NDIC.
The prescription drug OxyContin contains the narcotic oxycodone
hydrochloride and is available in controlled-release tablets of 10, 20,
40, and 80 milligrams. OxyContin is prescribed in the United States to
treat moderate to severe pain and is abused for its heroin-like effects.
The diversion and abuse of OxyContin have increased sharply since the drug
became available in 1996, raising concerns among law enforcement and
public health agencies.
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Oxycodone and Pain
Management
Oxycodone hydrochloride is an opiate agonist. Opiate agonists
provide pain relief by acting on opioid receptors in the spinal
cord, brain, and possibly in the tissues directly, and provide the
most effective pain relief available. Oxycodone has a high abuse
potential and is prescribed for moderate to severe pain associated
with injuries, bursitis, dislocations, fractures, neuralgia,
arthritis, lower back pain, and cancer. It is also used
postoperatively and for pain relief after childbirth. Individuals
who take the drug repeatedly can develop a tolerance or resistance
to its effects. Thus, a cancer patient who has developed a tolerance
for the drug can take a dose of oxycodone on a regular basis that
would be fatal to a person never exposed to oxycodone. |
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Most OxyContin abused in the United States is diverted by illegally
written or forged prescriptions, "doctor shopping" (when individuals, who
may or may not have a legitimate ailment, visit numerous doctors to obtain
drugs in excess of what should be prescribed legitimately), and theft.
According to law enforcement reporting, the availability of diverted
OxyContin may be stabilizing and has decreased in some areas. The theft of
OxyContin dosage units increased from 260,688 (791 incidents) in 2000, to
519,597 (1,228 incidents) in 2001, to 587,168 (1,479 incidents) in 2002,
but decreased to 464,312 (1,251 incidents) in 2003, according to the Drug
Enforcement Administration (DEA). OxyContin abusers also steal or buy
OxyContin from friends or family members with legitimate prescriptions who
often are prescribed a 30-day supply of the drug.
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Fraudulent OxyContin
Prescriptions
On February 28, 2003, the U.S. Attorney's Office for the Southern
District of Indiana announced that an Indiana doctor was sentenced
to serve 51 months' imprisonment following his guilty pleas to
unlawful trafficking in OxyContin and healthcare fraud. Between July
and December 2001, the doctor prescribed OxyContin to a woman in
amounts that were not medically necessary. For example, in one
14-day period in November 2001, the doctor prescribed 860 80-mg
tablets of OxyContin. From January through December 2001, $130,000
was paid by the Indiana Medicaid program for OxyContin prescribed to
this individual. After the prescriptions written by the doctor had
been filled, the OxyContin was allegedly sold for cash to several
individuals in Jennings County. The woman pled guilty to unlawful
trafficking in OxyContin and healthcare fraud and was sentenced in
December 2002 to 41 months' imprisonment.
Source: U. S. Attorney's Office,
Southern District of Indiana. |
National Drug Intelligence Center (NDIC) National Drug Threat Survey
2003 (NDTS) data also indicate that OxyContin is frequently diverted.
Nationally, NDTS 2003 data indicate that 67.0 percent of state and local
law enforcement agencies report that OxyContin is commonly diverted and
abused in their areas--a higher percentage than any other pharmaceutical
drug. A higher percentage of state and local law enforcement agencies in
the Southeast region report that OxyContin is commonly diverted and abused
in their areas (83.9%) than agencies in the Northeast/Mid-Atlantic
(75.0%), Great Lakes (65.4%), West Central (61.8%), Pacific (56.9%), and
Southwest (28.6%) regions.
The price of diverted OxyContin varies. DEA drug price data indicate
that diverted OxyContin typically is sold for $1 per milligram. For
example, a 40-milligram OxyContin tablet typically sells for $40; however,
the price may vary depending on availability and other factors.
