DRUG MAKERS TAKE AIM AT OPIATE ABUSE

Education efforts, reformulated pills could curb recreational use

Worried that millions of Americans are using prescription opiate
painkillers to get high rather than to ease severe chronic pain, drug
makers are working on ways to prevent such abuse.

Cooperating closely with government officials and pain specialists, the
companies are educating doctors, rewriting warning labels and tracking
pills as they move from pharmacy to patient.

They are also reformulating pills with added ingredients. One combination
blocks euphoria. Another produces a nasty burning sensation.

"The problem of prescription painkiller abuse is much bigger than people
realize," said Dr. Clifford Woolf, director of the neural plasticity group
and professor of anesthesia research at Massachusetts General Hospital in
Boston and Harvard Medical School.

According to the Substance Abuse and Mental Health Services Administration,
more Americans abuse prescription opiates than cocaine and the abusers far
outnumber those who misuse tranquilizers, stimulants, hallucinogens,
heroin, inhalants or sedatives. After marijuana, pain pills are the drug of
choice for America's teenagers and young adults.

In recent decades, doctors stopped prescribing opiates because 5 percent to
10 percent of people who took them became addicted.

But the 50 million Americans with chronic pain needed help. It arrived five
or six years ago with slow-release formulations of opiates. A person who
swallows such a pill feels no euphoria but is relieved of pain for up to 24
hours.

Unfortunately, addicts found they could grind the pills, swallow or snort
the powder and get a high dose of opiates delivered directly into their
bloodstreams.

Now drug makers are developing ways to reformulate prescription
painkillers. Purdue Pharma in Stamford, Conn., which makes OxyContin, is
thinking of adding a second drug, called an opiate antagonist, that
neutralizes the effects of the opiate. The antagonist would be walled off
using a sequestering technique, said Dr. David Haddox, the company's vice
president of health policy. A patient who swallowed the drug would get full
pain relief. But if someone tampered with the pills, the antagonist would
be released.

Then, Haddox said, "If you are a recreational drug user, you feel nothing.
The effect is canceled out."

A second approach is to mix in a chemical irritant like capsaicin, the main
ingredient of hot chili peppers, said Woolf. Because the esophagus and
stomach don't have many receptors for hot peppers, patients could take the
pills as prescribed and find relief, he said. But the lining of the nose
and cheeks are loaded with pepper receptors, and anyone who ground up such
a pill would get a burning feeling in the chest, face, rectum and extremities.

In another effort to address the problem, drug manufacturers are providing
doctors with tamperproof prescription pads that make forgeries difficult.
When a prescription is photocopied, the copies say "void."