OxyContin: Poor Man's Heroin

by Jim Kouri, CPP Sixty-nine percent of police chiefs and sheriffs have witnessed an increase in the abuse of painkillers such as OxyContin, according to the latest survey of police commanders by the National Association of Chiefs of Police. And this substance abuse is equally evident in US cities as well as rural communities. Abuse and diversion of the prescription pain reliever OxyContin are serious problems in certain areas of the United States, particularly in the East, according to a report by the US Drug Enforcement Administration.  In 1996 OxyContin was introduced as a longer lasting dosage of oxycodone, which is prescribed for the treatment of moderate to severe pain. Since 1996, Drug Abuse Warning Network data indicate an increasing number of emergency department mentions and deaths associated with oxycodone. The growing abuse of OxyContin, commonly known as Oxy’s, OC’s, Killers, Poor Man's Heroin, and Hillbilly Heroin, is leading to an increase in burglaries, thefts, and robberies of residences and pharmacies. Law enforcement officials have been monitoring oxycodone products for abuse and diversion over the last 30 years. Currently, these officials are taking action to control the illicit distribution of OxyContin nationwide. The Drug Enforcement Administration, Food and Drug Administration, US Attorneys, and state and local authorities recognize the problem and are working to limit diversion and abuse of this potentially dangerous drug. OxyContin is a tradename for the narcotic oxycodone hydrochloride (HCl), an opiate agonist. Oxycodone, a semisynthetic opioid derived from the opioid alkaloid thebaine, is similar to codeine, methadone, and morphine in producing opiate-like effects. Oxycodone is a Schedule II drug under the Controlled Substances Act because of its high propensity to cause dependence and abuse. Oxycodone is the active ingredient in a number of other commonly prescribed pain relief medications such as Percocet, Percodan, and Tylox. These medications contain oxycodone in smaller doses and are combined with other active ingredients like aspirin or acetaminophen. OxyContin contains oxycodone in various dosage strengths as the only active ingredient. These formulations are designed for a controlled release of the drug to minimize the total number of tablets a patient must take for around-the-clock pain relief. OxyContin’s intended application is the relief of moderate to severe pain of long duration, such as pain caused by rheumatoid arthritis and cancer. OxyContin, marketed in 1996 by Purdue Pharma L.P., was the first product capable of giving 12 hours of pain relief, making it the longest lasting oxycodone product on the market. OxyContin was initially available in 10-, 20-, and 40-milligram (mg) strengths. In 1997, an 80-mg tablet was introduced and later followed by a 160-mg tablet in 2000. Purdue Pharma, a major pharmaceutical manufacturer, also produces OxyFast, an immediate release liquid formulation containing 20-mg of oxycodone. Other pain medications such as Percocet, Percodan, and Percodan-Demi, which contain 5, 4.5, and 2.25 mg of oxycodone respectively, only provide short periods of pain relief (4 to 6 hours) and have to be taken at repeated intervals. Beginning in 1996, the first full year it was marketed, the number of OxyContin prescriptions rose to approximately 5.8 million prescriptions in 2000, according to the US Drug Enforcement Administration. This makes OxyContin the number-one prescribed Schedule II narcotic in the United States. Prescriptions dispensed for all other common opioid analgesics such as codeine, hydrocodone, morphine, and hydromorphone have risen 23 percent during this same period. Abuse of OxyContin in rural Maine, Kentucky, Virginia, and West Virginia brought national attention to this problem. Law enforcement personnel, pharmacists, and drug abuse treatment centers report the abuse of OxyContin primarily in the eastern portion of the United States; however, the problem is spreading throughout the United States. The areas most currently affected by OxyContin abuse are eastern Kentucky; New Orleans, Louisiana; southern Maine; Philadelphia and southwestern Pennsylvania; southwestern Virginia; Cincinnati, Ohio; and Phoenix, Arizona. OXYCONTIN ABUSE OxyContin is designed to be administered orally in tablet form; however, many abusers chew the tablets or crush them and snort the powder to defeat the intended time-release action. However, most deaths appear to be the result of oral ingestion of the intact tablet. Injection also is possible, but it requires a preparation regimen similar to that of heroin. Such a regimen requires the removal of the tablet coating by either sucking on it or scraping it with the teeth or a razor blade, followed by melting the remainder on a spoon, adding water, and then injecting the solution. Snorting or injecting hastens the body's absorption of OxyContin. Individuals abuse oxycodone to gain a euphoric high and to avoid the withdrawal symptoms associated with heroin. Because OxyContin contains large doses of oxycodone and produces opiate-like effects, it acts as a reasonable substitute for heroin; however, individuals do not necessarily need to be heroin addicts to become oxycodone abusers. DAWN reports an increase in the number of oxycodone-related deaths and emergency room visits since 1996. The number of emergency room episodes more than tripled from 1996 to 2000, with approximately 10,825 episodes in 2000 compared to 3,190 in 1996. DRUG DIVERSION ARRESTS Since pharmaceuticals containing oxycodone are controlled substances requiring a prescription, a variety of illegal techniques are used to obtain the drug. Pharmacy diversion, dishonest physicians, “doctor shopping,” fraudulent prescriptions, and robbery all contribute to the presence of diverted pharmaceuticals on the illicit market. Illegal acts by physicians and pharmacists are the primary sources of diverted pharmaceuticals available on the illicit market. In many cases, they create fraudulent prescriptions to obtain the drug for personal use or to provide associates with a supply of the drug for distribution purposes. To date, many physicians, pharmacists, and pharmacy technicians who have been illegally prescribing or diverting the narcotic OxyContin have been identified or arrested throughout the United States. With the abuse of OxyContin on the rise, law enforcement authorities throughout the United States are reporting an increase in the number of burglaries, thefts, and robberies of pharmacies and residences. According to police reports, homes are being robbed and individuals are being targeted for their supplies of OxyContin. In some pharmacy thefts, only OxyContin is stolen. From 2000 to mid-2001, the DEA’s Office of Diversion Control reported that the greatest number of OxyContin pharmacy thefts occurred in Pennsylvania followed by Florida, Ohio, Kentucky, and Georgia. Employees of the Purdue Pharma L.P. manufacturing section have also been arrested for stealing large amounts of OxyContin. OxyContin abuse and diversion will continue to spread throughout the United States. The popularity of OxyContin and oxycodone-related pharmaceuticals, coupled with large profit margins from the illicit market, increases the probability of future abuse and crimes associated with the drug. OxyContin abuse and diversion will continue to pose a significant problem for law enforcement authorities throughout the United States. The DEA, the FDA, US Attorneys, and state and local authorities recognize the problem and are working together to prevent the future diversion and abuse of OxyContin. Sources: National Association of Chiefs of Police, US Drug Enforcement Administration Jim Kouri, CPP is currently fifth vice-president of the National Association of Chiefs of Police. He's former chief at a New York City housing project in Washington Heights nicknamed "Crack City" by reporters covering the drug war in the 1980s. He's also served on the National Drug Task Force and trained police and security officers throughout the country. He writes for many police and crime magazines including Chief of Police, Police Times, The Narc Officer, Campus Law Enforcement Journal, and others. He's appeared as on-air commentator for over 100 TV and radio news and talk shows including Oprah, McLaughlin Report, CNN Headline News, MTV, Fox News, etc. His book Assume The Position is available at Amazon.Com, Booksamillion.com, and can be ordered at local bookstores.