bitter pill to swallow

Part of OxyContin's value as a painkiller is its ability to release the opioid oxycodone over a 12-hour period. But if someone crushes the pill and then snorts or injects the powder they can get the entire dose at once - along with an intense high.

To remove this possibility Remoxy's makers mixed oxycodone with gelatin to form a rubbery pill that simply bends when hit with a hammer.

“They mixed the opioid oxycodone with gelatin to form a rubbery pill that simply bends when hit with a hammer”

In some cases, instead of crushing pills, addicts may try to dissolve them and drink or inject the solution. But James Green of King Pharmaceuticals says the company's tests show that if people put the pill in water and then drink it, they don't get all the oxycodone at once. He declined to explain why, saying the results were commercial secrets.

Meanwhile, Grünenthal of Aachen, Germany, is taking a similar approach by developing opioid pills that are super-tough. In tests at the New York State Psychiatric Institute, 40 OxyContin addicts were given a placebo version of Grünenthal's pill and asked what they would like to use to crush it. "They asked for razors, knives, hammers, paperweights, pliers," says Sandra Comer, who helped run the tests. Each received their instrument of choice. Some were able to break the pill into a few smaller pieces, but none could crush it. "Someone asked for a blender," adds Comer. "The pill just spun around."

Those safeguards should deter at least some abusers - one of the tragedies of the current problem is the number of young people abusing opioids. Arthur Lipman, a pain expert at the University of Utah in Salt Lake City, says that teenagers often steal opioids from their parents for use at parties. Surveys of American teens show that around 10 per cent have abused an opioid in the past year. But if teenagers cannot easily get a high, they are likely to find the drugs less attractive. "That could be life-saving," says Lipman.

More-experienced addicts pose a greater challenge. Comer's work suggests that a hard pill prevents casual abuse, but it won't be so easy to defeat determined addicts. They may find a way of dissolving Grünenthal's pill, while methods for tampering with the rubbery Remoxy pills are already being discussed on internet chatrooms devoted to opioid abuse.

So Alpharma of Bridgewater, New Jersey, has created Embeda, a morphine pill that might prove harder to abuse. Like OxyContin, its active ingredient morphine tends to come as a slow-release pill that is commonly crushed by addicts. But Embeda has a core made of a substance called naltrexone, which binds to opioid receptors in the brain, preventing the morphine from reaching the same receptors. The core is coated to prevent the naltrexone from being absorbed into the body if the pill is simply swallowed. If crushed, the naltrexone is released and mixes with the morphine, so if the powder is then snorted, the morphine won't have any effect. Alpharma plans to apply for FDA approval next month.

No one is under any illusion that the tamper-resistant pills will deter everyone. "I don't know if addicts have better imagination than our people," says Jack Howard of Alpharma. "But they are pretty smart."

Some even think the drugs could make things worse. Labelling them as abuse-resistant could make doctors less likely to monitor patients for signs of abuse or even make patients think the drugs are safer. Partly because of these fears, members of an FDA advisory panel in May voted against approving another tamper-resistant opioid developed by Purdue Pharma of Stamford, Connecticut, which makes OxyContin. "You want to ensure that the problem you're trying to solve doesn't become worse," says Frank Vocci of the National Institute on Drug Abuse in Bethesda, Maryland, who voted against approval.

However, Purdue could gain approval if the labelling on the new opioid was cautious enough to prevent doctors assuming the product was safe, he says. Experts say the other tamper-resistant opioids have a good chance of getting approval if they are labelled appropriately.

[MsTerry]