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OxyContin is prevalent in every region of the country. However, law
enforcement reporting indicates that the availability of diverted
OxyContin may be stabilizing and has decreased in some areas. For example,
law enforcement reporting indicates that OxyContin availability has
decreased in areas covered by the Appalachia High Intensity Drug
Trafficking Area (HIDTA) and DEA Field Divisions in Detroit, Miami, and
Philadelphia. Nevertheless, NDTS 2003 data reveal that 67.0 percent of
state and local law enforcement respondents nationwide report that
OxyContin is a commonly diverted or illicitly used pharmaceutical in their
areas--higher than any other prescription narcotic including Percocet
(52.2%), codeine (50.4%), Percodan (44.6%), and Dilaudid (27.5%). More
agencies in the Southeast (83.9%), Northeast/Mid-Atlantic (75.0%), Great
Lakes (65.4%), West Central (61.8%), and Pacific (56.9%) regions report
that OxyContin is a commonly diverted or illicitly used pharmaceutical
than in the Southwest (28.6%) region.
Map 1.
Regions.
d-link
The total amount of diverted OxyContin available is unknown; however,
legitimate distribution of the drug has increased sharply since 2000,
thereby making more of the drug available for diversion. DEA reports
increases in the total amount of licit OxyContin distributed to
pharmacies, hospitals, practitioners, midlevel practitioners, and teaching
institutions from 14,002,125.38 grams in 2001, to 15,118,153.37 in 2002,
to 16,982,548.32 in 2003. Most of the OxyContin tablets were distributed
to pharmacies, where distribution increased from 13,244,842.07 grams in
2001, to 14,338,099.69 in 2002, to 16,164,721.94 in 2003. As legitimate
distribution of OxyContin has increased since 2000, the theft of OxyContin
also has increased. According to DEA, the theft of OxyContin dosage units
increased from 260,688 (791 incidents) in 2000 to 464,312 (1,251
incidents) in 2003.
In contrast to the increased distribution of OxyContin since 2000, the
number of investigations and arrests for OxyContin reported by DEA has
declined, and Organized Crime Drug Enforcement Task Force (OCDETF)
investigations and indictments have fluctuated. The number of DEA
OxyContin-related investigations declined from 172 in 2001, to 140 in
2002, to 71 in 2003. The number of OxyContin-related arrests by DEA also
declined from 202 in 2001, to 179 in 2002, to 141 in 2003. In contrast,
the number of OCDETF OxyContin-related investigations fluctuated from 10
in fiscal year (FY) 2001 to 22 in FY2002, but declined to 13 in FY2003.
The number of OCDETF indictments for OxyContin-related offenses increased
each year from 7 in FY2001, to 31 in FY2002, to 40 in FY2003.
The number of oxycodone samples submitted for testing has fluctuated;
however, oxycodone was one of the most analyzed drug items in 2002.
According to DEA System to Retrieve Information from Drug Evidence
(STRIDE) data, the number of oxycodone dosage units submitted for testing
decreased from 74,148.3 in 2001 to 24,040.4 in 2002, but increased to
59,695.9 in 2003. National Forensic Laboratory Information System data for
2002 show that oxycodone was among the 10 most analyzed drug items in
state and local forensic laboratories; however, oxycodone represented only
0.98 percent of total analyzed drug items.
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OxyContin is abused by individuals in all age groups and social strata;
however, national-level drug prevalence data indicate that males are more
likely to abuse OxyContin than females, and individuals in rural areas are
more likely to abuse the drug than individuals in large metropolitan
areas. According to Monitoring the Future (MTF) data, the rates of past
year OxyContin abuse were higher among eighth (1.9%), tenth (3.6%), and
twelfth (5.6%) grade males than were rates among eighth (0.9%), tenth
(2.4%), and twelfth (2.6%) grade females in 2002, the most recent year for
which such data are available. MTF data for 2002 further indicate that
rates of past year OxyContin abuse were higher among eighth (1.5%), tenth
(3.7%), and twelfth (4.7%) graders in nonmetropolitan statistical areas
(rural areas) than were rates of use among eighth (1.2%), tenth (2.0%),
and twelfth (3.7%) graders in large metropolitan statistical areas (urban
areas).
According to data from the National Survey on Drug Use and Health (NSDUH),
adults, particularly young adults, are more likely to abuse OxyContin than
are adolescents. NSDUH data for 2002--the latest year for which such data
are available--indicate that of the estimated 1,924,000 individuals who
have used OxyContin nonmedically at least once in their lifetime,
approximately 1,700,000 were aged 18 or older compared with 224,000 who
were aged 12 to 17. Moreover, NSDUH data for 2002 show that the rates of
lifetime OxyContin use were higher for individuals aged 18 to 25 (2.6%)
than for those aged 12 to 17 (0.9%) or those aged 26 or older (0.5%).
