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OxyContin and Shifting Trends in Opioid Abuse

OxyContin (also known simply as Oxy) is a branded form of oxycodone, an opioid prescription medication with a strong chemical resemblance to codeine. Unlike most other forms of oxycodone, it contains an extended-release formula that remains active in the body for as long as 12 hours. When OxyContin first entered the US market in the 1990s, it came in a readily crushable capsule that made the medication very easy to abuse. In order to correct this situation, the medication’s manufacturers re-introduced it to the market in a new, non-crushable form in 2009. While this action significantly decreased abuse of OxyContin, current evidence indicates that it also led to a significant increase in the abuse of other types of opioid drugs.

Oxycodone Basics

Like all other legal and illegal opioids, oxycodone has its origin in mind-altering substances derived from a plant called Papaver somniferum, popularly known as the opium poppy. The specific substance in this plant used to create oxycodone is called thebaine. Like most other legal opioids, oxycodone is valued for its ability to make alterations in normal brain and spinal cord chemistry that sharply decrease a person’s susceptibility to the effects of pain. In addition to capsules, available forms of the medication include tablets, liquids and concentrated liquids. Drug manufacturers often combine oxycodone with other pain-relieving medications such as aspirin, ibuprofen and acetaminophen (also known as paracetamol). Forms of these combination products marketed in the United States include Percocet, Endocet, Percodan, and Combunox.

OxyContin Basics

OxyContin is specifically designed to provide extended relief for severe pain. Its creators intended for the medication to reduce the risks of opioid-related abuse and addiction by offering a safer, less addictive alternative to prescription morphine. However, as stated previously, in its originally marketed form, OxyContin was easily crushable; in turn, this easy crushability made it possible for abusers of the drug to evade its timed-release features and get “high” in a relatively short period of time. Methods commonly used by abusers to introduce the medication into their bodies included nasal inhalation (snorting) and IV injection after mixing the medication with liquid.

The new version of OxyContin comes with safeguards designed to deter the efforts of drug abusers. As already noted, capsules of the medication can’t be crushed by any easily or practically available means. If an abuser does manage to crush a capsule and mix the medication with water, the resulting product will be a gel-like substance not suitable for IV injection. Prior to the introduction of this new version of OxyContin in 2009, almost 36 percent of people in drug rehab treatment throughout the US cited the medication as their preferred drug of abuse, according to a periodic anonymous survey conducted by researchers at Washington University Medical School. Slightly less than two years later, this number had declined rather dramatically to just under 13 percent.

Shifts to Other Opioids

Initially, there was some hope among substance abuse experts and public health officials that the reduced usefulness of OxyContin outside of a medical context would lead to an overall drop in the numbers of people in the US who abuse opioid drugs. Unfortunately, this anticipated drop did not appear. Instead, former users of OxyContin – who also commonly cited increasing costs as a reason for abandoning their reliance on Oxy – began to switch over to the use of a variety of other cheaper, more easily abused opioids. For instance, the percentage of abusers using the opioid medications hydromorphone (Dilaudid) and fentanyl (Duragesic, Fentora) rose from about 20 to percent to roughly 32 percent. In addition, the percentage of abusers using heroin rose from about 10 percent to 20 percent.

There are implications to the shift from OxyContin to heroin, in particular, that may have widespread effects on the public health impact of opioid use. While OxyContin is a known, consistently made product created in a controlled laboratory setting, heroin comes from illegal, unregulated settings where no one can accurately assess such things as the purity or overall quality of any given batch of the drug. This means that users of the drug cannot reliable determine how much heroin to take, or gauge their risks for exposure to dangerous drug additives or contaminants. Typically, the presence of these types of grey areas leads to a significant increase in the potential for unintended overdoses and drug poisonings. According to the researchers at Washington University Medical School, precisely this kind of increase occurred between 2010 and 2012.

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