“The root cause of such perverse effects was the substitution that occurred after the old version of OxyContin was retired. Nonmedical users turned to black-market alternatives that were more dangerous because their potency was highly variable and unpredictable—a hazard that was compounded by the emergence of illicit fentanyl as a heroin booster and substitute. The fallout from the reformulation of OxyContin is one example of a broader tendency: Interventions aimed at reducing the harm caused by substance abuse frequently have the opposite effect.
From 1988 to 2010, Powell notes in the journal Demography, the suicide rate among 10-to-17-year-olds fell by 36 percent. That drop was “followed by eight consecutive years of increases—resulting in an 83% increase in child suicide rates.” Based on interstate differences in nonmedical use of OxyContin prior to 2010, Powell estimates that “the reformulation of OxyContin can explain 49% of the rise in child suicides.”
Since “the evidence suggests that children’s illicit opioid use did not increase,” Powell says, it looks like “the illicit opioid crisis engendered higher suicide propensities by increasing suicidal risk factors for children,” such as child neglect and “alter[ed] household living arrangements.” He notes a prior study that found “states more
affected by reformulation experienced faster growth in rates of child physical abuse
and neglect starting in 2011.” And he suggests the suicide rate may also have been boosted by “parental death and incarceration” associated with the shift from legally produced pharmaceuticals to illicit drugs.”