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OxyContin® is a prescription painkiller used for moderate to high pain relief associated with injuries, bursitis, dislocations, fractures, neuralgia, arthritis, lower back pain, and pain associated with cancer.(1) OxyContin® contains oxycodone, the medication's active ingredient, in a timed-release tablet. Oxycodone products have been illicitly abused for the past 30 years.(2) Oxycodone is a Schedule II narcotic analgesic and is widely used in clinical medicine. It is marketed either alone as controlled release (OxyContin®) and immediate release formulations (OxyIR®, OxyFast®), or in combination with other nonnarcotic analgesics such as aspirin (Percodan®) or acetaminophen (Percocet®). The introduction in 1996 of OxyContin®, commonly known on the street as OC, OX, Oxy, Oxycotton, Hillbilly heroin, and kicker, led to a marked escalation of its abuse as reported by drug abuse treatment centers, law enforcement personnel, and health care professionals. Although the diversion and abuse of OxyContin® appeared initially in the eastern US, it has now spread to the western US including Alaska and Hawaii. Oxycodone-related adverse health effects increased markedly in recent years. In 2004, Food and Drug Administration (FDA) approved for marketing generic forms of controlled release oxycodone products.(3)
Oxycodone products are in Schedule II of the federal Controlled Substances Act of 1970.(4)
Kicker, OC, Oxy, OX, Blue, Oxycotton, Hillybilly Heroin
Pharmacological effects include analgesia, sedation, euphoria, feelings of relaxation, respiratory depression, constipation, papillary constriction, and cough suppression. A 10 mg dose of orally-administered oxycodone is equivalent to a 10 mg dose of subcutaneously administered morphine as an analgesic in a normal population. Oxycodone’s behavioral effects can last up to 5 hours. The drug is most often administered orally. The controlled-release product, OxyContin®, has a longer duration of action (8-12 hours).(5) The most serious risk associated with opioids, including OxyContin®, is respiratory depression. Common opioid side effects are constipation, nausea, sedation, dizziness, vomiting, headache, dry mouth, sweating, and weakness. Taking a large single dose of an opioid could cause severe respiratory depression that can lead to death.(6)
As with most opiates, oxycodone abuse may lead to dependence and tolerance. Acute overdose of oxycodone can produce severe respiratory depression, skeletal muscle flaccidity, cold and clammy skin, reduction in blood pressure and heart rate, coma, respiratory arrest, and death.(7) Chronic use of opioids can result in tolerance for the drugs, which means that users must take higher doses to achieve the same initial effects. Long-term use also can lead to physical dependence and addiction -- the body adapts to the presence of the drug, and withdrawal symptoms occur if use is reduced or stopped. Properly managed medical use of pain relievers is safe and rarely causes clinical addiction, defined as compulsive, often uncontrollable use of drugs. Taken exactly as prescribed, opioids can be used to manage pain effectively.(8)
Pharmaceuticals such as OxyContin® can be diverted in many ways. The most popular form is known as "doctor shopping," where individuals, who may or may not have legitimate illnesses requiring a doctor's prescription for controlled substances, visit many doctors to acquire large amounts of controlled substances. Other diversion methods include pharmacy diversion and improper prescribing practices by physicians.(9)
According to Monitoring the Future (MTF), rates of nonmedical use of prescription painkillers are relatively high among teenagers and include a significant increase in the abuse of OxyContin® among twelfth graders (see Appendix B of the 2006 National Drug Threat Assessment, Table 1 and Table 2).(10) The 2005 MTF shows annual use of OxyContin® by 12th graders has risen from 4.0 percent in 2002 to 5.5 percent in 2005. OxyContin® use has remained more stable in the lower grades since 2002, with 1.8 percent of 8th-graders and 3.2 percent of 10th-graders reporting annual use in 2005.(11)
Many States have launched efforts to curb the illegal use of OxyContin®. Louisiana, Maine, Virginia, Kentucky, Pennsylvania, and Tennessee have enacted legislation to deal with this issue. California, Hawaii, Idaho, Illinois, Indiana, Kentucky, Massachusetts, Michigan, Nevada, New Mexico, New York, Oklahoma, Rhode Island, Texas, Utah, and Washington have established prescription monitoring programs. Many more States are working to establish legislation and prescription monitoring programs to deal with diverted pharmaceuticals.(12)
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1. National Drug Intelligence Center, Information
Bulletin: OxyContin® Diversion
and Abuse, January 2001 Last updated: August 2006 |
