In Pain: A Bioethicist's Personal Struggle with Opioids

by Travis Rieder

In the case of OxyContin, Purdue’s label included the following peculiar claim: “Delayed absorption as provided by OxyContin tablets, is believed to reduce the abuse liability of a drug.” The reasoning in support of such an idea appears to have been something like the following: addiction is a result of the brain being trained to pursue a certain habit; and habits are reinforced as a result of how immediate and intense the reward from some activity is, and how regularly one engages in the activity. OxyContin, it was suggested, produces fewer and less intense “highs” by slowly releasing the opioid payload over time. This feature prevents the need to redose regularly, while also reducing the rapid, sharp upswings in drug levels making it to one’s brain. In short, taking an extended-release pill is less intensely and less immediately rewarding, and it can be done less often.