Rates of use for OxyContin may be trending upward. MTF data indicate
that past year use of OxyContin rose from 2002 to 2003, though not
significantly, for eighth (1.3% to 1.7%), tenth (3.0% to 3.6%), and
twelfth (4.0% to 4.5%) graders. The consequences of oxycodone (including
OxyContin) use also appear to be rising.
According to Drug Abuse Warning Network (DAWN) data, the estimated
number of emergency department (ED) mentions for oxycodone rose from
10,825 in 2000, to 18,409 in 2001, to 22,397 in 2002. DAWN data further
indicate that the estimated number of ED mentions for oxycodone increased
significantly in several DAWN reporting cities, particularly Detroit,
where oxycodone ED mentions increased 249.0 percent from 2001 (45) to 2002
(157). The number of oxycodone-related treatment admissions to publicly
funded facilities also appears to be increasing. According to the
Treatment Episode Data Set (TEDS), the number of oxycodone-related
admissions to publicly funded treatment facilities rose sharply from 138
in 1999, to 441 in 2000, to 1,039 in 2001, the latest year for which such
data are available. (Oxycodone-related admissions are not reported by all
states.)
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Effects of OxyContin Use
Individuals who abuse OxyContin risk developing tolerance for the
drug, meaning they must take increasingly higher doses to achieve
the same effects. Long-term abuse of the drug can lead to physical
dependence and addiction. Individuals who become dependent upon or
addicted to the drug may experience withdrawal symptoms if they
cease using the drug. Withdrawal symptoms associated with OxyContin
dependency or addiction include restlessness, muscle and bone pain,
insomnia, diarrhea, vomiting, cold flashes, and involuntary leg
movements. Individuals who take a large dose of OxyContin are at
risk of severe respiratory depression that can lead to death.
Inexperienced and new users are at particular risk because they may
be unaware of what constitutes a large dose and have not developed a
tolerance for the drug. OxyContin abusers who inject the drug expose
themselves to additional risks, including contracting HIV (human
immunodeficiency virus), hepatitis B and C, and other blood-borne
viruses. |
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OxyContin abuse will likely stabilize in the near future. Despite drug
prevalence data that indicate OxyContin abuse may be trending upward, MTF
data indicate that rates of abuse for "other narcotics" (oxycodones,
hydrocodones, and opium) have stabilized recently. According to MTF, the
rates of past year use of other narcotics increased steadily among twelfth
graders from a relatively low 3.3 percent in 1992, to 6.2 percent in 1997,
to 9.4 percent in 2002, but remained relatively stable at 9.3 percent in
2003. Among young adults (aged 19 to 28), rates of past year use also have
increased steadily from 1992 (2.5%) to 1997 (3.3%) to 2001 (5.0%), but
remained relatively stable at 5.1 percent in 2002, the latest year for
which such data are available. MTF has surveyed eighth, tenth, and twelfth
graders since 2002 concerning use of OxyContin. Although each grade has
shown increases in OxyContin abuse from 2002 to 2003, increases were all
under 1 percent.
In the near future, other pharmaceutical manufacturers are expected to
release generic forms of OxyContin. It is unclear what effect this will
have on the level of OxyContin abuse; however, more individuals may visit
physicians to obtain OxyContin or its less expensive generic equivalent.
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Executive Office of the President
Office of National Drug Control Policy
High Intensity
Drug Trafficking Area
Appalachia
U.S. Department of Health and Human Services
National Institutes of Health
National
Institute on Drug Abuse
Monitoring the Future
Substance Abuse and Mental Health Services
Administration
Office of
Applied Studies
Drug Abuse Warning Network
National Survey on Drug Use and Health
Treatment Episode Data Set
U.S. Department of Justice
Drug Enforcement Administration
Detroit Field
Division
Miami Field
Division
National
Forensic Laboratory Information System
Philadelphia
Field Division
System To
Retrieve Information From Drug Evidence
Executive Office for U.S. Attorneys
U.S. Attorney's
Office
Southern District of Indiana
Office of the Deputy Attorney General
Organized Crime
Drug Enforcement Task Force
Office of Diversion Control
Automation of
Reports and Consolidated Orders System
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