In 2010, Purdue Pharma replaced the original version of OxyContin, an extended-release oxycodone pill, with a reformulated product that was much harder to crush for snorting or injection. The reformulation of OxyContin was instead associated with an increase in deaths involving illicit opioids and, ultimately, an overall increase in fatal drug overdoses. Researchers ... found that death rates rose fastest in states where reformulation would have had the biggest impact. A new study by RAND Corporation senior economist David Powell extends those findings by showing that the reformulation of OxyContin also was associated with rising suicides among children and teenagers. 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. 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."