Verdriet kan verslaven Gepubliceerd: 26 juni 2008 11:41 | Gewijzigd: 26 juni 2008 11:42 Door onze redactie wetenschap Rotterdam, 26 juni. Verdriet over de dood van een geliefde kan iets ‘fijns’ hebben. Bij mensen die maar niet over de dood van een geliefde heenkomen, blijkt óók het beloningscentrum in de hersenen geactiveerd te worden als ze aan de overledene denken. Bij mensen die wel met het verlies leren leven, is dat niet zo. Dat blijkt uit hersenonderzoek onder 23 vrouwen van wie de moeder of een zus onlangs aan een erfelijke vorm van borstkanker was overleden. Het wordt binnenkort gepubliceerd in het wetenschappelijke tijdschrift NeuroImage. De meeste mensen wennen aan het verlies van een dierbare. Maar 15 tot 20 procent van de achterblijvers houdt lang last van een onstuitbaar verlangen naar de overledene en dagdromen over de tijd dat hij of zij nog leefde. Het niet kunnen stoppen aan de overledene te denken, tast ook hun dagelijks functioneren aan. Dit rouwsyndroom staat op de nominatie om onder de noemer ‘complicated grief’ (gecompliceerde rouw) te worden opgenomen in de volgende editie van het wereldwijd gebruikte, classificerende psychiatrisch handboek DSM-V. De Californische onderzoekers maakten hersenscans van de 23 vrouwen (12 ‘normaal’ rouwend, 11 pathologisch) terwijl die keken naar een foto van hun overleden dierbaren of van vreemden, en naar woorden die ze zelf met rouwen associeerden of naar neutrale woorden. Bij alle rouwende vrouwen in het onderzoek activeerden foto's van de dierbaren hersengebieden die met pijnverwerking geassocieerd worden. Maar alleen bij de elf zeer langdurig rouwende vrouwen was ook de nucleus accumbens het belonings- of genotscentrum actief, dat een rol speelt bij sociale hechting, maar ook bij verslavingen. Hoe sterker dat hersengebied geactiveerd was, hoe meer de vrouwen zeiden nog naar de overledene te verlangen. De nucleus accumbens speelt een rol bij sociale hechting, maar ook bij verslavingen. Bij seks, druggebruik en ander plezier komt er de neurotransmitter dopamine in vrij. In feite zijn zij verslaafd aan het denken aan de overledene, ook al maakt dat het veel moeilijker om te wennen aan de harde realiteit, aldus de onderzoekers. Rouwtherapie moet dus niet de pijn aanpakken, maar het verlangen en het gevoel van beloning daarbij. Wat maakt dat de ene persoon normaal gaat rouwen en de andere pathologisch, maakt dit onderzoek niet duidelijk. Het biedt wel aanknopingspunten voor behandeling. Die moet niet de pijn aanpakken, maar het verlangen en het gevoel van beloning daarbij. Ook suggereert dit onderzoek dat medicijnen die het dopaminesysteem beïnvloeden, zouden kunnen helpen.

[Braggi]

Translation please:

Grief can be addictive

Published: June 26, 2008 11:41 | Updated: June 26
2008 11:42

Our science editor

Rotterdam, June 26. Grief over the death of a
beloved can something 'fine'. When people but
not about the death of a loved one shelter, is also
the beloningscentrum in the brains activated in
if they are to the deceased thinking. For people who
or learn to live with the loss, it is not.
This is evident from brain among 23 women who
the mother or a sister recently undergone an inherited form of
breast cancer was deceased. It will be soon
published in the scientific journal
NeuroImage.
Most people get used to the loss of a
treasured. But 15 to 20 percent of the laggards
keep long burden of an unstoppable desire for the
deceased and daydream about the time that he or she still
lived. It can not stop to the deceased to
thinking, also affects their everyday functioning. This
rouwsyndroom is on the nomination to succeed in the denominator
'Complicated grief' (complicated grief) should be
included in the next edition of the world
used, classifying psychiatric manual DSM-V.
The Californian researchers did brain scans of the
23 women (12 'normal' grieving, pathological 11)
while that looked at a photograph of their deceased
loved ones or strangers, and words that they themselves
mourn associating with or neutral words. By
all grieving women in the study turned
photos of loved ones with brain areas
Associated pijnverwerking. But only in the
eleven very long grieving women was also the nucleus
accumbens the remuneration or genotscentrum over,
plays a role in social bonding, but also in
addictions. The stronger that brain activated
was, the more women still said to the deceased
to require.
The nucleus accumbens plays a role in social
adhesion, but also in addictions. By sex,
drug use and other fun comes the neurotransmitter
dopamine in freely. In fact they are addicted to the
reminiscent of the deceased, even though that makes it much
harder to get used to the hard realities, says the
researchers. Rouwtherapie should not the pain
tackle, but the desire and the feeling of reward
thereto.
What makes that one person normally goes mourn and
other pathological, this research is not clear.
It offers opportunities for treatment. Those
should not addressing the pain, but the desire and the
feeling of reward that. It also suggests that
research drugs that the dopamine
influence could help.

