Oxycodone is the active ingredient of both Oxycontin and oxycodone, and at first glance it may seem like they are interchangeable as prescription opioids for pain management. I’ve posted about this before in an article titled, Oxycontin: What’s the Big Deal? A comment recently stating, “The big deal is that people are dying and going to jail every day because of untreated addiction to prescribed medication.” brought this issue back to the front of my mind.
Oxycodone is the active ingredient in many prescription pain meds, including Perocet, Tylox as well as the single ingredient generic oxycodone. It is also the active ingredient in the combination immediate and time release Oxycontin. The problem with Oxycontin is that a large percentage of the oxycodone is immediately released, while the rest is released over time. The purpose of this is to give immediate relief of pain, while keeping pain controlled over time with the delayed absorption of part of the medication. Unfortunately the large percentage released immediately of this particular opioid which has a higher euphoria effect than most opioids makes it a very popular drug of abuse, and even used appropriately it has a high incidence of addiction.
This has resulted in the development of a whole sub-culture of Oxycontin abuse. It’s become known as Hillbilly Heroin or just oxy on the streets. Oxycontin is very commonly pulverized into a powder to void the delayed release effect, and ingested, injected, snorted, or inhaled. Smoking Oxycontin has become a common problem in some areas of the country.Oxycontin is arguable the most abused opioid in the US, and is a drug of choice for many prescription opioid addicts. It has little if any advantage over alternative opioids and is generally best avoided in non-malignant terminal pain patients.
Although physicians have come under a great deal of criticism, sometimes appropriately for excessive prescription of opioids, especially Oxycontin, we have also come under criticism for inadequate treatment of chronic pain. Recommendations for obtaining expert consultation when prescribing long term opioids sound fine at face value, but at least in the community where I work it is nearly impossible to find such an expert for consultion.
In the last two months I’ve had two young male patients present to the office for help with Oxycontin addiction. Neither of them had ever received a prescription for Oxycontin from a health care provider. Both had been given the drug by a friend at their work. One was trying the med to help with a nagging back ache, another just to see how he liked using the drug. Both told me they quickly became physically and psychologically addicted within a couple of weeks.
In my community it drug seeking patients have become such a problem that many chronic pain patient can’t find a doctor to prescribe pain meds. Physicians who become known as willing to take new patients for chronic pain medication management are quickly targeted by both patients with serious medical problems with pain medication requirements and by the drug seeking abusers. This reputation can quickly make a practice unpleasant and put the physician at risk for sanctions by their state review board.
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