Oxycontin Rehab Treatment

Also known as: Oxy, Oxy's, Oxies, Oxycotton, OC's, Killers, Oceans, O's, Oxycoffins.

Basics: OxyContin is one of several opium derivatives available by prescription. It is a high potency painkiller that comes in time release tablets that last for 12 hours. When used as prescribed it helps cancer patients and chronic pain sufferers manage their pain.

Major routes of administration: Oral, chewed, crushed and snorted, intravenous. Abusers lick or rub off the coating before administration.

Why it is a problem: Kids have figured out that if you chew/crush or snort the tablet that you bypass the time-release feature and it will give you a high much like high-grade heroin but with worse consequences. Most kids are actually not aware of the heroin link and do not realize how dangerous this drug is. 5mg of OxyContin has as much active ingredient (oxycodone) as one percocet. So chewing/snorting a 40mg OxyContin tablet is like taking eight percocets at once or a 80mg OxyContin tablet is like taking 16 percocets all at once. It is actually worse because percocets dissolve over four hours but crushing an OxyContin tablet immediately puts all of the narcotic in your system.

Possible effects of overdose and risks: Everyone's body is different but as little as half a pill when combined with alcohol or other depressants can lower your respiratory system enough to kill you. Taken in high doses OxyContin alone can kill you.

The abuse of oxycodone products in general has increased in recent years. In April 2000, The Journal of the American Medical Association (JAMA) published a study, which examined two data collection sources. The DEA Automation of Reports and Consolidated Orders System (ARCOS) data tracks the distribution of oxycodone and other opioid analgesics and the Drug Abuse Warning Network (DAWN) Medical Examiner (ME) and Emergency Department (ED) data ascertained the health consequences associated with its abuse from 1990 to 1996. The JAMA study found a 23 percent increase in the medical use of oxycodone with no corresponding increase in the illicit abuse of the drug. However, 1998 DAWN ME data reported a 93 percent increase in oxycodone mentions between 1997 and 1998 and the number of oxycodone-related DAWN ED mentions increased 32.4 percent from 1997 (4,857) to 1999 (6,429).

OxyContin is designed to be swallowed whole; however, abusers ingest the drug in a variety of ways. OxyContin abusers often chew the tablets or crush the tablets and snort the powder. Because oxycodone is water soluble, crushed tablets can be dissolved in water and the solution injected. The latter two methods lead to the rapid release and absorption of oxycodone. The alcohol and drug treatment staff at the Mountain Comprehensive Care Center, Prestonsburg, Kentucky, reports individuals who have never injected drugs are using OxyContin intravenously and they have never seen a drug "proliferate like OxyContin has since May 2000." The staff at this center has over 90 cumulative years' experience conducting drug evaluations.

OxyContin and heroin have similar effects; therefore, both drugs are attractive to the same abuser population. OxyContin is sometimes referred to as "poor man's heroin," despite the high price it commands at the street level. A 40 mg tablet of OxyContin by prescription costs approximately $4 or $400 for a 100-tablet bottle in a retail pharmacy. Street prices vary depending on geographic location, but generally OxyContin sells for between 50 cents and $1 per milligram. Thus, the same 100-tablet bottle purchased for $400 at a retail pharmacy can sell for $2,000 to $4,000 illegally.

OxyContin is, however, relatively inexpensive for those covered by health insurance, since the insurance provider covers most costs associated with doctor visits and the prescription. Unfortunately, many OxyContin abusers whose health insurance will no longer pay for prescriptions and who cannot afford the high street-level prices are attracted to heroin.

Opioids, Pain, and Addiction

Addiction to opioids used for legitimate medical purposes under a qualified physician's care is rare. According to the National Institute on Drug Abuse, however, many physicians limit prescribing powerful opioid pain medications because they believe patients may become addicted to the drugs. Recent evidence suggests that, unlike opioid abusers, most healthy, nondrug-abusing patients do not report euphoria after being administered opioids, possibly because their level of pain may reduce some of the opioid's euphoric effects making patients less likely to become abusers.

