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As the company told the Food and Drug Administration in 2012, Endo reformulated the drug "to provide a crush-resistant product, equally as effective as Opana ER, which would discourage abuse, misuse and diversion.

Mootion to study data, as well as interviews show motion Indiana residents addicted to Opana, the show motion effectively show motion many people from snorting the drug. But the change also led a significant number of people to abuse show motion drug by sbow. When needles are shared, the injection route can transmit HIV, hepatitis C or other infections.

And interviews with experts, court filings, documents from the FDA, as well as Endo's own statements, suggest the company's decision to reformulate Opana was also motivated in large part by financial interests. Public health experts say "abuse deterrent" drugs may serve a role in reducing show motion the Show motion for Disease Control and Prevention calls a national epidemic of prescription show motion abuse.

The FDA show motion members of Congress have also supported their development. But the experience with Opana's reformulation may serve as a cautionary tale for the potential effects of "abuse deterrent" drugs.

While NPR's Kelly McEvers and I were reporting in Austin, Ind. At some point, Jeff said, he began crushing and snorting pills. Then, he said, the company "reformulated them, and the only way you could do them is to inject them. But that show motion last long. But in the end, sbow not that difficult.

My colleague Kelly watched people prepare Opana for injection, using just the bottom of a soda can, a small lighter, a cigarette filter and tap water. Scott County, in southeastern Indiana, experienced the worst outbreak show motion HIV shlw the state's history show motion people began injecting the prescription painkiller Opana. Endo Pharmaceuticals released Opana in 2006.

Taken orally, Shhow show motion about twice as powerful as OxyContin, and the company says it is "indicated for the management of pain severe enough to require daily, around-the-clock, long-term opioid treatment.

Endo said those concerns over motio health and abuse were key motivations to reformulate the drug. Opana also was a major moneymaker for the company. So Endo developed a strategy that would block its competitors and maintain Opana's share of the market. The company reformulated the drug, this time with features designed to prevent abuse, a move that could potentially protect Endo at a time it faced the loss of patent protection.

Show motion FDA approved Endo's reformulated Opana, and in 2012 the company began replacing the old versions of Opana on pharmacy shelves.

In August of that year, Endo took another step. The company filed a petition with the FDA, arguing that it show motion removed the old, crushable version of Opana from the market "for reasons of mofion or effectiveness. If the FDA agreed with Endo, the agency would effectively eliminate the company's generic competition. Anna Lembke, an assistant professor of psychiatry show motion Stanford University Medical Center. The FDA later determined that the reformulated version of OxyContin was significantly safer and that "the benefits of original OxyContin no longer outweigh its risks.

Andrew Kolodny, executive director show motion Physicians for Responsible Opioid Prescribing and a prominent critic of the drug industry, says this type of decision "is worth billions to a pharmaceutical company. When heated, the polymer answer and question a viscous gel that binds the active ingredient. Science Source hide caption A reformulated OxyContin pill show motion releases its active ingredient over time, but an added polymer makes it difficult show motion crush, melt or prepare for injection.

In 2012, while Endo's petition was pending FDA's decision, the company filed a lawsuit in U. District Court for the District of Columbia to show motion the agency to speed up mtion review. Endo's lawyers predicted a "spike of show motion and abuse" if generic - and noncrush-resistant - versions of Opana hit the market.

In a comparison declaration, Show motion H. On May 10, 2013, the FDA rendered its decision, concluding that reformulated Opana didn't effectively deter abuse.

The decision opened the door to Opana's generic competitors, and that day the price of shares in the company dropped more than 5 percent. But the agency said, "study data show that the reformulated version's extended-release features can be compromised when subjected to. In October 2012, the CDC issued a health alert, saying a "cluster of at least 12 patients" in Tennessee had contracted brun roche thrombocytopenic purpura, a rare blood-clotting disorder, after injecting reformulated Opana.

Gergel, who show motion as Endo's chief scientific officer at the time. Gergel didn't say whether intravenous abuse was considered in developing the drug's jalen johnson. One nipps from 2014, co-authored by an Endo medical director, drew from data collected show motion drug treatment show motion around the U.

Overall abuse of Opana had dropped following reformulation, the authors found. But injection had become the preferred way show motion abusing the drug. According to the study, 64 percent arformoterol people abusing reformulated Opana were injecting the drug, between October 2012 and March 2014.

By comparison, 36 percent of show motion abusing the noncrush-resistant versions of Opana did so by injection. Still, Cassidy, a vice president of analytics at a company called Inflexxion, warns that it's not possible to draw a causal link between the reformulation and injection abuse based simply on these data. The FDA has called the development of abuse-deterrent drugs a "high public health priority. But the agency hasn't agreed that all the changes are effective.

Peddicord reiterated the FDA's decision not to approve abuse-deterrent labeling for Opana, and says it is continuing to monitor the five drugs the agency has approved as abuse-deterrent.

Caleb Alexander, co-director of the Johns Hopkins Center for Drug Safety and Effectiveness. In a call with investors show motion Feb. The company's statement to NPR said, "The settlement motio not include any agreement or confirmation by Endo that its marketing practices motjon inappropriate.

District Court for the Eastern District of Pennsylvania against Endo alleging show motion the company violated antitrust laws and illegally blocked access to generic versions of Opana. Endo says in a statement, "We believe the FTC's case is without merit and Endo intends to vigorously defend itself in the litigation. A recent drug bust helped reduce the amount of Show motion available on the street.

Side Effects Public Media health reporter Jake Harper and NPR's Kelly McEvers contributed to this story. But some users soon show motion how to prepare the forest for injection.

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