The Blue Ox

Have you every heard of Kicker, OC, Oxy, OX, Blue, Oxycotton,  or Hillybilly Heroin?

The National Drug Intelligence Center defines OxyContin®, as a trade name for the narcotic oxycodone hydrochloride, a painkiller (Schedule 11 controlled drug) available in the United States only by prescription. OxyContin is legitimately prescribed for relief of moderate to severe pain resulting from injuries, bursitis, neuralgia, arthritis, and cancer. Today, it is the most frequently prescribed opioid pain killer in North America. But, other individuals illegally abuse OxyContin for the euphoric effect it produces--an effect similar to that associated with heroin use.

Oxycodone is abused for its opiate-like effects. In addition to its equipotency to morphine in analgesic effects, it is also equipotent to morphine in relieving abstinence symptoms from chronic opiate (heroin, morphine) administration. For this reason, it is often used to alleviate or prevent the onset of opiate withdrawal by street users of heroin and methadone.

The Poor Man's Heroin

According to research by the National Institute of Mental Health, "OxyContin Diversion and Abuse," www.drug-addiction.com, 2003), OxyContin is designed to be swallowed whole; however, abusers ingest the drug in a variety of ways. Abusers often chew the tablets or crush the tablets and snort the powder. Because oxycodone is water soluble, crushed tablets can be dissolved in water and the solution injected. The latter two methods lead to the rapid release and absorption of oxycodone.

The alcohol and drug treatment staff at the Mountain Comprehensive Care Center, Prestonsburg, Kentucky, reported, "Individuals who have never injected drugs are using OxyContin  intravenously and they have never seen a drug 'proliferate like OxyContin has since May 2000.'" The staff at this center has over 90 cumulative years' experience conducting drug evaluations.

Since OxyContin and heroin are reported to have similar effects, both drugs are attractive to the same abuser population. OxyContin is sometimes referred to as "poor man's heroin," despite the high price it commands at the street level. A 40 mg tablet of OxyContin by prescription costs approximately $4 or $400 for a 100-tablet bottle in a retail pharmacy. Street prices vary depending on geographic location, but generally OxyContin sells for between 50 cents and $1 per milligram. Thus, the same 100-tablet bottle purchased for $400 at a retail pharmacy can sell for $2,000 to $4,000 illegally.

OxyContin is, however, relatively inexpensive for those covered by health insurance, since the insurance provider covers most costs associated with doctor visits and the prescription. Unfortunately, many OxyContin abusers whose health insurance will no longer pay for prescriptions and who cannot afford the high street-level prices are attracted to heroin. Here is some information from the U.S. Department of Justice about Oxy deaths:

"February 14, 2002, DEA has received 1,304 complete ME reports on OxyContin deaths from 32 states. Contrary to some reports, the documented evidence clearly shows that only 19% of the OxyContin deaths can be verified to be the result of a alcohol-drug interaction. Important also is the fact that only nine (9) deaths were associated with the presence of a "recent injection site", and only one death associated with snorting the drug; the vast majority of deaths have been associated with oral consumption of the drug.

"An additional caveat must be made regarding standard OxyContin treatment regimens as they apply to poly-drug use....Incident pain may occur as a result of the performance of normal activities of daily living, physical therapy, or simply ambulation to the physician’s office for treatment. Rescue medications are suggested to be immediate-release opiate formulations either alone or in combination with acetaminophen, aspirin, or other non-steroidal anti-inflammatory drugs (NSAID’s). These would include drugs like Vicodin®, Lortab®, Percodan®, Ketoprofen®, etc. The manufacturer’s product information clearly states, 'Food has no significant effect on the extent of absorption from OxyContin.' There is no adverse reaction notification for the co-administration of OxyContin and nicotine from cigarette smoking or with caffeine – a psychoactive drug found in many food products, including coffee. 

"By these treatment designs a "normal" patient receiving a standard OxyContin prescription regimen approved by the Food and Drug Administration may be a poly-drug user. One treatment strategy recommended for 'chronic pain' patients is the co-administration of opioids with anti-depressants – again, a treatment strategy, by its design, results in polydrug usage. With these facts in mind it was not surprising to find that many of the OxyContin deaths were associated with polydrug toxicologies. This does not minimize the significance of the role of OxyContin in these deaths....DEA can verify 146 deaths in which OxyContin was the direct 'cause of' or a contributing factor to the deaths; an additional 318 deaths lacking acetaminophen and/or salicylates in the toxicology findings most likely involved OxyContin, as well." (U.S. Department of Justice, Drug Enforcement Administration, Office of Diversion Control, 2002)

  
Who Uses OxyContin?