Action Plan to Prevent the Diversion and Abuse of OxyContin
Summary

In response to growing concern among federal, state and local officials about the dramatic increase in the illicit availability and abuse of the prescription drug OxyContin, the Drug Enforcement Administration (DEA) has embarked on a comprehensive effort to prevent its diversion and abuse.

The pharmacological effects of OxyContin, a brand name formulation of the Schedule II narcotic oxycodone, make it attractive to abusers as it offers reliable strength and dosage levels and may, in some instances, be covered by the abuser's health insurance. Abusers have discovered that the controlled release formula of OxyContin can be easily compromised allowing inhalation or injection for a powerful, morphine-like high.

Reports of the diversion and abuse of OxyContin are currently concentrated in rural areas of the eastern United States; however, DEA's Office of Diversion Control has identified this activity as a growing problem throughout the nation1. It has been described by some local law enforcement officials as a national epidemic in the making. National indicators such as DAWN (Drug Abuse Warning Network) and STRIDE (System to Retrieve Information from Drug Evidence) show recent increases in oxycodone overdoses and law enforcement encounters. Some jurisdictions report as much as a 75% increase in property and other crimes that they specifically attribute to the abuse of OxyContin. Tazewell County, VA estimates that OxyContin addiction is behind 80 to 95% of all crimes committed there.

Criminal activities resulting from the abuse of OxyContin are quickly depleting the resources, financial as well as human, of local law enforcement. Some states, such as Maine, Virginia and Kentucky, have become so alarmed by this problem that they have begun to take extraordinary action to deal with it. Officials in Kentucky are utilizing a powerful new tool called KASPER (Kentucky All-Schedule Prescription Electronic Reporting), a database of all controlled substances dispensed by Kentucky pharmacists, in their investigations of OxyContin -related crime2. The Attorney General of Virginia recently convened a meeting of officials from five states to discuss ways to halt illegal trafficking in OxyContin.

Data from the Office of Diversion Control Quarterly Reports indicate that OxyContin has risen dramatically in recent months in terms of mention by the field offices as a 'most abused' drug.

Article published in the Louisville, KY The Courier-Journal, February 8, 2001

The Problem

OxyContin is a Schedule II controlled release form of the narcotic oxycodone manufactured by Purdue Pharma L.P. in 10mg, 20mg, 40mg, 80mg, and 160mg tablets. The controlled release method of delivery used in OxyContin allows for a longer duration of drug action, and consequently, the manufacture of tablets containing larger doses of the active ingredient. It is legitimately used as a medication to treat moderate to severe pain and is becoming the drug of choice in many pain management clinics. In a little over four years, sales have reached $1 billion.

Oxycodone has been marketed in combination products with aspirin and acetaminophen (Percodan and Percocet ) for many years. Diversion and abuse of these products continue. However, because they contain these other ingredients and only 5 to 10mg of oxycodone, they are primarily abused orally. While prescriptions for oxycodone combination products have increased during the period from 1996 to 2000, prescriptions for oxycodone single entity products (such as OxyContin ) have increased over fourteen-fold.

OxyContin has become a target for diverters and abusers of controlled substances because of the larger amounts of the active ingredient in relation to other previous oxycodone products and the ability of abusers to easily compromise the controlled release formulation. Simply crushing the tablet can negate the timed effect of the drug, enabling abusers to swallow, inhale, or inject the drug, which is water soluble, for a powerful morphine-like high.

Common means of OxyContin diversion are fraudulent prescriptions, doctor shopping, over-prescribing, and pharmacy theft. There have been many instances of pharmacies being robbed strictly for their supply of OxyContin. Investigations have uncovered organized rings of individuals diverting, selling and abusing OxyContin. Intelligence has also shown that foreign diversion is another source of the OxyContin being sold and used illegally in the United States.

