MORE ABOUT OXYCONTIN ®

Abuse and diversion of the prescription pain reliever OxyContin ® are serious problems in certain areas of the United States, particularly in the East. In 1996, OxyContin ® was introduced as a longer lasting dosage of oxycodone, which is prescribed for the treatment of moderate to severe pain. Since 1996, Drug Abuse Warning Network (DAWN) data indicate an increasing number of emergency department mentions and deaths associated with oxycodone. The growing abuse of OxyContin ®, commonly known as Oxy’s, OC’s, Killers, Poor Man’s Heroin, and Hillbilly Heroin, is leading to an increase in burglaries, thefts, and robberies of residences and pharmacies.

Law enforcement officials have been monitoring oxycodone products for abuse and diversion over the last 30 years. Currently, these officials are taking action to control the illicit distribution of OxyContin ® nationwide. The Drug Enforcement Administration (DEA), Food and Drug Administration (FDA), U.S. Attorneys, and state and local authorities recognize the problem and are working to limit diversion and abuse of this potentially dangerous drug.

BACKGROUND

OxyContin ® is a tradename for the narcotic oxycodone hydrochloride (HCl), an opiate agonist. Oxycodone, a semisynthetic opioid derived from the opioid alkaloid thebaine, is similar to codeine, methadone, and morphine in producing opiate-like effects. Oxycodone is a Schedule II drug under the Controlled Substances Act because of its high propensity to cause dependence and abuse.

Oxycodone is the active ingredient in a number of other commonly prescribed pain relief medications such as Percocet, Percodan, and Tylox. These medications contain oxycodone in smaller doses and are combined with other active ingredients like aspirin or acetaminophen. OxyContin ® contains oxycodone in various dosage strengths as the only active ingredient. These formulations are designed for a controlled release of the drug to minimize the total number of tablets a patient must take for around-the-clock pain relief. OxyContin ’s intended application is the relief of moderate to severe pain of long duration, such as pain caused by rheumatoid arthritis and cancer.

OxyContin ®, marketed in 1996 by Purdue Pharma L.P., was the first product capable of giving 12 hours of pain relief, making it the longest lasting oxycodone product on the market. OxyContin ® was initially available in 10-, 20-, and 40-milligram (mg) strengths. In 1997, an 80-mg tablet was introduced and later followed by a 160-mg tablet in 2000.¹ Purdue Pharma L.P. also produces OxyFast, an immediate release liquid formulation containing 20-mg of oxycodone. Other pain medications such as Percocet, Percodan, and Percodan-Demi, which contain 5, 4.5, and 2.25 mg of oxycodone respectively, only provide short periods of pain relief (4 to 6 hours) and have to be taken at repeated intervals.

Beginning in 1996, the first full year it was marketed, the number of OxyContin ® prescriptions rose to approximately 5.8 million prescriptions in 2000. This makes OxyContin ® the number-one prescribed Schedule II narcotic in the United States. Prescriptions dispensed for all other common opiod analgesics such as codeine, hydrocodone, morphine, and hydromorphone have risen 23 percent during this same period.

EFFECTS

OxyContin ® is prescribed for the management of moderate to severe pain. Normal side effects include nausea, drowsiness, constipation, and, to a lesser extent, dizziness, headache, vomiting, and sweating. An acute overdose of oxycodone may cause drowsiness, skeletal muscle flaccidity, cold and clammy skin, constricted pupils, bradycardia (slow heartbeat), hypotension, respiratory depression, coma, and death.

ABUSE

Geographic Areas of Abuse

Abuse of OxyContin ® in rural Maine, Kentucky, Virginia, and West Virginia brought national attention to this problem. Law enforcement personnel, pharmacists, and drug abuse treatment centers report the abuse of OxyContin ® primarily in the eastern portion of the United States; however, the problem is spreading throughout the United States. The areas most currently affected by OxyContin ® abuse are eastern Kentucky; New Orleans, Louisiana; southern Maine; Philadelphia and southwestern Pennsylvania; southwestern Virginia; Cincinnati, Ohio; and Phoenix, Arizona.

At the request of the DEA, the American Methadone Treatment Association asked its members and all state methadone authorities to provide any available information regarding the number of patients seeking treatment for OxyContin ® abuse, as compared to those admitted for abuse of other licit and illicit drugs for the first half of 2001.

• Kentucky – Representatives from the Cumberland River Comprehensive Care reported that 120 of its 295 admissions (40 percent) were related to OxyContin ®. The Mountain Comprehensive Care Center reported 204 of its 237 emergency room admissions (86 percent) were also related to OxyContin ®. In Frankfort County, 453 of 608 admissions (74.5 percent) were attributed to the abuse of OxyContin ®.
• Louisiana – The Center for Behavioral Health in Louisiana reported that 40 percent of new treatment admissions throughout the state were for the abuse of OxyContin ®.
• Maine – The Discovery House Clinic in Winslow reported that 37 of its 75 new drug treatment admissions (49 percent) were OxyContin ® related. The Discovery House Clinic in South Portland reported that 45 of its 150 new drug treatment admissions (30 percent) were also OxyContin ® related.
• Pennsylvania – Two narcotic treatment programs in southwestern Pennsylvania reported that 90 percent of all new admissions were OxyContin ® abusers.
• South Carolina – The Center for Behavioral Health in South Carolina reported that 30 percent of new treatment admissions throughout the state resulted from OxyContin ® abuse.
• Virginia – One narcotic treatment program in southwestern Virginia reported that 80 to 85 percent of its patient admissions were the result of OxyContin ® abuse.

According to the DEA Office of Diversion Control, as of November 1, 2001, medical examiners in 31 states have reported 1,096 overdose deaths involving oxycodone. Medical examiner reporting verified that 117 of these deaths were OxyContin ® related.

ILLICIT USE

OxyContin ® is designed to be administered orally in tablet form; however, many abusers chew the tablets or crush them and snort the powder to defeat the intended time-release action. However, most deaths appear to be the result of oral ingestion of the intact tablet. Injection also is possible, but it requires a preparation regimen similar to that of heroin. Such a regimen requires the removal of the tablet coating by either sucking on it or scraping it with the teeth or a razor blade, followed by melting the remainder on a spoon, adding water, and then injecting the solution. Snorting or injecting hastens the body’s absorption of OxyContin ®.

Individuals abuse oxycodone to gain a euphoric high and to avoid the withdrawal symptoms associated with heroin. Because OxyContin ® contains large doses of oxycodone and produces opiate-like effects, it acts as a reasonable substitute for heroin; however, individuals do not necessarily need to be heroin addicts to become oxycodone abusers.

DAWN reports an increase in the number of oxycodone-related deaths and emergency room visits since 1996. The number of emergency room episodes more than tripled from 1996 to 2000, with approximately 10,825 episodes in 2000 compared to 3,190 in 1996.

From 1996 to 1999, the number of drug abuse deaths reported to DAWN that involved oxycodone more than quadrupled, with 268 deaths in 1999 compared to 51 in 1996.

Information compiled from Drug Enforcement Administration.