Prescription Opioid Abusers Prefer to Get High on Oxycodone and Hydrocodone
Researchers investigate factors that influence the choice of abused
drugs, reports PAIN®
Philadelphia, PA, December 2, 2013
Prescription
opioid abuse has reached epidemic levels in the past 15 years. Scientists investigating
why people favor one drug over another have found that oxycodone and
hydrocodone are the drugs of choice for 75% of opioid-dependent individuals.
Their results, published in the current issue of PAIN®,show that oxycodone was the
most popular drug overall because of the quality of the high for those who
sought such effects. Nonetheless, hydrocodone remains one of the most popular
primary drugs, even though it has lower euphoric qualities. In addition, users
say they are concerned about acetaminophen poisoning since, until recently, all
hydrocodone products contained non-steroidal anti-inflammatory drugs.
Opioids
used to manage pain in general medicine and dentistry are not only well known
for their analgesic properties, but also for their ability to produce a high. Although
most opioid classes have seen increases in their misuse, hydrocodone and
oxycodone, which are the most commonly prescribed opioids in the United States,
are by far the most popular drugs of choice among prescription opioid abusers.
Both drugs have a long history of use for nontherapeutic purposes.
Investigators
from the Department of Psychiatry at Washington University in St. Louis
(Missouri) and the Center for Applied Research on Substance Use and Health
Disparities at Nova Southeastern University in Miami, Fla., sought to identify
the factors that influence the choice of primary drugs of abuse in 3,520
opioid-dependent individuals entering drug-treatment programs across the United
States. Prospective participants were identified through the ongoing nationwide
Survey of Key Informants' Patients (SKIP) program. That program is a key
element of the post marketing surveillance system, Researched Abuse, Diversion
and Addiction-Related Surveillance (RADARS®) System. SKIP consists of
more than 150 treatment centers, both public and privately funded, and is
geographically balanced with urban, suburban, and rural patients.
To
help determine the choice of one opioid over another, researchers used anonymous,
self-administered surveys to assess the influence of sex, age, race/ethnicity,
area of residence, source of income, health-care coverage, drug-use patterns,
and other decision-related factors.
To
add richness to the study, investigators also recruited 200 patients who
previously had completed the SKIP survey and indicated that they were willing
to give up their anonymity to participate in a follow-up study using
non-structured, qualitative interviews, dubbed Researchers and Participants
Interacting Directly (RAPID).
Oxycodone
was the choice of significantly more users (44.7%) than hydrocodone (29.4%)
because the quality of the high was viewed to be much better by oxycodone users
(54%) than hydrocodone users (20%). Far fewer participants selected any other
opioid as their primary drug. While 90% of users selected mood alteration as a
reason for using their primary drug, a very large percentage of each sample – 50%
to 60% -- indicated that the treatment of pain was also a factor in their use.
This finding suggests that, in the view of many patients, pain was inadequately
managed.
Despite
its high abuse rates among prescription opioid abusers, hydrocodone is viewed
as less attractive than oxycodone by active abusers because, unlike many
oxycodone products that are 100% oxycodone, hydrocodone is frequently combined
with acetaminophen. This can deter users from increasing the dose in order to
get high.
Oxycodone
users are more likely to tamper with their drugs in order to inhale or inject
the drug. The introduction of an OxyContin abuse-deterrent formulation in 2010
led to a significant drop in the use of OxyContin, but the overall impact on
total oxycodone users was not sufficiently significant to change the rank of
order of abuse rates; oxycodone products remained more popular than hydrocodone
products.
A key
question the researchers set out to answer is why hydrocodone remains one of
the most popular primary drugs even though it produces a lower quality of high
and raises the potential for acetaminophen poisoning.
"The
data show that hydrocodone is popular because it is relatively inexpensive,
easily accessible through physicians, friends, and families, and is perceived
as relatively safe to use, particularly by risk-averse users. This group
includes generally risk-averse women, elderly people, non-injectors, and those
who prefer safer modes of acquisition than dealers, such as doctors, friends,
or family members," says Theodore J. Cicero, PhD, of the Department of Psychiatry at Washington
University in St. Louis. "In contrast, we found that oxycodone is much
more attractive to risk-tolerant young male users who prefer to inject or snort
their drugs to get high and are willing to use riskier forms of diversion
despite paying twice as much for oxycodone than hydrocodone.
"It
is clear that not all drug abusers share the same characteristics," he
continues. "The decision to use one drug over another is a complex one, largely
attributable to individual differences such as personality, gender, age, and
other factors. Prevention and treatment approaches should benefit from this
because it may help prescribing physicians determine which drug to prescribe
and monitor for abuse."
# # #
Notes for editors
"Factors influencing the selection of hydrocodone and oxycodone as primary
opioids in substance abusers seeking treatment in the United States," by
Theodore J. Cicero, PhD; Matthew S. Ellis, MPE; Hilary L. Surratt, PhD; Steven
P. Kurtz, PhD (DOI: http://dx.doi.org/10.1016/j.pain.2013.07.025).
It appears in PAIN, Volume 154, Issue
12 (December 2013) published by Elsevier.
Full text of the article is available to credentialed
journalists upon request. Contact Terry Materese at +1 215 239 3196 or painmedia@elsevier.com for copies.
Journalists wishing to interview the authors should contact James Dryden at the
Office of Medical Public Affairs for Washington University in St. Louis at +1 314
286 0110 or jdryden@wustl.edu.
About PAIN®
PAIN®,
the official journal of the International Association for the Study of Pain® (IASP®), publishes 12
issues per year of original research on the nature, mechanisms, and treatment of
pain. This peer-reviewed journal provides a forum for the dissemination of
research in the basic and clinical sciences of multidisciplinary interest and
is cited in Current Contents and MEDLINE. It continues to be ranked No.1 out of
the 29 journals in the Anesthesiology category, according to the2012 Journal Citation Reports, published by Thomson Reuters. www.painjournalonline.com
About the International Association For The Study of PAIN®
(IASP®)
IASP® is the world's largest multidisciplinary
organization focused specifically on pain research and treatment. It is the
leading professional forum for science, practice, and education in the field of
pain, bringing together scientists, clinicians, health-care providers, and
policymakers to stimulate and support the study of pain and to translate that
knowledge into improved pain relief worldwide. Founded in 1973, IASP has nearly
8,000 members from 133 countries and in 90 chapters. www.iasp-pain.org
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Media contact
Terry Materese
+1 215 239 3196
+1 215 327 9934
painmedia@elsevier.com