Objective

Continued increases in the diversion and abuse of OxyContin are considered likely unless firm and immediate action is taken. It is the goal of this action plan to reduce the existing and potential costs to public health and safety by having a significant and immediate impact on the diversion and abuse of OxyContin.

Action Plan

In order to combat the serious and growing problems stemming from the diversion and abuse of OxyContin, DEA has developed a four-part action plan. The elements of the plan are as follows:

Enforcement and Intelligence: DEA must focus existing resources and management attention on investigations of the diversion and abuse of OxyContin. These investigations require coordination and support from enforcement, diversion, and intelligence groups. Coordinated operations have been initiated in field offices to target individuals and organizations involved in the diversion, illegal sale, pharmacy theft, fraud and abuse of OxyContin. DEA is using all available enforcement tools to disrupt these illegal operations. This includes interagency efforts on the federal, state, and local levels and extends to the international as well as the domestic arena.

DEA is continuing to identify large volume purchasers of OxyContin for referral to field offices for appropriate action. All exports of OxyContin are being closely scrutinized in order to detect possible diversion trends particularly in those countries having limited controls on pharmaceutical products.

A complete assessment of the scope and magnitude of OxyContin legitimate use and abuse is being undertaken utilizing traditional and novel data sources. DEA has initiated contact and continues to work with the National Institute of Drug Abuse, the Substance Abuse and Mental Health Services Administration, the National Institute of Justice, and others, to modify data sources (e.g., National Household Survey, Monitoring the Future Survey, etc.) to improve the specificity of the data collected to reflect OxyContin abuse.

Regulatory and Administrative: DEA is utilizing its full range of regulatory and administrative authority to pursue action as necessary to prevent the diversion and abuse of OxyContin. In doing so, it is essential that DEA elicit the support of other regulatory agencies. These actions are not intended to impact on the availability of legitimate drug products for medical use.

DEA continues to examine the rapid increase in the requested levels of oxycodone quota by the manufacturer of OxyContin. DEA continues to work closely with the Food And Drug Administration (FDA) in strongly urging the rapid reformulation of OxyContin to the extent that it is technically possible, in order to reduce the abuse of the product, particularly by injection. Additionally, both agencies will continue monitoring practices that may contribute to diversion or abuse.

DEA continues to work with the Interagency Narcotic Treatment Review Board and the Federation of State Medical Boards to develop further cooperation on such issues as physician education on the treatment of pain, the recognition of addiction, and implementation of the Federation’s Model Guidelines on Pain Treatment.

DEA will pursue legislative initiatives to assist states with funding for prescription data collection and analysis. Seek Industry Cooperation: DEA continues to stress the importance of voluntary cooperation from industry in adhering to the spirit and substance of existing law and regulations. The agency is increasing its cooperative efforts with all levels of industry in order to stem the abuse and diversion of OxyContin.

As the sole manufacturer of OxyContin, the cooperation of Purdue Pharma L.P. is integral to the success of DEA’s Action Plan in preventing the abuse and diversion of OxyContin. Purdue Pharma has been encouraged to develop a balanced marketing strategy that ensures appropriate use of OxyContin. Purdue agrees that OxyContin should only be prescribed to patients where use of an opioid is appropriate for moderate to severe pain lasting more than a few days. Moreover, OxyContin should only be prescribed by physicians who are knowledgeable about the use of opioids in the treatment of pain. Purdue Pharma will be encouraged to support and provide educational programs alerting legitimate patients as well as the general public to the dangers inherent in the abuse of such drugs.

In order to assist in identifying sources of diversion, DEA proposes that Purdue Pharma modify the shape, indicia, and color of OxyContin tablets manufactured for export from the United States. DEA is working with medical organizations and institutions, government agencies and international health care groups to better assess the legitimate medical needs for narcotic analgesics including OxyContin. Such groups include the American Pain Society, American Academy of Pain Medicine, the Joint Commission on Accreditation of Healthcare Organizations, the World Health Organization, and the National Institutes of Health.

