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A 2010 effort to deter opioid abuse led to a surge in heroin overdoses, according to a new working paper in NBER. The painkiller OxyContin was reformulated in 2010, and while it became harder to abuse, "each prevented opioid death was replaced with a heroin death," the paper says.

Expand chart
Adapted from Evans et. al., 2018,  "How the Reformation of OxyContin Ignited the Heroin Epidemic", The National Bureau of Economic Research; Note: "Opioids" includes all opioid related deaths aside from those that are exclusively attributed to heroin; Chart: Axios Visuals

Why it matters: This underlines yet another reason why the opioid epidemic is so difficult to address. Even common-sense solutions may have unintended consequences.

More from the paper:

  • The Food and Drug Administration "has promoted the development of abuse-deterrent opioids ... Despite the enthusiasm for [abuse-deterrent formulations], our results suggest that the benefits of the reformulation are easily undone when there are readily-available substitutes."

The FDA's response: “The lowest cost substitute for individuals suffering from substance use disorder is often street drugs like heroin, or increasingly synthetic fentanyl products being shipped into the U.S. from other countries. Abuse deterrent formulations are not a silver bullet solution to the opioid crisis," FDA Commissioner Scott Gottlieb said.

  • This, he said, is why the agency has been pushing so hard for more funding and resources dedicated to its work at international mail facilities, as illegal opioids increasingly arrive to the U.S. in the mail.

Data note: While the authors argue that there "appears to have been one-for-one substitution of heroin deaths for opioid deaths" after the 2010 reformulation, the raw numbers seem to show more fluctuation. I asked the researchers why:

  • "From 2004-August 2010, you get a relatively steady increase. Then from August 2010 through the end of 2013, things are flat or decreasing slightly," said Ethan Lieber, an economics professor at the University of Notre Dame.
  • "We do see a rise in opioid death rates starting at the end of 2013, but that's due to a separate event, the adulteration of opioids and heroin with fentanyl (which makes using these things far more dangerous) ... Prior to fentanyl, opioid death rates appeared to have leveled off."

Go deeper

Congress plots COVID pandemic-era office upgrades

oving crates outside Rep. Elise Stefanik's old office Tuesday. Photo: Bill Clark/CQ-Roll Call, Inc via Getty Images

The House plans to renovate members' suites even though staff are worried about an influx of contractors and D.C. is tightening restrictions on large gatherings, some staffers told Axios.

Why it matters: The Capitol has been closed to public tours since March. Work over the holiday season comes as U.S. coronavirus cases spike, Americans beg for more pandemic assistance and food lines grow.

Trump pressures Barr to release so-called Durham report

Bill Barr. Photo: Jabin Botsford/The Washington Post via Getty Images

President Trump and his allies are piling extreme pressure on Attorney General Bill Barr to release a report that Trump believes could hurt perceived Obama-era enemies — and view Barr's designation of John Durham as special counsel as a stall tactic, sources familiar with the conversations tell Axios.

Why it matters: Speculation over Barr's fate grew on Tuesday, with just 49 days remaining in Trump's presidency, after Barr gave an interview to the Associated Press in which he said the Justice Department has not uncovered evidence of widespread fraud that could change the election's outcome.

CDC to cut guidance on quarantine period for coronavirus exposure

A health care worker oversees cars as people arrive to get tested for coronavirus at a testing site in Arlington, Virginia, on Tuesday. Photo: Olivier Douliery/AFP via Getty Images

The CDC will soon shorten its guidance for quarantine periods following exposure to COVID-19, AP reported Tuesday and Axios can confirm.

Why it matters: Quarantine helps prevent the spread of the coronavirus, which can occur before a person knows they're sick or if they're infected without feeling any symptoms. The current recommended period to stay home if exposed to the virus is 14 days. The CDC plans to amend this to 10 days or seven with a negative test, an official told Axios.

  • The CDC did not immediately respond to a request for comment.

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