[There, that makes it perfectly clear.]

[Braggi]

...

[There, that makes it perfectly clear.]

Perhaps we should package grief in tamper proof pills.

-Jeff

[MsTerry]

Translation please:

Grief can be addictive

Published: June 26, 2008 11:41 | Updated: June 26
2008 11:42

Our science editor

Rotterdam, June 26. Grief over the death of a
beloved can something 'fine'. When people but
not about the death of a loved one shelter, is also
the beloningscentrum in the brains activated in
if they are to the deceased thinking. For people who
or learn to live with the loss, it is not.
This is evident from brain among 23 women who
the mother or a sister recently undergone an inherited form of
breast cancer was deceased. It will be soon
published in the scientific journal
NeuroImage.
Most people get used to the loss of a
treasured. But 15 to 20 percent of the laggards
keep long burden of an unstoppable desire for the
deceased and daydream about the time that he or she still
lived. It can not stop to the deceased to
thinking, also affects their everyday functioning. This
rouwsyndroom is on the nomination to succeed in the denominator
'Complicated grief' (complicated grief) should be
included in the next edition of the world
used, classifying psychiatric manual DSM-V.
The Californian researchers did brain scans of the
23 women (12 'normal' grieving, pathological 11)
while that looked at a photograph of their deceased
loved ones or strangers, and words that they themselves
mourn associating with or neutral words. By
all grieving women in the study turned
photos of loved ones with brain areas
Associated pijnverwerking. But only in the
eleven very long grieving women was also the nucleus
accumbens the remuneration or genotscentrum over,
plays a role in social bonding, but also in
addictions. The stronger that brain activated
was, the more women still said to the deceased
to require.
The nucleus accumbens plays a role in social
adhesion, but also in addictions. By sex,
drug use and other fun comes the neurotransmitter
dopamine in freely. In fact they are addicted to the
reminiscent of the deceased, even though that makes it much
harder to get used to the hard realities, says the
researchers. Rouwtherapie should not the pain
tackle, but the desire and the feeling of reward
thereto.
What makes that one person normally goes mourn and
other pathological, this research is not clear.
It offers opportunities for treatment. Those
should not addressing the pain, but the desire and the
feeling of reward that. It also suggests that
research drugs that the dopamine
influence could help.

[There, that makes it perfectly clear.]

[MsTerry]

Is that why they are scared of homeopathy?

Tamper-proof prescription drugs may halt abuse
29 June 2008
NewScientist.com news service
Jim Giles

IT'S a class of drug abused by 1.5 million Americans. To quit, addicts have to go cold turkey: vomiting, diarrhoea, insomnia. Thousands die every year from overdoses. Add up the days lost from work and the money spent caring for addicts, and the toll reaches $10 billion annually.

You'd be forgiven for thinking that the drugs in question are crack cocaine or heroin. Instead, the culprits are prescription painkillers such as oxycodone and hydrocodone. By binding to and disrupting the activity of brain cells that control the experience of pain, they ease the suffering caused by a range of conditions from back problems to terminal cancer. When milder painkillers fail, opioids bring vital relief.

Around a decade ago, when medical organisations began encouraging doctors to do more to help patients in pain, opioids, which can be formulated to offer long-lasting relief, seemed to be the answer. But although pain management has improved, the huge rise in prescriptions is fuelling an epidemic of opioid abuse (see Graph), which is costing lives. In 2005, prescription opioids played a role in 8500 fatal overdoses, more than the figures for cocaine and heroin combined.

"Judged by any measure - person years of life lost, healthcare costs, self reports of drug abuse - the prescription drug problem is a crisis that is steadily worsening," said Leonard Paulozzi, an epidemiologist at the Centers for Disease Control and Prevention in Atlanta, Georgia, at a recent Senate hearing on unintentional drug overdoses. Studies have also shown that people are turning to the internet in droves to find ways to tamper with prescription drugs (New Scientist, 3 June 2006, p 6).

