of prescription drugs fuelled by online recipes
NewScientist.com news service, Hazel Muir
"IF YOU just swallow
them you will not be getting the full effects."
Instead, the website tells abusers of a common
prescription drug to crush the time-release beads
and snort them, or swallow the powder in a piece of
tissue paper to get a longer-lasting "hit".
These words could
kill. Yet tampering with prescription drugs to
amplify their effects is a growing health hazard. A
study published this month suggests that droves of
people are turning to the internet to search for and
swap advice on how to tamper with prescription
drugs, for instance, by snorting those prescribed
for hyperactivity disorders, or chewing skin patches
containing potentially lethal painkillers (Drug
and Alcohol Dependence, DOI:
10.1016/j.drugalcdep.2005.11.027). Toxicologists are
calling on pharmaceutical companies to wise up to
"Drug misusers are
tampering with the drugs to get high, and you get
high by getting the drug in faster or giving a
bigger dose," says Edward Cone, the author of the
study and a toxicologist at ConeChem Research in
Maryland, which advises the pharmaceutical industry
on drug abuse prevention. "All of these drugs are
toxic or lethal at certain levels, so this is a very
real health issue."
In March, the
International Narcotics Control Board released a
report identifying North America, especially the US,
as a hotspot for prescription drug misuse. In 2003,
the US National Survey of Drug Use and Health showed
that the number of people misusing legal
painkillers, tranquillisers, stimulants and
sedatives had reached 6.3 million - more than twice
the number taking cocaine.
Users get hold of the
drugs by every route imaginable, including conning
doctors with bogus ailments, using prescriptions
intended for other people or buying them from
illegal internet pharmacies. "In the US, the abuse
of pharmaceutical drugs is reaching epidemic
proportions," Cone says.
The appearance of
websites detailing the recreational use of these
drugs, which even post recipes on how to heighten
the hit, is the latest twist in this trend
(see "Recipe for abuse").
The traffic on some of the sites is enormous. One,
which includes around 3000 personal accounts of
experiences with a wide range of legal and illicit
drugs, receives an average of 420,000 hits a day.
"Some people post their progress on beating a new
formulation almost on a daily basis. Then others
respond with questions and experiences of their own
- it feeds on itself," says Cone.
For instance, some
sites suggest ways of tampering with skin patches
designed to slowly release the opioid painkiller
fentanyl. Users sometimes extract the drug from a
patch to eat, inject or smoke. Yet a single patch
can contain enough fentanyl to kill several people,
according to toxicologist Bruce Goldberger from the
University of Florida in Gainesville. "It's like
Russian roulette - you just don't know how much drug
you're going to get," he says.
sometimes extract fentanyl from a patch to eat or
inject. Yet a single patch can contain enough to
kill several people"
Goldberger says the
tampering problem began to escalate in the mid-1990s
when OxyContin came on the market. OxyContin, made
by Connecticut-based company Purdue Pharma, is a
sustained-release formula of oxycodone, another
powerful opioid painkiller. Recreational users
quickly realised they could defeat the
sustained-release formula by chewing the tablets, or
crushing them to snort or inject.
Surveys by the US
Drug Abuse Warning Network (DAWN) suggest the number
of emergency hospital visits involving oxycodone
misuse increased about 10-fold between 1996 and
2004. Estimates suggest that in 2004 there were more
than 36,000 admissions involving misuse of the drug,
now nicknamed "hillbilly heroin".
There are no official
US national statistics on how often drug tampering
leads to a fatal overdose. But tampering is
implicated in roughly 200 deaths each year in
Florida alone, according to Goldberger, whose lab
oversees much of the state's post-mortem
investigations. He adds that because the
circumstances of a drug overdose are often unclear,
that is probably the tip of the iceberg.
Whether the popular
online schemes for drug tampering are effective is
often unclear. "Many of the procedures look like
they would work," says Cone. "But as far as I know,
there is no one evaluating them." Users therefore
have no way of assessing them - except by giving
them a go.
