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Friday, May 02, 2008

Maker of OxyContin toughens its tablets

The effort, which requires approval from the FDA, makes the drug more difficult to crush into a powder.

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The maker of OxyContin has developed a new form of the tablet that it says will be harder to crush into a powder -- a process that converted what might have been a miracle painkiller into a street drug with the potency of heroin.

In documents released Thursday by the U.S. Food and Drug Administration, Purdue Pharma described a new form of OxyContin that has been in the works for more than five years.

The new tablets have "plasticlike properties which make them difficult to break," the company said.

Purdue, which hopes to market its newly formulated drug under the same OxyContin brand name, is seeking approval from the FDA. A hearing is scheduled for Monday in Gaithersburg, Md., before two advisory committees.

When the FDA first approved OxyContin in 1995, Purdue touted its time-release formula, which slowly distributes the drug's active ingredient -- oxycodone, a derivative of opium -- into a patient's bloodstream for up to 12 hours, providing more effective and consistent pain relief.

But it didn't take long for abusers to figure out how to compromise the time-release formula. By crushing the tablets and snorting or injecting the powder, they obtained an intense high similar to that produced by heroin.

Law enforcement officials in many parts of the country, including far Southwest Virginia, have since blamed OxyContin for a wave of addiction, crime and death from overdoses.

Although Purdue now claims to have a safer drug, critics say the company's track record of over-promoting its top-selling product should be taken into account during the FDA approval process.

Last May, Purdue and three of its top executives were convicted of misbranding OxyContin, or making false presentations to physicians that oversold the drug's painkilling abilities while downplaying its potential for abuse.

As part of a plea agreement obtained by federal prosecutors in Roanoke and Abingdon, Purdue agreed to pay $634.5 million in fines and fees.

Art Van Zee, a Lee County physician who has been critical of Purdue in the past, said he thinks the criminal case should be "a major issue" in the FDA's consideration of whether the new drug is safe enough to be put on the market.

"They did systemically oversell the benefits and trivialize the risks of OxyContin," Van Zee said. "So if they are the ones that are going to be in charge of marketing a new opioid, that's a substantial concern."

Abuse of OxyContin in the coalfields of far Southwest Virginia, often described by law enforcement and public health officials as an epidemic, has not waned since it first showed up in the late 1990s, Van Zee said.

In a region where prescription medication is readily available because of the prevalence of coal mining and other high-risk industries, OxyContin is often the drug of choice for abusers.

Police last year reported a resurgence of OxyContin-related arrests. And the state medical examiner's office has counted more than 250 fatal overdoses from oxycodone, the active ingredient in OxyContin, in Western Virginia since 2000.

Despite its dark side, OxyContin is prescribed in growing numbers by physicians who see it as a valuable medication when used appropriately. In papers filed with the FDA, Purdue said the new formulation of OxyContin will not diminish the drug's effectiveness.

In recent years, several companies have been scrambling to develop an opium-based medication that provides strong pain relief without the risk for abuse that comes with OxyContin.

Purdue is the first to seek government approval for such a drug, FDA spokeswoman Susan Cruzan said.

To come up with a more tamper-resistant drug, Purdue introduced a polymer into the drug during the manufacturing process and then heated the tablet to above the polymer's melting point, according to documents posted on the FDA's Web site Thursday. As it cooled, the polymer fused with the drug's painkilling component "to impart plasticlike properties to the tablet," Purdue said.

Not only are the tablets harder to crush into a powder, the company said, but the resulting larger fragments retain some of the drug's time-release function. And when mixed with water, the new drug becomes a jellylike substance that is virtually impossible to inject through a syringe, Purdue said.

While the new drug has passed a rigorous round of testing, Purdue conceded that the company has not found a way to prevent misuse of OxyContin by those who swallow too many pills at once.

James Heins, a spokesman for Purdue, declined to comment in detail Thursday.

"We look forward to the advisory committee meeting on our New Drug Application," Heins wrote in an e-mail. "Since this new formulation has not been approved by the FDA, the company is not making any further statements."

Neither Heins nor Cruzan would say how long it might take the FDA to act on the company's application.

On Monday, the FDA's Anesthetic and Life Support Drugs Advisory Committee and the Drug Safety and Risk Management Advisory Committee will meet in a hotel ballroom to discuss the safety implications of Purdue's new drug.

In a memo to committee members, an FDA official outlined several concerns the agency has. At first, only the lower concentrations of OxyContin will have the new tamper-resistant qualities, with the company continuing to make and distribute 60- and 80-milligram doses of the drug in its current form.

"This raises concerns that, should any information regarding the new formulation be included in the label prior to [Purdue] successfully reformulating the higher strengths, prescribers and patients might mistakenly assume that all strengths have abuse resistant features," wrote Bob Rappaport, director of the FDA's division of anesthesia, analgesia and rheumatology products.

Another concern is how to inform physicians of the changes without giving them and their patients a false sense of security. "These are clearly difficult questions for which there are no easy answers," Rappaport wrote.

Even Purdue -- which more than a decade ago touted the wonders of its new drug with an aggressive marketing campaign -- seems more cautious this time around.

"There is no assurance that all of the benefits described will be realized," the company wrote at the end of its 31-page proposal to the FDA. "We will be monitoring this product in the marketplace to evaluate its impact."

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