Awareness / Education / Outreach Initiatives: Recognizing the importance of the appropriate use of opioids in the treatment of pain, DEA must work to increase national awareness of the dangers associated with the abuse of OxyContin. An aggressive, national outreach effort to educate the public, schools, the healthcare industry, and state and local governments on the dangers related to the abuse of OxyContin will be implemented.

DEA must work proactively with the American Medical Association, Federation of State Medical Boards, National Association of Chain Drug Stores, National Association of Boards of Pharmacy, etc., to alert the healthcare industry to the growing problems associated with OxyContin abuse. DEA is enhancing existing public awareness programs, including the Demand Reduction Program and the DEA’s public internet web sites, in order to educate the public on the dangers of OxyContin abuse.

What authority does the DEA have to regulate the handling of controlled substances, like OxyContin?

DEA’s authority to regulate pharmaceutical controlled substances is derived from the Controlled Substances Act (CSA) [21 U.S.C. §§ 801-971]. The CSA mandates that DEA prevent, detect and investigate the diversion of legally manufactured controlled substances while, at the same time, ensuring that there are adequate supplies to meet the legitimate medical needs in the United States.

To enable the DEA to achieve these goals, the CSA established five schedules into which controlled substances are separated according to their approved medical use and abuse potential. Schedule I controlled substances are those deemed not to have legitimate medical uses and have a very high potential for abuse. Schedule II substances, including OxyContin, are approved for medical use and also have a very high abuse potential. Schedules III, IV and V include controlled substances that have all been approved for medical use and have diminishing potential for abuse.

The CSA also established a closed system of distribution that includes the registration of controlled substances handlers, including manufacturers, distributors, importers, exporters, practitioners and pharmacists. Production quotas as well as recordkeeping and security requirements are designed to enable DEA to track and safeguard potentially dangerous controlled substances as they are transferred from the manufacturer to the ultimate user.

Is the DEA planning to restrict the prescribing of OxyContin to pain treatment centers or physicians specifically accredited as pain management specialist?

Throughout DEA’s examination of the abuse of OxyContin, numerous options have been explored and discussed with the healthcare community and pharmaceutical industry. None of these options will be employed unilaterally by DEA without considering the effects they may have on public health.

The CSA requires that controlled substances be prescribed, dispensed or administered only for legitimate medical purposes by practitioners acting in the usual course of their professional practice. The CSA and its implementing regulations do not define "legitimate medical purpose" nor do they set standards as to what constitutes "the usual course of professional practice." DEA relies on the medical community to make these determinations. DEA has a well-established relationship with experts in the field of pain management and has enlisted their expertise in devising strategies to ensure that OxyContin and other powerful opioids are appropriately prescribed.

DEA agrees with pain treatment specialists’ assertions that many general practitioners have not received adequate training to address complex chronic pain syndromes. These specialists emphasize that Schedule II opioids are best used as the treatment of last resort for chronic pain; and that when they are used, they should be part of a multi-disciplinary approach to pain management, including physical and psychological therapy. DEA has strongly supported the establishment of "Model Guidelines for the Use of Controlled Substances in Pain Management" by the Federation of State Medical Boards. These guidelines reflect currently accepted standards that may be used by both medical professionals and regulators in determining the appropriateness of opioid prescribing.

What is the relationship between DEA and the Food and Drug Administration (FDA) in regulating drugs like OxyContin?

The FDA is responsible for approving drugs for medical use. These drugs include those sold over-the-counter, those requiring a prescription, and prescription drugs that are controlled under the CSA. The FDA also sets regulations for the marketing of drugs, including controlled substances.