Goldberger says he
was reluctant to discuss the problem of drug
tampering publicly several years ago, for fear of
planting the idea in someone's head. "But today, the
information is already out there," he says. "If you
don't know how to tamper with a product all you have
to do is a Google search."
So what should be
done? Goldberger says education about the hazards of
drug tampering is vital, along with systematic
surveys to uncover the real extent of the problem.
Cone argues that companies could also do much more
to make their drugs tamper-resistant, by making
tablets that are likely to be abused harder to crush
and snort, for instance
(see "Tamper proof").
While these measures wouldn't stamp out drug
tampering completely, "we can certainly do better
than we're doing now," says Cone.
number of emergency hospital visits involving
oxycodone increased 10-fold between 1996 and 2004"
The good news is that
some barriers to tampering seem to be genuinely
effective. Disgruntled recreational users report
online that one methylphenidate drug called Concerta,
a stimulant used to treat attention deficit
hyperactivity disorder (ADHD), is very difficult to
crush and snort. One user's verdict reads: "No
effects to very minimal with an irritated nose full
Another example is
Marinol, used to treat nausea in chemotherapy
patients. Marinol capsules contain a synthetic
version of the psychoactive chemical in cannabis
mixed with sesame oil, which is hard to remove. That
means, in other words: "Smoking it is disgusting and
tastes like a bowl full o'seed".
companies are starting to take the problem
seriously, says Nora Volkow of the National
Institute on Drug Abuse in Bethesda, Maryland. For
instance, Purdue Pharma is reformulating OxyContin
to make it less easy to tamper with. Novartis, which
makes Ritalin, an ADHD drug that some people take
recreationally, has also developed a one-a-day
Ritalin tablet that parents can give their children
before they go to school, so there is less risk of
the drug falling into the wrong hands in
"We have a role to
play, but we're not the only ones," says Chris
Lewis, a spokesman for Novartis, who believes that
society as a whole should be doing more to educate
people about the hazards of misusing prescription
drugs. He stresses that the company makes sure
doctors are fully aware of the drug's uses and
Some industry experts
question whether tamper-proofing is the best route.
"We make medicines in the most palatable and
effective form for the patients who need it - that
is our responsibility," says Richard Ley, a
spokesman for the Association of the British
Pharmaceutical Industry. He says making drugs
tamper-proof would make them more expensive for
patients and health services, and delay the
marketing of vital new medicines.
That view is
understandable, says Volkow. But she argues that
prescription drug abuse is now so out of control in
the US that cooperation from pharmaceutical firms is
essential. "We have an urgent problem that needs to
be stopped. In our high-school surveys of kids aged
12 to 18, 10 per cent have tried opiates for
non-medical reasons - it's gigantic."
Recipe for abuse
document a bewildering range of recipes for
tampering with prescription drugs. For example,
users of some online forums recommend snorting
oral amphetamines and drugs to treat attention
deficit hyperactivity disorder. This defeats the
tablets' sustained-release mechanisms and
delivers a faster, more intense hit.
Users have also
twigged that they can manipulate the absorption
rate of prescription amphetamines by mixing them
with chemicals that alter their pH. The drugs
can be addictive, and very high doses can raise
blood pressure and cause dangerous heart
abused prescription drugs are tranquillisers,
which recreational users frequently mix with
other drugs, taking a tranquilliser to combat a
cannabis-induced panic, for instance. Long-term
use can lead to physical dependence and
The most commonly
abused prescription drugs are opioid
painkillers. Most misusers take these drugs
orally, but some people snort them. Websites
also detail ways to "purify" the narcotic
component by dissolving the tablets. These drugs
are addictive, while a large single dose can
cause severe respiratory problems and death.
- Drug companies
could use a variety of chemical tricks to
tablets harder to crush can prevent users
snorting or injecting them.
add a substance that blocks any psychoactive
hit if the user snorts or injects a drug.
To prevent people
"purifying" the narcotic component by
dissolving the drug, manufacturers could
design tablets that turn into a useless jelly
They could add a
waxy coating or matrix that traps the drug if
someone tries to extract it through heating.
In some cases,
just a nasty flavour or dye might be enough to
discourage all but the most hardened drug