Oxycodone products have been illicitly abused for almost the last 40 years. (Drug Enforcement Administration, Congressional Testimony, Statement by Terrance W. Woodworth, Deputy Director, Officer of Diversion Control, Before the House Committeee on Energy and Commence, Subcommittee on Oversight and Investigations, August 28 2001)

Individuals of all ages abuse OxyContin--data reported in the National Household Survey on Drug Abuse indicate that nearly 1 million U. S. residents aged 12 and older used OxyContin nonmedically at least once in their lifetime.(National Drug Intelligence Center, www.justice.gov, Department of U.S. Justice) 

OxyContin abuse among high school students is a particular problem. Some studies say more than 3.5 million Americans over the age of 12 have reported using OxyContin on a regular basis. (Reported by Jill Gonzalez,
www.oxycontinabuse.com, 2007)

"Four percent of high school seniors in the United States abused the drug at least once in the past year," according to the University of Michigan's Monitoring the Future Survey. (National Drug Intelligence Center, www.justice.gov, Department of U.S. Justice, 2004) The 2005 MTF Survey shows annual use of OxyContin by 12th graders has risen from 4.0 percent in 2002 to 5.5 percent in 2005. (National Drug Intelligence Center, National Drug Threat Assessment, 2006) 

The abuse of a new sustained-release formulation of oxycodone, known as OxyContin7, has escalated over the last year. Drug abuse treatment centers, law enforcement personnel, and health care professionals have reported a dramatic increase in the abuse of these sustained release products in Maine, Virginia, West Virginia, Ohio, Kentucky and Maryland. Recently, abuse has spread to other states such as Pennsylvania and Florida.The number of Emergency Department episodes more than tripled from 1996 to 2000: 3,190 episodes in 1996 to 10,825 in 2000.
("What Is OxyContin?" www.prescription-drug-rehab.com, Narconon Vista Bay, 2009)

 
Efforts To Control the Problem

OxyContin is frequently made more available by "doctor shopping," where individuals, who do not have a legitimate illness, repeatedly visit many doctors to acquire large amounts of controlled substances. Other methods of obtaining oxyContin include pharmacy diversion, robbery, fake/stolen prescription, the internet and improper prescribing practices by physicians.

Here are the most common means of OxyContin Diversion: (Drug Enforcement Administration Office of Diversion Control

• Fraudulent prescriptions
  
• Doctor shopping
  
• Over-prescribing
  
• Pharmacy theft
  
• Organized rings of individuals diverting and selling OxyContin
• Foreign diversion and smuggling into the U.S.

Enforcement & Intelligence

Focus existing resources on investigations of illicit sales and abuse of OxyContin

• Investigate pharmacy thefts with other law enforcement agencies.
  
• Identify large volume purchasers.
  
• Participate in Healthcare Fraud Working Groups.
  
• Work with international organizations.

Regulatory & Administrative

• Utilize the full range of DEA’s authority to restrict abuser access to OxyContin.
• Work closely with the FDA urging reformulation to reduce abuse potential.

Seek Industry Cooperation

• Encourage Purdue Pharma to develop a balanced market strategy.
• Solicit support in providing educational programs.

So, Is There An Answer?

Despite all the increased efforts by the FDA, DEA, and state/local authorities such as better record keeping by pharmacies and physicians, and some states' banning of the drug over the internet, the illicit use of OxyContin is at an all time high.

In a relatively new study (Deni Carise, Karen Dugosh, A. Thomas McLellan, Amy Camilleri, George Woody, and Keven Lynch; Am J Psychiatry 164:1750-1756, November 2007) found the following:

“One main finding of this study was that most of the OxyContin use reported in the sample of individuals seeking addiction treatment did not originate from physician prescriptions, but rather from illicit sources, such as family, friends, or other illegitimate sources. Clearly, the pharmaceutical opioid problems of the individuals in this sample were part of a larger pattern of alcohol and other drug use—the problems were not “accidental,” secondary to prescribed use for pain or other medical problems. These results also suggest that those who suffer from OxyContin abuse or dependence share many characteristics with those who are dependent on other classes of drugs.”

The study also found that among those who abused OxyContin, 51% had experienced symptoms of depression in the past 30 days, and 36% had chronic medical problems. The study suggests that psychiatric problems are some of the strongest predictors of OxyContin abuse. Maybe, the finger for Oxy abuse should point in some new directions. Not only a microscopic investigation into pill clinics may be required to help solve the problem, but also mirrors into the family medicine cabinet and into family social practices may be helpful.