This paper traces the history of oxycodone from its semi-synthetic creation to its emergence as a leading cause of prescription drug addiction and overdose deaths. It examines oxycodone's chemical composition and intended medical uses in pain management, describes its effects on the central nervous system and the mechanisms of physical dependence, and analyzes its current impact on public health and workplace productivity. The paper argues that while oxycodone has legitimate medical applications, its high addiction potential warrants stricter prescribing guidelines and prioritization of alternative pain management strategies.
Most of us think of opium and opiates in fairly dramatic terms. We think of Dorothy in the Wizard of Oz, lulled into a stupor after falling asleep in a field of poppies, or worse, the image of a person hopelessly captivated by heroin. However, the face of drug addiction is changing. Many people are now addicted to supposedly healthy, doctor-prescribed painkillers. Drugs like oxycodone have the same chemical composition as opiates like heroin, even though they were scientifically created in laboratories. This paper provides a brief history of oxycodone and its use and abuses.
Although oxycodone has many legitimate applications in pain management, it is not a harmless drug and has the potential to become extremely addictive. This addictive property was not initially noted, but after cases of abuse began to surface, concerns arose. As one source notes, "Until 1995, when the Food and Drug Administration approved OxyContin there was little concern over the abuse of oxycodone producers. But, in 1996 when the manufacturer of OxyContin began to market and distribute the drug, concerns and reports of illicit use and abuse began to increase." The rapid emergence of oxycodone as a public health threat marks a critical turning point in the history of prescription drug regulation.
Oxycodone is a semi-synthetic opiate manufactured by modifying the chemical thebaine, an organic chemical found in opium. It is the active ingredient in a number of commonly prescribed pain relief medications such as Percocet, Percodan, and Tylox. All of these common drugs contain low-dose forms of oxycodone. By far the most potent variety is OxyContin, with tablets that range in strength from 10 mg to 80 mg.
The intended use of OxyContin is for long-term relief (up to twelve hours) of moderate to severe pain associated with conditions such as cancer and arthritis. The tablets are time-released to ensure slower and steadier pain management. However, despite the apparently benign time-release format, OxyContin has proven to be extremely addictive and the subject of much criticism. It is often abused by adolescents, and abuse of the drug is on the rise. The drug has a high street value of $25–$40 for a pill that costs $4 to produce.
OxyContin, which may be the most recognized form of oxycodone, is a drug with high abuse potential and has been linked to numerous overdose deaths. In 1996, for example, data from the federal government linked oxycodone to 49 deaths. This early warning sign did not prevent the widespread adoption and marketing of the drug, a decision that would have profound public health consequences in the decades to follow.
When used properly, the drug is intended to blunt the sufferer's reaction to pain by depressing the central nervous system and the reactions it sends regarding pain messages. It is often prescribed for individuals experiencing chronic pain from diseases like cancer and arthritis. However, abusers may use it as a substitute for heroin, or they experience a "high" because of its depressive effects on the nervous system. Oxycodone products and all medications containing it are Schedule II controlled substances, reflecting their recognized abuse potential.
The drug also causes elevated levels of dopamine, a neurotransmitter linked to stimulating a sensation of pleasure in the user. This is another similarity with heroin. Tolerance develops as the body responds to repeated use of the drug by producing less dopamine. The less dopamine produced by the body, the greater the addict's need for the drug. This biochemical cycle creates a powerful mechanism of physical dependence that is extremely difficult to break without medical intervention.
Because of its physically addictive nature and the "crash" experienced with withdrawal from regular use, most people find it impossible to quit oxycodone without formal support. Withdrawal symptoms may be severe and can include anxiety, nausea, insomnia, muscle pain, fevers, and other flu-like symptoms. The use of a rehabilitation facility is frequently recommended for chronic addicts. The severity of withdrawal is one reason why addiction to oxycodone persists even when users recognize its dangers.
The scale of the oxycodone crisis has reached epidemic proportions. The number of annual overdose deaths from narcotic painkillers has grown four times higher than it was a decade ago. The current statistic is that about 16,000 people a year die of overdoses involving prescription narcotics. Despite increasing awareness of the addictive potential of oxycodone and well-publicized cases of addiction, addiction rates and fatalities are on the rise.
Studies have indicated that when individuals are prescribed oxycodone for problems such as back pain resulting from a workplace injury, it is the leading predictor for them not returning to work for long periods of time, or ever. Thus, oxycodone abuse does not only have profound negative effects for the individual, but also for society as a whole in terms of lost productivity. The drug also causes permanent changes in the brain, reducing dopamine production and making it difficult for the abuser to experience pleasure in a normal fashion. This neurological damage extends the harm beyond the initial period of addiction, affecting long-term recovery prospects.
The main positive development regarding oxycodone is that awareness about drug addiction is growing regarding prescription drug use and abuse. However, the epidemic, particularly in its street form, continues to grow nationally and internationally. The drug is prescribed and continues to be prescribed for certain legitimate uses, but the addictive potential suggests that it should be more limited in the range of conditions for which it is prescribed, with a focus on short-term use for those with a low risk of addiction (such as after wisdom tooth extraction) or for individuals who are severely ill with chronic conditions such as persons undergoing cancer treatment.
For persons experiencing chronic pain as a result of injuries, less addictive drugs and rehabilitative therapy seem warranted. Pain prescriptions like oxycodone may seem like an "easy fix" for their palliative effects, but the damage done to both the sufferer and society ultimately results in more costs than gains. A more cautious and selective approach to oxycodone prescribing can help preserve its legitimate medical use while reducing the broader public health catastrophe it has become.
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