The Death of Hillbilly Heroin?
OxyContin was developed in the 1990s for the purpose of providing around-the-clock relief from moderate to severe acute pain, chronic pain or pain associated with cancer or other terminal conditions. OxyContin contains the opioid drug oxycodone (other opioid drugs include morphine, codeine, heroin and methadone). OxyContin, with its time-release properties, was billed as an improvement on the decades-old Percocet, which contained 5 mg of oxycodone and gave pain relief for only about 5 hours. One 80mg OxyContin pill contains the same amount of oxycodone as 16 Percocets, and therein lies the fly in the proverbial ointment. Addicts quickly discovered that there was an amplified bang for their buck to take an OxyContin pill and crush it down in order to nullify the time-release coating. Once crushed, the OxyContin could then be chewed, snorted or dissolved in water and injected to produce a heroin-like euphoria. The risk to the abuser is significant and well-known: overdose and death.
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OxyContin was first introduced to the U.S. market in 1996. By 2001 OxyContin was leading the non-generic narcotic pain reliever segment and by 2008, U.S. sales topped $2.5 billion (roughly a half billion tablets). According to IMS-Brogan (which tracks drug trends), sales in Canada rose from $3 million in 1998 to $243 million in 2010. North Americans now consume more OxyContin than all other countries of the world combined. And somewhere along that timeline, OxyContin morphed from the panacea for terminal cancer patients into what is commonly referred to as “hillbilly heroin”. Each year in Ontario, there are more deaths due to OxyContin overdoses than due to drowning.
At the end of this month, the manufacturer is removing the brand OxyContin from the Canadian market. At the same time, as a result of a third party review of the Ontario Drug Benefit claims data looking at the use of oxycodone long-acting tablets, the Ontario Health Ministry is delisting OxyContin from the Ontario Drug Benefit (ODB) formulary. In addition, the Ministry will make it more difficult to access OxyContin's replacement, OxyNEO, which comes on the market March 1. OxyNEO will also contain oxycodone and offer the same effectiveness of OxyContin, but will be harder to crush, and will turn into a thick gel-like substance when 'cooked' or mixed with water for intravenous injection. OxyNEO will be funded through the province's Exceptional Access Program, which means the drug will be more tightly controlled. In order to obtain a prescription for a drug under the EAP, the patient's physician must submit a request to the Health Ministry providing the clinical rationale for requesting the unlisted drug. According to the Ministry's website, an EAP approval may take up to three months to process, from the date of the application request.
While the phasing out of funding of OxyContin under the ODB is to be loudly applauded, questions remain: How will communities, particularly those that are remote and have limited access to treatment options, respond to the acute surge of cases of oxycodone withdrawal? Will OxyContin addicts turn to heroin, cocaine or another opioid to fill the abyss, or will the limited supply on the streets simply drive up the price per pill (currently just shy of $80 for an 80mg dose) and set the scene for an explosion in crime rates? For addicts, March may indeed "come in like a lion".
Jennifer Hartman, guest blogger
* photo from Narconon International
