Title:

Intelligence Bulletin:
OxyContin Diversion, Availability, and Abuse

Publication Date: August 2004

Document ID: 2004-L0424-017

This report provides an assessment of OxyContin diversion and abuse in the United States.

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Contents

Overview

Diversion

Availability

Abuse

Outlook

Sources

List of Maps

Map 1. Regions.

NDIC.

Overview

The prescription drug OxyContin contains the narcotic oxycodone hydrochloride and is available in controlled-release tablets of 10, 20, 40, and 80 milligrams. OxyContin is prescribed in the United States to treat moderate to severe pain and is abused for its heroin-like effects. The diversion and abuse of OxyContin have increased sharply since the drug became available in 1996, raising concerns among law enforcement and public health agencies.

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Diversion

Most OxyContin abused in the United States is diverted by illegally written or forged prescriptions, "doctor shopping" (when individuals, who may or may not have a legitimate ailment, visit numerous doctors to obtain drugs in excess of what should be prescribed legitimately), and theft. According to law enforcement reporting, the availability of diverted OxyContin may be stabilizing and has decreased in some areas. The theft of OxyContin dosage units increased from 260,688 (791 incidents) in 2000, to 519,597 (1,228 incidents) in 2001, to 587,168 (1,479 incidents) in 2002, but decreased to 464,312 (1,251 incidents) in 2003, according to the Drug Enforcement Administration (DEA). OxyContin abusers also steal or buy OxyContin from friends or family members with legitimate prescriptions who often are prescribed a 30-day supply of the drug.

National Drug Intelligence Center (NDIC) National Drug Threat Survey 2003 (NDTS) data also indicate that OxyContin is frequently diverted. Nationally, NDTS 2003 data indicate that 67.0 percent of state and local law enforcement agencies report that OxyContin is commonly diverted and abused in their areas--a higher percentage than any other pharmaceutical drug. A higher percentage of state and local law enforcement agencies in the Southeast region report that OxyContin is commonly diverted and abused in their areas (83.9%) than agencies in the Northeast/Mid-Atlantic (75.0%), Great Lakes (65.4%), West Central (61.8%), Pacific (56.9%), and Southwest (28.6%) regions.

The price of diverted OxyContin varies. DEA drug price data indicate that diverted OxyContin typically is sold for $1 per milligram. For example, a 40-milligram OxyContin tablet typically sells for $40; however, the price may vary depending on availability and other factors.

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Availability

OxyContin is prevalent in every region of the country. However, law enforcement reporting indicates that the availability of diverted OxyContin may be stabilizing and has decreased in some areas. For example, law enforcement reporting indicates that OxyContin availability has decreased in areas covered by the Appalachia High Intensity Drug Trafficking Area (HIDTA) and DEA Field Divisions in Detroit, Miami, and Philadelphia. Nevertheless, NDTS 2003 data reveal that 67.0 percent of state and local law enforcement respondents nationwide report that OxyContin is a commonly diverted or illicitly used pharmaceutical in their areas--higher than any other prescription narcotic including Percocet (52.2%), codeine (50.4%), Percodan (44.6%), and Dilaudid (27.5%). More agencies in the Southeast (83.9%), Northeast/Mid-Atlantic (75.0%), Great Lakes (65.4%), West Central (61.8%), and Pacific (56.9%) regions report that OxyContin is a commonly diverted or illicitly used pharmaceutical than in the Southwest (28.6%) region.

Map 1. Regions.

d-link

The total amount of diverted OxyContin available is unknown; however, legitimate distribution of the drug has increased sharply since 2000, thereby making more of the drug available for diversion. DEA reports increases in the total amount of licit OxyContin distributed to pharmacies, hospitals, practitioners, midlevel practitioners, and teaching institutions from 14,002,125.38 grams in 2001, to 15,118,153.37 in 2002, to 16,982,548.32 in 2003. Most of the OxyContin tablets were distributed to pharmacies, where distribution increased from 13,244,842.07 grams in 2001, to 14,338,099.69 in 2002, to 16,164,721.94 in 2003. As legitimate distribution of OxyContin has increased since 2000, the theft of OxyContin also has increased. According to DEA, the theft of OxyContin dosage units increased from 260,688 (791 incidents) in 2000 to 464,312 (1,251 incidents) in 2003.

In contrast to the increased distribution of OxyContin since 2000, the number of investigations and arrests for OxyContin reported by DEA has declined, and Organized Crime Drug Enforcement Task Force (OCDETF) investigations and indictments have fluctuated. The number of DEA OxyContin-related investigations declined from 172 in 2001, to 140 in 2002, to 71 in 2003. The number of OxyContin-related arrests by DEA also declined from 202 in 2001, to 179 in 2002, to 141 in 2003. In contrast, the number of OCDETF OxyContin-related investigations fluctuated from 10 in fiscal year (FY) 2001 to 22 in FY2002, but declined to 13 in FY2003. The number of OCDETF indictments for OxyContin-related offenses increased each year from 7 in FY2001, to 31 in FY2002, to 40 in FY2003.

The number of oxycodone samples submitted for testing has fluctuated; however, oxycodone was one of the most analyzed drug items in 2002. According to DEA System to Retrieve Information from Drug Evidence (STRIDE) data, the number of oxycodone dosage units submitted for testing decreased from 74,148.3 in 2001 to 24,040.4 in 2002, but increased to 59,695.9 in 2003. National Forensic Laboratory Information System data for 2002 show that oxycodone was among the 10 most analyzed drug items in state and local forensic laboratories; however, oxycodone represented only 0.98 percent of total analyzed drug items.