Now drug companies are fighting back with a solution of their own - tamper-resistant opioids. Even if some people find ways around these new pills, experts say that anything that makes abuse harder will help cut the numbers of addicts.

None of the new pills has yet been approved for sale. But earlier this month, Pain Therapeutics of San Mateo, California, and King Pharmaceuticals of Bristol, Tennessee, asked the US Food and Drug Administration (FDA) to approve Remoxy, a new form of OxyContin, one of the most widely prescribed opioid-based painkillers.


A bitter pill to swallow

Part of OxyContin's value as a painkiller is its ability to release the opioid oxycodone over a 12-hour period. But if someone crushes the pill and then snorts or injects the powder they can get the entire dose at once - along with an intense high.

To remove this possibility Remoxy's makers mixed oxycodone with gelatin to form a rubbery pill that simply bends when hit with a hammer.

“They mixed the opioid oxycodone with gelatin to form a rubbery pill that simply bends when hit with a hammer”

In some cases, instead of crushing pills, addicts may try to dissolve them and drink or inject the solution. But James Green of King Pharmaceuticals says the company's tests show that if people put the pill in water and then drink it, they don't get all the oxycodone at once. He declined to explain why, saying the results were commercial secrets.

Meanwhile, Grünenthal of Aachen, Germany, is taking a similar approach by developing opioid pills that are super-tough. In tests at the New York State Psychiatric Institute, 40 OxyContin addicts were given a placebo version of Grünenthal's pill and asked what they would like to use to crush it. "They asked for razors, knives, hammers, paperweights, pliers," says Sandra Comer, who helped run the tests. Each received their instrument of choice. Some were able to break the pill into a few smaller pieces, but none could crush it. "Someone asked for a blender," adds Comer. "The pill just spun around."

Those safeguards should deter at least some abusers - one of the tragedies of the current problem is the number of young people abusing opioids. Arthur Lipman, a pain expert at the University of Utah in Salt Lake City, says that teenagers often steal opioids from their parents for use at parties. Surveys of American teens show that around 10 per cent have abused an opioid in the past year. But if teenagers cannot easily get a high, they are likely to find the drugs less attractive. "That could be life-saving," says Lipman.

More-experienced addicts pose a greater challenge. Comer's work suggests that a hard pill prevents casual abuse, but it won't be so easy to defeat determined addicts. They may find a way of dissolving Grünenthal's pill, while methods for tampering with the rubbery Remoxy pills are already being discussed on internet chatrooms devoted to opioid abuse.

So Alpharma of Bridgewater, New Jersey, has created Embeda, a morphine pill that might prove harder to abuse. Like OxyContin, its active ingredient morphine tends to come as a slow-release pill that is commonly crushed by addicts. But Embeda has a core made of a substance called naltrexone, which binds to opioid receptors in the brain, preventing the morphine from reaching the same receptors. The core is coated to prevent the naltrexone from being absorbed into the body if the pill is simply swallowed. If crushed, the naltrexone is released and mixes with the morphine, so if the powder is then snorted, the morphine won't have any effect. Alpharma plans to apply for FDA approval next month.

No one is under any illusion that the tamper-resistant pills will deter everyone. "I don't know if addicts have better imagination than our people," says Jack Howard of Alpharma. "But they are pretty smart."

Some even think the drugs could make things worse. Labelling them as abuse-resistant could make doctors less likely to monitor patients for signs of abuse or even make patients think the drugs are safer. Partly because of these fears, members of an FDA advisory panel in May voted against approving another tamper-resistant opioid developed by Purdue Pharma of Stamford, Connecticut, which makes OxyContin. "You want to ensure that the problem you're trying to solve doesn't become worse," says Frank Vocci of the National Institute on Drug Abuse in Bethesda, Maryland, who voted against approval.

However, Purdue could gain approval if the labelling on the new opioid was cautious enough to prevent doctors assuming the product was safe, he says. Experts say the other tamper-resistant opioids have a good chance of getting approval if they are labelled appropriately.