How we may be able to solve the Reformulated OxyContin problem

[Anonymous]

The first step in solving the problem is that of learning why the new formula appears to have introduced such a substantial change in the degree of pain relief and adverse events experienced by some patients, and why there is such a difference in the degree of this change, from one patient to the next.

A chemist I know claims he has discovered this. He believes that the problem has to do with polyethylene oxide (POE) being susceptible to being broken down by various digestive enzymes with some being more effective at breaking it down than others.

Now different people produce different amounts of digestive enzymes, and the amount produced may decline with age in some people. The chemist mentioned above says he has experimented with appying different digestive enzymes to polyethylene oxide in an environment where simulated digestive juices were supplied and stomach churning was simulated. He found several enzymes that did aid in breakdown of POE. One, lactase, is an enzyme available on pharmacy shelves for people who produce insufficient amounts of it on their own. It was not among the more effective of the enzymes he tested, and among enzymes that produced results, it took the longest to do so. It is, however, the one for which amounts produced vary the most widely from one individual to the next, and it is also one for which ingestion of supplements can result in very high active levels.

Knowing this, perhaps OxyContin can be modified to use an alternative to POE that does not change breakdown rate depending upon digestive enzyme levels. Until some change is made, at least, physicians should be instructed not to prescribe OxyContin to patients who take lactase supplements (such as Lactaid).

 

[Anonymous]

The first step in solving the problem is that of learning why the new formula appears to have introduced such a substantial change in the degree of pain relief and adverse events experienced by some patients, and why there is such a difference in the degree of this change, from one patient to the next.

A chemist I know claims he has discovered this. He believes that the problem has to do with polyethylene oxide (POE) being susceptible to being broken down by various digestive enzymes with some being more effective at breaking it down than others.

Now different people produce different amounts of digestive enzymes, and the amount produced may decline with age in some people. The chemist mentioned above says he has experimented with appying different digestive enzymes to polyethylene oxide in an environment where simulated digestive juices were supplied and stomach churning was simulated. He found several enzymes that did aid in breakdown of POE. One, lactase, is an enzyme available on pharmacy shelves for people who produce insufficient amounts of it on their own. It was not among the more effective of the enzymes he tested, and among enzymes that produced results, it took the longest to do so. It is, however, the one for which amounts produced vary the most widely from one individual to the next, and it is also one for which ingestion of supplements can result in very high active levels.

Knowing this, perhaps OxyContin can be modified to use an alternative to POE that does not change breakdown rate depending upon digestive enzyme levels. Until some change is made, at least, physicians should be instructed not to prescribe OxyContin to patients who take lactase supplements (such as Lactaid).

The variability from person to person is not due to enzymes, but to the fact that Purdue's does not have a robust manufacturing procedure,e.g. different batches turn out with different hardness, and different dissolution rates in-vivo.

 

[Anonymous]

The variability from person to person is not due to enzymes, but to the fact that Purdue's does not have a robust manufacturing procedure,e.g. different batches turn out with different hardness, and different dissolution rates in-vivo.

Here is a simple algorithm that will solve your problem Old formulation in spoon melts and you can bang immeaditely new formula can't bang or diffucult to bang hmmm why all the complaints

 

[Anonymous]

Here is a simple algorithm that will solve your problem Old formulation in spoon melts and you can bang immeaditely new formula can't bang or diffucult to bang hmmm why all the complaints

Most people take oxycontin exactly as directed, and have been having major problems since the reformulation. Posts like the one quoted are from people who have no idea of what it means to be a compliant patient.

They are, however in the minority among those who have trouble with the new formula.

Our problem is not with banging or snorting or whatever terms you use. Most of the people having problems with the new drug hate the fact that people do such things. Not only for altruistic reasons, but because the response to people doing so has been to change oxycontin into an inferior product.

The problem is that, [I}when swallowed as directed[/I], there is great variability in the effects of the drug from one person to the next, and there are a plethora of new side effects that never occurred with the old formula. Problems such as hives, nausea, indigestion, headache, incontinence (due to the lubricating qualities of the new drug), etc...

I still have three weeks until my next doctor appointment (because I have proven to be a compliant patient, I only need to see him once every three months at which time he gives me three prescriptions), but when I see him next, I will ask him to change my prescription to anything other than oxycontin.

 

[Anonymous]

The first step in solving the problem is that of learning why the new formula appears to have introduced such a substantial change in the degree of pain relief and adverse events experienced by some patients, and why there is such a difference in the degree of this change, from one patient to the next.

A chemist I know claims he has discovered this. He believes that the problem has to do with polyethylene oxide (POE) being susceptible to being broken down by various digestive enzymes with some being more effective at breaking it down than others.

Now different people produce different amounts of digestive enzymes, and the amount produced may decline with age in some people. The chemist mentioned above says he has experimented with appying different digestive enzymes to polyethylene oxide in an environment where simulated digestive juices were supplied and stomach churning was simulated. He found several enzymes that did aid in breakdown of POE. One, lactase, is an enzyme available on pharmacy shelves for people who produce insufficient amounts of it on their own. It was not among the more effective of the enzymes he tested, and among enzymes that produced results, it took the longest to do so. It is, however, the one for which amounts produced vary the most widely from one individual to the next, and it is also one for which ingestion of supplements can result in very high active levels.

