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. - --- MAP posted-by: Jay Bergstrom