MEDTOX Journal February 2009

One of the axioms of criminal justice and healthcare professionals is that people with untreated pain issues will often resort to the purchase of narcotics out on the street and maintain lives as addicts. It is also widely believed that a percentage of people properly treated with narcotics will develop problems with their control once the drugs are discontinued. In some parts of the country, prescription narcotic abuse is rampant, other parts of the country it isn't. The most popularly abused opiates are drugs like Vicodin (hydrocodone) and Oxycontin (continual release oxycodone), these drugs are taken orally in their tablet form or they are crushed up and injected intravenously.

Of great concern is the abuse of Oxycontin and its new generic versions. It is a compact, powerful drug that is composed of a concentrated dose of oxycodone that's designed to uniformly dissolve over a 12-hour period of time. To a achieve a uniform, consistent release of the drug, a substantial amount of oxycodone is compacted with a binder that controls the rate that the drug breaks down and released absorbed into the bloodstream. When the drug is crushed up, dissolved in water and then allowed to dry, Oxycontin has been converted into a sort of Oxy-now! When injected or smoked, the drug is totally, rapidly absorbed into the bloodstream. Many career heroin users describe the high as being better than that of heroin. (This claim actually makes sense when one takes the time to study oxycodone's pharmacology)

It's been unclear as to the pathways that people addicted to Oxycontin and Vicodin take to get to a point of dependency. The public regularly hears about repeated stories of professional athletes who have become dependent on opiates because of their chronic use of the drugs to treat pain caused by severe skeletal wear and tear. Although these cases do and will continue to occur, it's more evident that Oxycontin and Vicodin abusers present with backgrounds that are decidedly different. In a recently published study in the American Journal of Drug and Alcohol Abuse[1], researchers from the University of Kentucky College of Medicine found that the precipitating factors of rural prescription opiate abuse were not related to uncontrolled pain or dependencies caused by over prescribing by physicians. Rather the factors most associated with opiate abuse were prior illicit drug use with substances such as methamphetamine, cocaine and heroin along and histories of psychiatric and mental health problems.

There was no correlation of prescription opiate abuse with pain syndromes or other health related isues. It is also becoming clear that there is considerable movement in the "drug of choice" decisions made by chronic users of methamphetamine, cocaine and heroin. Drug users who've become physically wrung out by their initial drug of choice, switch over to a another and maybe diametrically different sort of drug as a means of managing or negating the cumulative side effects of their first choice drug. Oxycontin addicts who first started out as "meth" users or cocaine users and cross over to the relative slow lane of Oxy are not an uncommon occurrence anymore.; the movement in the opposite direction is also not unusual either. In communities where there is considerable prescription opiate abuse, these findings may help in the development of needed outreach and community based programs.

[1] Havens J, Stoops, W, Leukefeld, C et. al. Prescription opiate misuse among rural stimulant users in a multistate community-based study. J American Drug and Alcohol Abuse 2009; 35: 18-23.