Pubdate: Mon, 08 Jun 2015
Source: Denver Post (CO)
Copyright: 2015 The Denver Post Corp
Contact:  http://www.denverpost.com/
Details: http://www.mapinc.org/media/122
Author: Electa Draper

RESEARCHER'S DRUG WEBSITE A WINDOW INTO OPIOID ABUSE

Name your poison - illicit prescription painkillers, heroin - and Dr. 
Richard Dart at Denver Health can tell you what it costs on the black market.

Or, thanks to him, you can look it up yourself.

Dart, director of the Rocky Mountain Poison and Drug Center, 
co-founded a website called StreetRx that allows buyers and sellers 
to anonymously report what price a pill of oxycodone, tramadol - or 
whatever - is going for in Denver or Chicago or New York.

"Did you get a good deal?" the site asks. "See what others paid."

At the same time, buyers and dealers who post their illegal 
activities also are making that information available to academics, 
law enforcement and the public. For more than a decade, the number of 
overdose deaths from prescription opioids climbed. It began to level 
off in 2011 and declined in 2012. Opioids are powerful painkillers 
including fentanyl and oxycodone. Heroin deaths, meanwhile, have been 
on the rise.

Five years after its inception - overcoming a slow start - StreetRx 
is seeing heavy traffic and creating an unexpected data cache for 
Dart and other researchers.

Dart believes the site is helping tamp down the nation's epidemic of 
prescription opioid abuse, which for the first time in decades is 
slackening nationwide and in Colorado.

In Colorado, the rate of calls to the poison center involving opioid 
abuse almost quadrupled between 2003 and 2010, Dart said. But since 
then, the rate has dropped to 44 percent of the peak 2010 level.

Colorado ranks 12th in the nation for "nonmedical use" of opioid 
painkillers, according to 2013 state statistics.

StreetRx helps officials understand market forces and even exploit 
them to make pills less popular. When the manufacturer of OxyContin 
reformulated the drug to make it difficult to snort or inject, its 
popularity and price dropped. That encourages other manufacturers and 
regulators to pursue the strategy.

"They changed the formula so you can't crush it easily," Dart said. 
"If you get it wet, it gets gummy. Not good for intravenous abuse, 
which delivers a drug more quickly and at greater strength. A drug 
taken orally is only partially absorbed. It was a huge success."

StreetRx, which sees about 2,500 unique visitors a day and is 
expanding into seven other countries, not only helps researchers and 
law enforcement officers track the market, it gives them insight into 
drug abusers, without tracing individuals. It shows which public 
policies are effective.

Drug poisoning, or overdose, is the leading cause of injury-related 
death in the U.S. In 2013 it killed 43,982 Americans - 16,235 of 
those deaths, or 37 percent, involved opioid painkillers, according 
to the Centers for Disease Control and Prevention.

Prescription drug overdoses killed about 35 Coloradans a month in 
2013, almost three times the number of alcohol-related driving deaths 
in the state.

In the never-ending search for new weapons in the drug war, Dart and 
some colleagues got the idea for StreetRx while chatting in a pub.

"I had been reading about crowdsourcing," Dart said. He and his 
scientist buddies thought it could work for illicit drugs.

So StreetRx was launched in 2010 by Epidemico, a disease-tracking 
computer informatics company set up by scientists from Harvard 
Medical School, the Massachusetts Institute of Technology and Boston 
Children's Hospital. StreetRx, which logs 200 to 250 price entries a 
month, also gives users links to treatment programs and drug-disposal sites.

"It's an interesting and novel data source - an innovative tool," 
said Dr. Caleb Alexander, director of the Johns Hopkins Center for 
Drug Safety and Effectiveness.

In a study currently under review, Alexander compared StreetRx prices 
of prescription drugs with pharmacy prices and volumes sold to 
examine how supply drives opioid demand and abuse.

Law enforcement uses the site's drug pricing to inform its undercover 
buying and selling.

"The biggest value for us is, if an undercover agent is posing as an 
addict or a dealer, he has to know what he should be offering to be 
credible," said Cmdr. John Burke, head of the Warren County Drug Task 
Force in southwest Ohio, a local, state and federal law enforcement 
team that makes about 200 street buys a year.

StreetRx is part of the Denver-based RADARS System - Researched 
Abuse, Diversion and Addiction-Related Surveillance. It's another 
Dartfounded nationwide database. It collects information from 
multiple sources on illegal uses of prescription drugs, which 
pharmaceutical companies are required to report to the Food and Drug 
Administration.

RADARS, a moneymaker because the pharmaceutical companies pay for the 
information, could have been a private business for Dart. Instead, he 
set it up to be owned and operated by the drug center, a division of 
the Denver Health and Hospital Authority, to track the public health plague.

In the U.S., the CDC reports, the drug-related death rate more than 
doubled, from 6.1 to 13.8 per 100,000 population, from 1999 to 2013. 
The death rate involving opioids almost quadrupled in the same period.

Yet Dart's findings, published in The New England Journal of Medicine 
in January, show that the trend flattened or slightly decreased from 
2011 through 2013. The CDC numbers show a similar trend. RADARS, 
which has a reporting lag of only three months compared with the 
CDC's delay of more than a year, saw the downturn continue through 2014.

"These findings suggest that the United States might be making 
progress in controlling the abuse of opioid analgesics," which 
include hydrocodone and oxycodone.

But it's like "squeezing the balloon," Dart said. If you apply 
pressure in one spot, the balloon bulges out somewhere else.

"If you make one drug harder to use, they switch," he said. "The 
catch is, heroin use is increasing."

Dart said all prescription painkillers should be formulated with 
abuse-deterrent features. The Food and Drug Administration has said 
the evolving science should be part of the plan.

Using data from a variety of sources, including StreetRx, Dart tracks 
availability of prescriptions, diversion to black markets, abuse 
statistics and mortality rates.

The flattening of opioid abuse likely can be attributed to hundreds 
of programs improving patients' and prescribers' awareness of risks, 
law enforcement shutting down pill mills, Medicaid/ Medicare 
tightening restrictions, manufacturers' use of abuse-deterrent 
measures, and pharmacies better monitoring doctor shopping and other abuses.

"It's great the trend is turning down," Dart said. "But we built up 
this big population who need treatment because we know that the 
number of people abusing opioids grew 20- to 30fold since the 1980s."

And the increase in heroin use, he said, means public health policy 
must adapt yet again.
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MAP posted-by: Jay Bergstrom