Oxycontin should be prescribed less often by doctors

Oxycontin is an oral pain medication that contains the single active ingredient oxycodone. Oxycodone is one of the most potent of the oral opiates, and has more euphoric effect than many other opiate analgesics.

Oxycontin is the most notorious prescription drug of abuse in the US, and for good reason. Though marketed as a sustained release medication, as much as 30% of the medication is absorbed immediately and the rest absorbed more slowly from the intestinal tract. This fairly large immediate release portion gives a prominent euphoric response, the desired response to opiates by abusers.

In addition since Oxycontin does not contain acetaminophen (active ingredient in Tylenol) its abuse potential is not limited by toxicity of extremely high doses of acetaminophen. This combination is the major the major attraction for abusers. As a single ingredient formulation it is easily ground into a powder for intranasal use or for injection like heroin.

One of its many street nicknames is “Hillbilly Heroin” because of its popularity in some rural eastern US locations shortly after its release by Purdue Pharma in 1996. If you read the DEA information page on Oxycontin you find that most of the page is related to the abuse of this drug.

The release of Oxycontin in 1996 coincided with a major concern that severe pain was being undertreated routinely by most physicians. End-stage cancer patients, post-op patients, and others often were, and to a lesser degree continue to be under dosed and undertreated for their pain out of fear of addiction and side effects like respiratory depression and death. Medical schools and residency programs strongly encouraged physicians to treat pain more aggressively. These criticisms were valid in many regards, and Oxycontin soon became a popular medication for use in these cases because it is very effective in severe pain.

The problem was that it became even more popular as a drug of abuse. Once doctors became comfortable with using Oxycontin as an effective medication for severe acute postoperative pain and for severe pain associated with terminal illnesses, it was often also used to treat pain of other causes, like acute back pain, fibromyalgia, acute injuries, etc. Some patients quickly became addicted to this medication.

Oxycontin was also often diverted (sold on the street) for overt abuse because its street value is so high. By some reports the street value of Oxycontin is as high as $1 per milligram. It is often prescribed at doses of 20 to 80 mg twice daily, so tricking physicians into prescribing Oxycontin and then selling it on the street became a lucrative business as demand increased.

By obtaining prescriptions from multiple physicians a fraudulent patient who is good at the job can do very nicely financially. Now physicians face the dilemma of trying to treat pain adequately without becoming a supplier of opiates for diversion and overt abuse by patients or family members.

At this time I almost never start patients on Oxycontin. There are other opiates that also work well in appropriate cases, with far lower abuse potential and popularity. In my estimation, far more than half of new patients to a practice requesting Oxycontin are seeking it for diversion or for personal abuse. More Americans die each year from prescription opiate overdose than from herion overdose.

I find it easy to “just say no” to Oxycontin requests.

Edward Pullen is a family physician who blogs at DrPullen.com A medical blog for the informed patient.

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