Opioid epidemic Oxycodone, like other opioid analgesics, tends to induce feelings of euphoria, relaxation, and reduced anxiety in those who are occasional users. The abuse of Oxycodone, as well as related opioids more broadly, is not unique to the United States and it is a common drug of abuse globally.
United States Oxycodone is the most widely recreationally used opioid in America. In the United States, more than 12 million people use opioid drugs recreationally. The
U.S. Department of Health and Human Services estimates that about 11 million people in the U.S. consume oxycodone in a non-medical way annually. Opioids were responsible for 49,000 of the 72,000
drug overdose deaths in the U.S. in 2017. In 2007, about 42,800 emergency room visits occurred due to "episodes" involving oxycodone. In 2008, recreational use of oxycodone and hydrocodone was involved in 14,800 deaths. Some of the cases were due to overdoses of the acetaminophen component, resulting in fatal liver damage. In September 2013, the US
Food and Drug Administration (FDA) released updated labeling guidelines for long-acting and extended-release opioids requiring manufacturers to remove moderate pain as an indication for use, instead stating the drug is for "pain severe enough to require daily, around-the-clock, long term opioid treatment". The updated labeling does not restrict physicians from prescribing opioids for moderate pain, as needed.
Lawsuits In October 2017,
The New Yorker published a story on
Mortimer Sackler and
Purdue Pharma regarding their ties to the production and manipulation of the oxycodone markets. In 2019,
The New York Times ran a piece confirming that
Richard Sackler, the son of Raymond Sackler, told company officials in 2008 to "measure our performance by Rx's by strength, giving higher measures to higher strengths". This was verified with documents tied to a lawsuit – which was filed by the Massachusetts attorney general,
Maura Healey – claiming that Purdue Pharma and members of the Sackler family knew that high doses of OxyContin over long periods would increase the risk of serious side effects, including addiction. Despite Purdue Pharma's proposal for a US$12 billion settlement of the lawsuit, the attorneys general of 23 states, including Massachusetts, rejected the settlement offer in September 2019.
Australia The non-medical use of oxycodone existed since the early 1970s, but by 2015, 91% of a national sample of injecting drug users in Australia had reported using oxycodone, and 27% had injected it in the last six months.
Canada Opioid-related deaths in Ontario had increased by 242% from 1969 to 2014. By 2009 in Ontario there were more deaths from oxycodone overdoses than from cocaine overdoses. Deaths from opioid pain relievers had increased from 13.7 deaths per million residents in 1991 to 27.2 deaths per million residents in 2004. The non-medical use of oxycodone in Canada became a problem. Areas where oxycodone is most problematic are
Atlantic Canada and
Ontario, where its non-medical use is prevalent in rural towns and in many smaller to medium-sized cities. Oxycodone is also widely available across
Western Canada, but
methamphetamine and
heroin are more serious problems in larger cities, while oxycodone is more common in rural towns. Oxycodone is diverted through
doctor shopping, prescription forgery, pharmacy theft, and overprescription. The recent formulations of oxycodone, particularly Purdue Pharma's crush-, chew-, injection- and dissolve-resistant OxyNEO which replaced the banned OxyContin product in Canada in early 2012, have led to a decline in the recreational use of this opiate but have increased the recreational use of the more potent drug fentanyl. According to a Canadian Centre on Substance Abuse study quoted in
Maclean's magazine, there were at least 655 fentanyl-related deaths in Canada in five years. In Alberta, the Blood Tribe police claimed that from the fall of 2014 through January 2015, oxycodone pills or a lethal fake variation referred to as Oxy 80s containing
fentanyl made in illegal labs by members of organized crime were responsible for ten deaths on the
Blood Reserve, which is located southwest of
Lethbridge,
Alberta. Province-wide, approximately 120 Albertans died from fentanyl-related overdoses in 2014. The first known death due to overdose in the UK occurred in 2002.
Preventive measures In August 2010,
Purdue Pharma reformulated their long-acting oxycodone line, marketed as OxyContin, using a polymer, Intac, to make the pills more difficult to crush or dissolve in water to reduce non-medical use of OxyContin.
Inactive ingredients/excipients are
butylated hydroxytoluene (BHT),
hypromellose,
polyethylene glycol 400, polyethylene oxide, magnesium stearate, and titanium dioxide.
Pfizer manufactures a preparation of short-acting oxycodone, marketed as Oxecta, which contains inactive ingredients, referred to as tamper-resistant Aversion Technology. Approved by the FDA in the U.S. in June 2011, the new formulation, while not being able to deter oral recreational use, makes crushing, chewing, snorting, or injecting the opioid impractical because of a change in its chemical properties.
Legal status Oxycodone is subject to international conventions on narcotic drugs. In addition, oxycodone is subject to national laws that differ by country. The 1931
Convention for Limiting the Manufacture and Regulating the Distribution of Narcotic Drugs of the
League of Nations included oxycodone. The 1961
Single Convention on Narcotic Drugs of the
United Nations, which replaced the 1931 convention, categorized oxycodone in Schedule I. Global restrictions on Schedule I drugs include "limit[ing] exclusively to medical and scientific purposes the production, manufacture, export, import, distribution of, trade in, use and possession of" these drugs; "requir[ing] medical prescriptions for the supply or dispensation of [these] drugs to individuals"; and "prevent[ing] the accumulation" of quantities of these drugs "in excess of those required for the normal conduct of business". In addition, it is in Schedule 8 of the Australian Standard for the Uniform Scheduling of Drugs and Poisons ("Poisons Standard"), meaning it is a "controlled drug... which should be available for use but require[s] restriction of manufacture, supply, distribution, possession and use to reduce abuse, misuse and physical or psychological dependence".
