Oxycodone is a narcotic painkiller often prescribed in its pure form for acute, post-operative pain or in a combination with other drugs for moderate pain. Oxycodone is found in a number of prescription opioids like OxyContin, Percocet, Percodan, Combunox, Roxiprin, Roxicodone, Endocet, Endodan, and Targiniq ER. The reason oxycodone is called an “opioid” is because it is manufactured by modifying an organic compound called thebaine, which is found in opium. To clarify:
Opiate: A drug (such as morphine, codeine or heroin) containing or derived from opium or the opium poppy, used to alleviate pain, or induce sleep or euphoria.
Opioid: A synthetic or semi-synthetic substance producing an opium-like effect, often prescribed for alleviation of moderate to severe pain; a prescription painkiller in the opiate class.
NOTE: The words opiate and opioid are often used interchangeably.
The Story of Oxycodone
The late 1800s and early 1900s saw an effort to create a non-addictive opioid. Heroin, marketed by the Bayer corporation of Germany in the 1890s, was originally at the forefront of this project. However, it soon became abundantly clear that heroin was extremely addictive.
After heroin’s ban in America, two German scientists created oxycodone. It was touted as a non-addictive, semi-synthetic substitute for heroin, morphine and opium. The timeline goes like this:
- 1916: Oxycodone is created.
- 1939: Oxycodone is first introduced to America.
- 1950: Percodan – a combination of oxycodone and aspirin – is released to American physicians for prescription.
- 1963: The attorney general of California cites Percodan abuse as the source of one-third of all drug addiction in the state.
- 1970: Oxycodone is listed as a Schedule II drug in the new Controlled Substances Act. According to the Drug Enforcement Administration (DEA): “Schedule II drugs, substances, or chemicals are defined as drugs with a high potential for abuse, less abuse potential than Schedule I drugs, with use potentially leading to severe psychological or physical dependence. These drugs are also considered dangerous.”
- 1974: Percocet is approved by the Food and Drug Administration (FDA).
- 1989: The Texas Medical Board adopts language to support wider use of painkillers by doctors. Fourteen states follow in its footsteps.
- 1996: Perdue Pharma releases OxyContin.
World’s Most Commonly Abused Legal Drug
The commonly prescribed painkiller OxyContin is an extended release medication. This means that the tablet is specially designed to release small amounts of oxycodone for up to 12 hours. The pill itself gradually dissolves in the individual’s stomach acid, releasing the drug very slowly into the system. This works well for someone who has just had an operation or has another chronic pain situation. He or she can take one tablet and experience pain relief for an extended period of time.
By 1998, only two years after OxyContin’s release, the drug became responsible for 80% of Perdue profits. In the same time period, OxyContin became notorious among drug enforcement officers and police.
A primary problem with OxyContin was that, if crushed, the entire 12-hour dose could be effectuated at once. Drug users and opiate addicts could crush the highly addictive drug into powder and snort it, smoke it or inject it intravenously.
A survey done by the FDA showed that from 1992 to 2006, national admissions for treatment involving opioids spiked from less than 40,000 to over 120,000 individuals.
In 2001, Perdue was required to add warnings against the recreational use of OxyContin. In spite of this, OxyContin became extremely popular as a recreational drug throughout the United States. It heavily affected Kentucky, Virginia, West Virginia, Pennsylvania, Ohio, and Maine. Because many of those states are in Appalachia, OxyContin became known as “Hillbilly Heroin” among other names.
A 2006 government survey of 16 states reported that, out of addicts admitted to rehab for opioid abuse treatment, over half were using oxycodone.
According to the ASAM, (American Society of Addiction Medicine) in 2015, of the 21.5 million Americans 12 or older that had a substance use disorder, 1.9 million had a substance use disorder involving prescription opiates. It also states that “drug overdose is the leading cause of accidental death in the US, with 47,055 lethal drug overdoses in 2014. Opioid addiction is driving this epidemic, with 18,893 overdose deaths related to prescription pain relievers, and 10,574 overdose deaths related to heroin in 2014.”
An FDA report indicates that oxycodone may be more addictive than morphine. It also showed that the labeling, insisted upon in 2001, probably backfired as it indicated that crushing OxyContin would cause the full impact of the drug to be felt at once. This informed the patient or user how they could abuse the drug, essentially acting as a “how-to” for the potential addict.
In 2010, pharmacies dispensed an equivalent of 69 tons of pure oxycodone. Per capita, oxycodone sales increased five to six-fold in Tennessee from 2000 to 2010. Florida had a similar problem. In 2000, oxycodone sales centered in one specific area of Florida; by 2010, the drug was flowing all through the state. New York City and its suburbs saw a huge leap in oxycodone sales between 2000 and 2010; in Staten Island, sales had jumped by 1200 percent.
Pill Mills: Candy Stores for Addicts
In 2011, the Sheriff of Broward County, Florida said “We have more pain clinics than McDonalds.” That powerful statement reflected a big problem in Florida and around the United States: “Pill Mills” – locations where uncaring and unethical “doctors” prescribe bottle after bottle of pain meds to their patients, no matter the real or imagined malady. Many addicts (and drug dealers) came to Florida’s pain clinics complaining of a trumped-up illness so they could lay their hands on addictive pain pills like OxyContin. Doctors gave prescriptions out like candy. This got so bad that Interstate 75, which runs through Florida, became known as the “Oxy Express.”
From 2003 to 2009, Florida’s overdose deaths increased by 61%. Significantly contributive to this was the abuse and unscrupulous prescription of pain pills. After legislation was enacted and police enforcement increased, the number of overdose deaths in the state decreased by 16.7% between 2010 and 2012.
“Tamper Proofing” Causes Users to Switch to Other Drugs
OxyContin was reformulated in 2013 to create a “tamper proof” version. This pill is more difficult to crush and turns into a gel when it has been compromised. The new pill is difficult to inject and cannot be snorted.
Perdue released the new pill type, but the FDA required all time-release oxycodone manufacturers (those companies creating the drug in a generic version) also provide a tamper-proof pill. The FDA withdrew all crushable OxyContin from sale.
Although the new, tamper-proof pill does not completely eliminate the ability to abuse the drug, anecdotal evidence indicates that those who have been addicted to OxyContin are no longer interested in the drug in its tamper-proof form.
While this reduces the likelihood of new addicts to the drug, it means that those already addicted are turning to other opiates, some of which are even more potent and addictive, including Opana (oxymorphone) and the illicit drug heroin.
As concerned individuals, groups and governments work to prevent future addicts, it’s also important for everyone to realize that individuals already addicted need treatment. If you or someone you know are suffering from addiction to oxycodone or any other drug, get help.