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Abuse

OxyContin is abused by individuals in all age groups and social strata; however, national-level drug prevalence data indicate that males are more likely to abuse OxyContin than females, and individuals in rural areas are more likely to abuse the drug than individuals in large metropolitan areas. According to Monitoring the Future (MTF) data, the rates of past year OxyContin abuse were higher among eighth (1.9%), tenth (3.6%), and twelfth (5.6%) grade males than were rates among eighth (0.9%), tenth (2.4%), and twelfth (2.6%) grade females in 2002, the most recent year for which such data are available. MTF data for 2002 further indicate that rates of past year OxyContin abuse were higher among eighth (1.5%), tenth (3.7%), and twelfth (4.7%) graders in nonmetropolitan statistical areas (rural areas) than were rates of use among eighth (1.2%), tenth (2.0%), and twelfth (3.7%) graders in large metropolitan statistical areas (urban areas).

According to data from the National Survey on Drug Use and Health (NSDUH), adults, particularly young adults, are more likely to abuse OxyContin than are adolescents. NSDUH data for 2002--the latest year for which such data are available--indicate that of the estimated 1,924,000 individuals who have used OxyContin nonmedically at least once in their lifetime, approximately 1,700,000 were aged 18 or older compared with 224,000 who were aged 12 to 17. Moreover, NSDUH data for 2002 show that the rates of lifetime OxyContin use were higher for individuals aged 18 to 25 (2.6%) than for those aged 12 to 17 (0.9%) or those aged 26 or older (0.5%).

Rates of use for OxyContin may be trending upward. MTF data indicate that past year use of OxyContin rose from 2002 to 2003, though not significantly, for eighth (1.3% to 1.7%), tenth (3.0% to 3.6%), and twelfth (4.0% to 4.5%) graders. The consequences of oxycodone (including OxyContin) use also appear to be rising.

According to Drug Abuse Warning Network (DAWN) data, the estimated number of emergency department (ED) mentions for oxycodone rose from 10,825 in 2000, to 18,409 in 2001, to 22,397 in 2002. DAWN data further indicate that the estimated number of ED mentions for oxycodone increased significantly in several DAWN reporting cities, particularly Detroit, where oxycodone ED mentions increased 249.0 percent from 2001 (45) to 2002 (157). The number of oxycodone-related treatment admissions to publicly funded facilities also appears to be increasing. According to the Treatment Episode Data Set (TEDS), the number of oxycodone-related admissions to publicly funded treatment facilities rose sharply from 138 in 1999, to 441 in 2000, to 1,039 in 2001, the latest year for which such data are available. (Oxycodone-related admissions are not reported by all states.)

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Outlook

OxyContin abuse will likely stabilize in the near future. Despite drug prevalence data that indicate OxyContin abuse may be trending upward, MTF data indicate that rates of abuse for "other narcotics" (oxycodones, hydrocodones, and opium) have stabilized recently. According to MTF, the rates of past year use of other narcotics increased steadily among twelfth graders from a relatively low 3.3 percent in 1992, to 6.2 percent in 1997, to 9.4 percent in 2002, but remained relatively stable at 9.3 percent in 2003. Among young adults (aged 19 to 28), rates of past year use also have increased steadily from 1992 (2.5%) to 1997 (3.3%) to 2001 (5.0%), but remained relatively stable at 5.1 percent in 2002, the latest year for which such data are available. MTF has surveyed eighth, tenth, and twelfth graders since 2002 concerning use of OxyContin. Although each grade has shown increases in OxyContin abuse from 2002 to 2003, increases were all under 1 percent.

In the near future, other pharmaceutical manufacturers are expected to release generic forms of OxyContin. It is unclear what effect this will have on the level of OxyContin abuse; however, more individuals may visit physicians to obtain OxyContin or its less expensive generic equivalent.

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Sources

Executive Office of the President
     Office of National Drug Control Policy
          High Intensity Drug Trafficking Area
               Appalachia

U.S. Department of Health and Human Services
     National Institutes of Health
          National Institute on Drug Abuse
               Monitoring the Future

     Substance Abuse and Mental Health Services Administration
          Office of Applied Studies
               Drug Abuse Warning Network
               National Survey on Drug Use and Health
               Treatment Episode Data Set

U.S. Department of Justice
     Drug Enforcement Administration
          Detroit Field Division
          Miami Field Division
          National Forensic Laboratory Information System
          Philadelphia Field Division
          System To Retrieve Information From Drug Evidence

     Executive Office for U.S. Attorneys
          U.S. Attorney's Office
               Southern District of Indiana

     Office of the Deputy Attorney General
          Organized Crime Drug Enforcement Task Force

     Office of Diversion Control
          Automation of Reports and Consolidated Orders System

Addresses

National Drug Intelligence Center
319 Washington Street, 5th Floor
Johnstown, PA 15901

Tel. (814) 532-4601
FAX (814) 532-4690
E-mail NDIC.Contacts@usdoj.gov

Tel. (703) 556-8970
FAX (703) 556-7807

Web Addresses

ADNET:  http://ndicosa 
      DOJ:  http://www.usdoj.gov/ndic/
      LEO:  home.leo.gov/lesig/ndic/ 
     RISS:  ndic.riss.net

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