Canada Oxycodone is a controlled substance under Schedule I of the
Controlled Drugs and Substances Act (CDSA). In February 2012, Ontario passed legislation to allow the expansion of an already existing drug-tracking system for publicly funded drugs to include those that are privately insured. This database will function to identify and monitor patient's attempts to seek prescriptions from multiple doctors or retrieve them from multiple pharmacies. Other provinces have proposed similar legislation, while some, such as Nova Scotia, have legislation already in effect for monitoring prescription drug use. These changes have coincided with other changes in Ontario's legislation to target the misuse of painkillers and high addiction rates to drugs such as oxycodone. As of 29 February 2012, Ontario passed legislation delisting oxycodone from the province's public drug benefit program. This was a first for any province to delist a drug based on addictive properties. The new law prohibits prescriptions for OxyNeo except to certain patients under the Exceptional Access Program including palliative care and in other extenuating circumstances. Patients already prescribed oxycodone will receive coverage for an additional year for OxyNeo, and after that, it will be disallowed unless designated under the exceptional access program. Much of the legislative activity has stemmed from Purdue Pharma's decision in 2011 to begin a modification of OxyContin's composition to make it more difficult to crush for snorting or injecting. The new formulation, OxyNeo, is intended to be preventive in this regard and retain its effectiveness as a painkiller. Since introducing its
Narcotics Safety and Awareness Act, Ontario has committed to focusing on drug addiction, particularly in the monitoring and identification of problem opioid prescriptions, as well as the education of patients, doctors, and pharmacists. This Act, introduced in 2010, commits to the establishment of a unified database to fulfil this intention. Both the public and medical community have received the legislation positively, though concerns about the ramifications of legal changes have been expressed. Because laws are largely provincially regulated, many speculate a national strategy is needed to prevent smuggling across provincial borders from jurisdictions with looser restrictions. In 2015, Purdue Pharma's abuse-resistant OxyNEO and six generic versions of OxyContin had been on the Canada-wide approved list for prescriptions since 2012. In June 2015, then-federal Minister of Health Rona Ambrose announced that within three years, all oxycodone products sold in Canada would need to be tamper-resistant. Some experts warned that the generic product manufacturers may not have the technology to achieve that goal, possibly giving Purdue Pharma a monopoly on this opiate. Several class-action suits across Canada have been launched against the Purdue group of companies and affiliates. Claimants argue the pharmaceutical manufacturers did not meet a standard of care and were negligent in doing so. These lawsuits reference earlier judgments in the United States, which held that Purdue was liable for wrongful marketing practices and misbranding. Since 2007, the Purdue companies have paid over CAN$650 million in settling litigation or facing criminal fines.
Germany The drug is in Appendix III of the Narcotics Act (
Betäubungsmittelgesetz or BtMG). The law allows only physicians, dentists, and veterinarians to prescribe oxycodone and the federal government to regulate the prescriptions (e.g., by requiring reporting).
Japan Oxycodone is a restricted drug in Japan. Its import and export are strictly restricted to specially designated organizations having a prior permit to import it. In a high-profile case an American who was a top Toyota executive living in Tokyo, who claimed to be unaware of the law, was arrested for importing oxycodone into Japan.
Singapore Oxycodone is listed as a Class A drug in the
Misuse of Drugs Act of Singapore, which means offences concerning the drug attract the most severe level of punishment. A conviction for unauthorized manufacture of the drug attracts a
minimum sentence of 10 years of imprisonment and
corporal punishment of 5 strokes of the cane, and a maximum sentence of life imprisonment or 30 years of imprisonment and 15 strokes of the cane. The minimum and maximum penalties for unauthorized trafficking in the drug are respectively 5 years of imprisonment and 5 strokes of the cane, and 20 years of imprisonment and 15 strokes of the cane.
United Kingdom Oxycodone is a Class A drug under the
Misuse of Drugs Act 1971. For Class A drugs, which are "considered to be the most likely to cause harm", possession without a prescription is punishable by up to seven years in prison, an unlimited fine, or both. Dealing of the drug illegally is punishable by up to life imprisonment, an unlimited fine, or both.
United States Under the Controlled Substances Act, oxycodone is a
Schedule II controlled substance whether by itself or part of a multi-ingredient medication. The
Drug Enforcement Administration (DEA) lists oxycodone both for sale and for use in manufacturing other opioids as ACSCN 9143 and in 2013 approved the following annual aggregate manufacturing quotas: 131.5 metric tons for sale, down from 153.75 in 2012, and 10.25 metric tons for conversion, unchanged from the previous year. In 2020, oxycodone possession was decriminalized in the U.S. state of
Oregon.
Economics The
International Narcotics Control Board estimated of oxycodone were manufactured worldwide in 1998; United States accounted for 82% of consumption in 2007 at . Canada, Germany, Australia, and France combined accounted for 13% of consumption in 2007. In 2010, of oxycodone were illegally manufactured using a fake pill imprint. This accounted for 0.8% of consumption. These illicit tablets were later seized by the U.S. Drug Enforcement Administration, according to the International Narcotics Control Board. The board also reported manufactured in 2010. This number had decreased from a record high of in 2009.
Names Expanded expressions for the compound oxycodone in the academic literature include "dihydrohydroxycodeinone", "Eucodal", The word "oxycodone" should not be confused with "
oxandrolone", "
oxazepam", "
oxybutynin", "
oxytocin", or "
Roxanol". Other brand names include Longtec and Shortec. == References ==