RACHEL MARTIN, HOST:
Every day, according to the Centers for Disease Control, 44 Americans die because they have overdosed on prescription painkillers. The CDC calls it an epidemic, and drug companies are responding by trying to develop versions of the most addictive painkillers, opioids, that will diminish a user's physical craving for the medicine. Now, to do this, to create these less addictive drugs, pharmaceutical companies are recruiting thousands of self-identified drug users to test their products. David Crow is a reporter for the Financial Times. He's just published a big report on this, and he joins me now to talk more about it. Thanks so much for being with us.
DAVID CROW: Thanks for having me.
MARTIN: Opioids, as we mentioned, are the worst in terms of their addictive quality. These companies are trying to come up with drugs that will achieve the same painkilling effect without the addictiveness. So this is actually possible?
CROW: What they're trying to do is develop a new generation of opioid painkillers that have features that make them harder to abuse. Some of the strategies that have been pursued include hard shells that make it harder to crush up the pill so that you can snort it or gumming agents that make it harder to put into a syringe so that you can inject it. And some companies are experimenting with putting different chemicals in the center of the pill that will remain dormant. But if it's tampered with, that chemical would be released, and it would counteract the effect of the opioid.
MARTIN: All right. So let's get to the clinical trials. Who are they testing these drugs on? And what's the screening process like?
CROW: OK, so they're testing these drugs on recreational drug users. And the participants go through a screening process where they have to wash out, where they don't have any opioid in their system, and also where they're given a drug called naloxone, which cuts off the effects of opioids. And at that point, if you were addicted or physically dependent, your body would show signs of withdrawal. And that is the screening process.
MARTIN: How often do they end up taking these pills? What's the setting? Are they supervised?
CROW: So basically, the process is this. You go into a clinic where you stay. They provide you with accommodation. To begin with, you wash out. And you fast before you do the trials. And then you start taking the drugs. You'll be given three pills. You won't be told what they are. You'd be given the abuse deterrent pill. You'd be given the existing opioid, the drugs that are so easy to abuse today. And you'd be given a placebo. And then, over the course of the study, you'd be asked to rate them on a drug-liking scale. How much did you enjoy this? And, of course, the aim of these new abuse deterrent opioids is to get a lower score. And then they take this evidence to the regulator, to the FDA. And they say, look, this is less easily abused. Take that off the market, and start selling our drug instead.
MARTIN: Does that mean they are satisfied that these new drugs do the work they're actually supposed to do? They actually diminish pain; they just do it whilst not making somewhat addicted to the drug.
CROW: All these drugs really do is make it harder to abuse them. But there are several flaws. Firstly, while a hard shell that withstands sort of crushing up with a hammer or something might fool the casual recreational drug user on a Friday night, they're not going to stop a sort of "Breaking Bad"-style drug dealer with a knowledge of chemistry and a laboratory in their basement. The other big problem is that a lot of abuse isn't through these methods where you have to tamper the pill. About 90 percent of opioid abuse is actually oral.
MARTIN: So if there are still these outstanding questions about these new drugs, how much of this is actually about creating a different public reputation for pharmaceutical companies who've been under a lot of pressure because of the rates of addiction when it comes to prescription drugs?
CROW: I mean, not just their reputation but also their revenues. This is a very big opportunity for the drug companies, who get to take products that are very cheap at the moment, to reengineer them in some way, and then to start selling them for sort of four or five times what they cost at the moment. There are many doctors who say that this is just completely the wrong approach. And these doctors argue that actually what is needed is an overhaul, a complete change in approach to how opioids are prescribed.
MARTIN: David Crow with the Financial Times. Thanks so much for talking with us.
CROW: Thanks a lot. Transcript provided by NPR, Copyright NPR.