DEA does not directly regulate the marketing of controlled substances. However, in keeping with DEA’s mandate to ensure appropriate safeguards against diversion, DEA is concerned when marketing and advertising tactics appear to create an increased possibility for diversion or misuse. If marketing tactics seem to lead to oversupply or minimize the abuse potential of a controlled substance, the DEA makes every effort to work with pharmaceutical companies and the FDA to find appropriate solutions to these problems.

What evidence does the DEA have to support accounts that OxyContin is being abused to the extent that has been reported by the media?

Since its introduction in 1996, the number of OxyContin prescriptions dispensed has increased 20-fold to about 6 million in 2000. During this same time, medical examiners, drug treatment centers, law enforcement personnel, and pharmacists have reported a substantial increase in the abuse of this product.

Information received from the Drug Abuse Warning Network (DAWN) indicates that instances of emergency department episodes and medical examiners reports involving oxycodone, the active ingredient in OxyContin, have increased significantly since 1996. Reports from 20 metropolitan areas within the continental U.S. indicate that oxycodone-related deaths and emergency department episodes have increased 400 percent and 100 percent, respectively.

Most deaths reported in the media and attributed to OxyContin have generally occurred in areas outside the DAWN system, such as Maine, West Virginia, and rural Kentucky. DEA has been actively collecting and evaluating data from medical examiners in these areas to more clearly ascertain the extent of abuse problems.

Drug treatment programs have also provided evidence regarding an increase in OxyContin abuse. Programs in West Virginia, Pennsylvania, Kentucky, and Virginia, the states that have been most severely affected by this trend, report that 50 to 90 percent of newly admitted patients identified OxyContin as their primary drug of abuse.

What steps are currently being taken to address the widespread abuse of OxyContin?

DEA’s approach to dealing with the abuse and diversion of OxyContin is consistent with the methods normally used in combating the diversion of pharmaceutical controlled substances. These approaches include liaison with the heathcare community, the pharmaceutical industry, and other domestic and international agencies; education of medical professionals regarding various scams that are used to obtain controlled substances for illicit purposes; and the investigation of suspected diverters.

For a more detailed description of DEA’s strategies you may access the Office of Diversion Control’s web site at www.DEAdiversion.usdoj.gov. for the document "Working to Prevent Diversion and Abuse of OxyContin".

What strengths of OxyContin are most commonly abused or diverted?

Law enforcement and forensic laboratory data indicate that their exhibits are primarily for the 40 mg. tablets, although all strengths (10 mg., 20 mg., 40 mg., 80 mg., and 160 mg.) have been encountered.

Did DEA have any part in Purdue’s decision to "temporarily suspend" distribution of the 160 mg. strength tablet?

DEA has expressed its concerns to Purdue regarding the diversion and abuse of their OxyContin products. DEA recognizes the therapeutic value of long-acting opioids in the treatment of chronic pain. However, it has been found that the controlled release formulation used in OxyContin products can be easily compromised. The ability to quickly release a high dose of oxycodone that is intended for slow release, whether intentional or not, makes this product both attractive to abusers and dangerous to individuals who have not developed a tolerance to opioids.

DEA has not asked Purdue to withdraw the 160 mg. tablet and recognizes that this dosage may be appropriate for a limited number of patients. The Associate Press reported on May 11, 2001, that Purdue stated that government pressure played no part in its decision to suspend distribution of OxyContin 160 mg. tablets. It would not be appropriate for DEA to speculate about the decision.

Is DEA going to reduce manufacturing quotas for oxycodone, the active ingredient in OxyContin?

All quotas are reviewed annually to ensure that the amount of controlled substances produced are sufficient to meet the legitimate medical, scientific, research, and industrial needs of the U.S. This review includes a yearly forecast of expected changes in medical use, data from prescription and hospital use, as well as abuse, trafficking and diversion data. Quotas may be increased or decreased depending on expected needs or excessive supplies. Excessive inventories of any controlled substance heighten the chances of possible diversion.

Source D.E.A

see Drug Abuse
see Addiction