Millions of OxyContin prescriptions are written each year and it is an oft-abused medication. But, OxyContin is not alone. Nearly 1.8 million Americans were addicted to some form of prescription pain reliever in 2011, much more than those addicted to cocaine and heroin combined.
Increasing the drug’s potential for addiction, some who abuse OxyContin crush the pills and snort the powder like cocaine or dissolve it and shoot it like heroin to get a more intense rush.
OxyContin, the brand name for the long-acting form of oxycodone, carries a significant risk for overdose and deaths from overdose. It’s in the same family of substances as heroin and methadone.
The effects of oxycodone — also found in Percocet, Roxicodone, Roxicet, Endocet and Endodan — lasts for about five hours, whereas OxyContin’s effects last for 12 hours.
How it starts
“Availability is a huge factor,” says Nicholas Reuter of Reckitt Benckiser Pharmaceuticals on the increasing abuse of OxyContin tablets. Prior to his current position, Reuter worked for the FDA and the U.S. Substance Abuse and Mental Health Services Administration.
He names public health messages on the dangers of heroin abuse as another important factor driving this epidemic.
Public health messages in the 1990s warned against intravenous drug use due to the risk of contracting HIV from shared needles. Subsequently, from 1994 to 2002, use of oxycodone-containing oral medications more than quadrupled.
One way people become addicted is after being prescribed opiates for legitimate reasons — such as pain from injuries or car accidents — and they become physically dependent on them.
“Anybody who’s using an opioid for pain treatment beyond a certain amount of days or weeks becomes dependent,” Reuter says. “The risk of physical dependence is very real.”
There is a difference, however, between being physically dependent on a medication and becoming an abuser. Drug abuse is defined as “compulsive drug use despite harmful consequences,” according to the National Institute on Drug Abuse. That includes negative effects on family relationships and job obligations.
Another sector of oxycodone and OxyContin abusers have never had legitimate complaints of pain, but take the medication for the euphoric high. They may obtain a prescription from a physician under false pretenses, buy the pills illegally from a dealer, or obtain them from friends or family members who were prescribed them legally.
Focusing on pain
Around the same time as this surge in OxyContin and shorter-acting oxycodone abuse, there was also a push in the medical field known as “pain is the fifth vital sign.”
This push encourages providers to not only check a patient’s four vital signs — blood pressure, heart rate, rate of breathing and oxygen level — but to also ask about the patient’s pain on a scale of one to ten, and address it.
This especially affects those with chronic pain, who now get prescriptions for large quantities of pain medications from physicians.
“For a long time, chronic pain wasn’t acknowledged,” Reuter says. “Now oxycodone and methadone has been taken out of the hospital setting and is being used for the prescription treatment of chronic pain.”
Cracking down
Earlier this year, New York City reported a seven-fold increase in deaths from prescription opiates since 1990, while heroin overdoses declined. Whites were more likely to overdose than blacks and Latinos, and in areas of lower poverty rates.
San Francisco has seen the same outcomes. The city has fewer than ten fatal overdoses from heroin each year now, down significantly from the 1990s. Yet deaths from prescription painkillers are increasing.
Three years ago, the FDA approved a form of OxyContin that decreases its abuse potential. It can’t prevent the addiction issue as a whole, but the new form will keep abusers from crushing the pills. As an additional effort, the FDA recently banned the crushable forms from reaching the U.S. market.
Usually, according to Reuter, tabs of OxyContin from a street dealer costs on average $1 per milligram. So, one 80mg tablet of “Oxy” costs $80 each. The street value of these new abuse-resistant tabs has decreased because the demand has decreased, likely because it can’t be crushed.
Some worry that this change will in turn push OxyContin abusers into becoming heroin abusers.
Reuter, on the other hand, feels that the crackdown on OxyContin abuse may push more people toward treatment rather than heroin. However, he does cite statistics from SAMHSA that link prescription opiate misuse to heroin abuse later on, and thus considers it to be a gateway drug.
Doctors are also being urged to help curtail their role in this trend.
New York City, for example, has put out guidelines for doctors in emergency rooms who prescribe pain medication – such as limiting prescriptions to only one or two days’ worth of pain meds. However, some doctors debate that the ER is not where the problem lies, and that ER doctors rarely prescribe long-acting medications such as OxyContin, but rather shorter-acting ones like Percocet or oxycodone.
Fighting the addiction
Those addicted to opiates are often prescribed the opiates methadone or Suboxone to help wean them from their addiction. Health care providers are then able to slowly decrease the amount of opiate the person receives.
Methadone can be abused or sold illegally, while Suboxone can’t be crushed and abused. Many methadone clinics use liquid though, to decrease the ability of someone to save it and sell it later.
An implant from Titan Pharmaceuticals – also meant to help wean people from opiates – was rejected by the FDA earlier this month. The implant would have been placed under the skin in the arm to release the same type of medication as Suboxone. One of the FDA’s issues is that addicted patients may find ways to remove the implant and extract the medication from it.
Treatment for opiate addiction can be a long process.
“[With drug abuse], the brain has changed to the point where they now need the opioids just to feel normal,” says Reuter. “It can be reversed, but it takes time.”
The average length of treatment to get someone completely off of any opiate including the substitutes like methadone or Suboxone is almost seven years, he adds. Meaning, they’re no longer exhibiting drug-seeking behavior.
With pain medicine clinics being shut down and pharmacies not stocking certain dosages anymore, there will be a need for more addiction treatment options. Reuter hopes the Affordable Care Act will make more programs available.
“The next few years will tell us where we go with this epidemic,” he says.
Dr. Tyeese Gaines is a physician-journalist with over 10 years of print and broadcast experience, now serving as health editor for NBC’s theGrio.com. Follow her on twitter at @doctorty.