Knowing this, perhaps OxyContin can be modified to use an alternative to POE that does not change breakdown rate depending upon digestive enzyme levels. Until some change is made, at least, physicians should be instructed not to prescribe OxyContin to patients who take lactase supplements (such as Lactaid).

Why is this being dismissed so quickly? If enzymes really do help it's worth people giving them a try while Purdue figures out what to do about the problem. Why should they not take enzymes if the medicine isn't working?

 

[Anonymous]

If the new Oxy sells Purdue will never remove it. They don't care.

 

[Anonymous]

If the new Oxy sells Purdue will never remove it. They don't care.

Unless a major safety issue comes up...Remember the Palladone?

 

[Anonymous]

If the new Oxy sells Purdue will never remove it. They don't care.

I've read many chronic pain boards posts regarding complaints with the new formula. Patients are planning to switch or have already switched to another medication such as MsContin, Opana, Kadian, Methadone, etc. Many chronic pain patients are doing so due to lack of pain relief after trying a higher dosage, side effects, and higher cost.

Customers are also saying that they will not buy *any* medication by Purdue. I have also read that Medicare will not be covering Oxycontin this year, but I haven't personally confirmed this yet.

Your right, Purdue doesn't care, and people are very aware of this because they found out the hard way. Patients became ill, pain returned, and they were out more money than before.

Some patients have only been receiving the new formula for the last few months at most. Doctors are doing their best to choose the best alternatives for their patients as it can sometimes take many months to find the right combination, and truth be told, both doctor and patient don't want to start the process all over again. Considering most doctors didn't even know about the change in formula until their patients told them, the OP disaster wouldn't make headlines overnight, though it might be around the corner. And sales aren't going to take a significant hit?

 

[Anonymous]

Some patients have only been receiving the new formula for the last few months at most. Doctors are doing their best to choose the best alternatives for their patients as it can sometimes take many months to find the right combination, and truth be told, both doctor and patient don't want to start the process all over again. Considering most doctors didn't even know about the change in formula until their patients told them, the OP disaster wouldn't make headlines overnight, though it might be around the corner. And sales aren't going to take a significant hit?

Let it. While I am sorry for their employees, Purdue deserves everything they are going to get.

I am nearly as furious with them as my doctor is. When I saw him last week, he commented "If one more Purdue rep tells me it's biocompatible, " ... his voice trailed off, but I could see murder in his eyes.

Whether Purdue sold the old formula or sold the new formula, junkies were going to get their high. If not from Purdue's product, then from someone else's, or from street heroin.
So now, maybe junkies won't be getting high on Purdues product. And Purdue will lose some diversion based revenue. But they are losing even more revenue from all the little old ladies who would never dream of abusing their medicines, and from so many other compliant patients.

Their action has not and will not solve the drug problem. Nor is it their place to be doing so. They are manufacturers, not police entities.

What Purdue has accomplished more than anything else is to alienate their number one source of revenue, OxyContin customers, and to make those customers more aware than they ever wanted to be that there exist competing products that can be a solution to what is now being called "the OxyContin problem".

 

[Anonymous]

Let it. While I am sorry for their employees, Purdue deserves everything they are going to get..

I couldn't agree with you more.

 

[Anonymous]

I couldn't agree with you more.

Me too. The old formulation has been abused for years and the company has known it all along. It has always amazed me how it was FDA approved as BID and most doctors were RXing it TID because of end of dose failure after 8 hours. The quick bolus affect was the driver for all the drug attics and so we did have smooth sailing for those years bonus wise. I think Purdue will quickly see our market share dropping and the fact that most people who were getting prescriptions of the old formulation were not seeing their doctors for pain management purposes. I have always been imbarrassed selling it knowing it was being mostly abused in my territory.

 

[Anonymous]

The new formulation is a total disaster for us. Most of my doctors are complaining about it every time I see them. I am embarrassed to be selling this crap and yet we could not get the FDA approval for "tamper resistant." Now we have this honker tablet that patients are complaining is hard to swallow and are gaging on it. Way to go Purdue!

 

[Adrian]

I'm not sure what, if anything can be done about the OP, I have remained on the same dosage for over 5 years (1- 80mg tablet - 3 times a day). The first month I took OP I went through withdrawls, had terrible headaches everyday, nausea and no pain relief all for $1,100.00 a month. When I complained to my Doctor that it wasn't working well she recommended I not eat when take it, worse nausea. Then when Whole pills passed through my system they tried to say it was only the shell, what BULL. This medication was never tested on patients that had taken the old formula. During testing subjects were given 1 tablet - 1 time a week. Only 10 mg & 80 mg were tested. No one cared if it worked as long as they looked good, and all of a sudden the government will pay for brand name oxycontin. I think the FDA is as shady as Purdue. Purdue patented this medication around 1995, now thanks to the reformulation they get to extend that to 2013. Its all about the almighty dollar for Purdue, the government wants to look good for re-election, meaning more money for them also. We can only hope karma catches up with them. Seeing someone you love suffer changes your out look about alot of things. The only advice I have is COMPLAIN to FDA & Purdue, and before it kills us begin keeping detailed records of your experience with OC & OP, at least our relatives may be compensated (if possible).