Oxycodone misuse sparked opioid epidemic
The start of the opioid epidemic is ironically linked to a drug that was supposed to help people suffering from moderate to severe pain.
While oxycodone was first synthesized by German scientists during the 1910s, it wasn’t until the mid-1990s — with the development and release of the painkiller OxyContin — when the chemical’s full potential for abuse was realized.
OxyContin, a prescription painkiller developed by Purdue Pharma, received FDA approval in 1995 and reached the U.S. market the following year, slowly spreading to other countries. It took off immediately, largely on the strength of marketing from Purdue and other drug companies.
“There was a big push by the pharmaceutical drug companies for doctors to use these medicines,” said Dr. Scott Cook, medical director of Recovery Centers of America at Monroeville. “We were told they were not addictive. It was obvious that these medications were addictive, but the marketing was so strong … that we ended up, as doctors, buying into this.”
Dr. C. Thomas Brophy, medical director at the Ellen O’Brien Gaiser Center in Butler, said oxycodone is an opioid receptor agonist, meaning it fully activates the opioid receptor and opens a channel that releases dopamine.
“If a person is taking an opioid for about 10 to 15 days, then they become chemically dependent on that opioid and they need it or else they go through withdrawal,” he said.
Although oxycodone, and all products containing it, have been listed as a Schedule II controlled substance by the U.S. government since 1970, this failed to stop oxycodone abuse from skyrocketing once OxyContin received approval.
“The worst of it was probably around 2005 to 2015,” Brophy said. “During that 10-year period, massive amounts of oxycodone were being prescribed. … There were a lot of opioid prescriptions that were just being given automatically. Everybody who had surgery was given a preprinted prescription for 30 pills or 60 pills.”
At one point, the drug — which usually comes in 10mg, 20mg, 40mg, and 80mg tablets — could easily be abused by crushing the tablets and ingesting them, or dissolving them in water and injecting the mixture to receive a “high.”
Some clinics, known as “pill mills,” gained a reputation for being able to supply users with large amounts of OxyContin and other opioids of abuse. According to Cook, it became difficult to track down whether or not a user already had a prescription.
“A patient could go to Doctor A at 9 a.m., get a bunch of pain pills prescribed, fill them, then go see Doctor B at 12 noon and get more pain pills filled,” Cook said. “We had no way to double-check.”
Brophy agreed.
“There were even physicians … that were known as “the candy man,” and addicts would specifically seek out those physicians because they knew that they could get a prescription for the drug that they wanted,” he said.
To keep patients safe, one local dentist — Dr. Paul Keelan, who owns Keelan Dental in Butler and Valencia — steers clear of oxycodone in his practice.
“We never prescribe oxycodone and only occasionally hydrocodone,” Keelan said. “We have tried to move away completely from prescribing narcotics in our office.”
In 2010, Purdue Pharma — the developers of OxyContin — reformulated the drug to make it harder for users to abuse. According to the Pharmaceutical Journal, in a 2015 survey of 10,784 patients with opioid-use disorder, only 26% of them said they used OxyContin in 2012, compared to 45.1% in 2009.
However, this change had an unintended side effect.
“When people are desperate and they're looking for more oxycodone, they revert to more of the illicit drug market,” Brophy said.
According to the New England Journal of Medicine, many of those who were already hooked on the substance ended up switching to harder illicit drugs such as heroin, which were easier and cheaper to obtain anyway.
By the mid-2010s, the opioid epidemic finally became too prominent to ignore, leading to statewide and nationwide crackdowns on the amount of OxyContin and other opioid prescriptions. In 2016, the Centers for Disease Control enacted guidelines on prescribing opioids for chronic pain.
“(OxyContin) became kind of the poster child for the opioid crisis, because the numbers of prescriptions really skyrocketed in a 20-year period,” Cook said.
According to Kaiser Family Health, opioid prescriptions among Medicaid enrollees fell by 44% from 2016 to 2019.
“Everything was changed as far as guidelines for managing acute pain and managing chronic pain,” Brophy said. “The only physicians that are prescribing more than 10 days worth of oxycodone at a time are the pain clinic doctors, and they're very selective about who they choose.”
Patient reaction to the new pain management guidelines is mixed.
“We have had pushback from patients when we tell them we will not be prescribing narcotics, and an equal amount relieved that we will not be prescribing a narcotic,” Keelan said. “We explain the reasoning but there is definitely a prevalence of thought among patients that narcotics are the norm.”
Although prescriptions of oxycodone have dropped off in recent years, they haven’t stopped, largely because there are some cases the drug can do that no other pain medicine can.
“Oxycodone is still used for acute pain,” Brophy said. “Like a bone that was fractured, and that person's going to be in pretty severe pain for the first three to five days. But as their body heals, the need for pain medication should go down significantly.”
However, most previous use cases for oxycodone have given way to alternative forms of pain management.
“If it goes beyond (three to five days), then the appropriate thing is to refer the patient to a chronic pain management facility,” Brophy said. “That's where they talk about all the different options and alternatives, which include long-term transdermal patches and things like that.”
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