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6/18/2001

Federal Reports Say Oxycodone Abuse Is On The Rise

Donna Young

Midwestern farmlands, small Appalachian towns, and rural areas along the eastern seaboard are facing a crisis: a sudden increase in the abuse of the extended-release formulation of oxycodone hydrochloride known as OxyContin, according to the U.S. Justice Department and the Drug Enforcement Administration (DEA).

DEA says pharmacists, law enforcement officials, and drug abuse treatment centers in Kentucky, Maine, Maryland, Ohio, Pennsylvania, Virginia, and West Virginia have reported that abuse of the product is on the rise.

The National Association of Attorneys General (NAAG) stepped in May 14, convening its first meeting of the Prescription Drug Abuse Task Force at the organization's headquarters in Washington, D.C. NAAG said the group met to develop strategies for reducing the illegal use of prescription drugs, particularly OxyContin.

J. Joseph Curran, Jr., Maryland's attorney general, said the task force faces the dilemma of ensuring that physicians and pharmacists can provide patients who need OxyContin with the drug while keeping the drug off the illegal market.

"It is a good drug for those who are in need of pain relief," Curran said. "But sadly, we are getting reports from law enforcement about the increase of illegal sales and reports of overdose deaths."

The appeal of OxyContin. Purdue Pharma LP of Stamford, Connecticut, developed OxyContin in 1996 and sells it as 10-, 20-, 40-, and 80-mg tablets. A 160-mg tablet became available in July 2000, but Purdue pulled it from the market in May because of concerns about the possibility of illicit use of the high-strength product.

According to the Justice Department's National Drug Intelligence Center (NDIC) January 2001 report, OxyContin Diversion and Abuse, OxyContin has become the oxycodone product of choice for drug abusers.

Drug abusers choose OxyContin over immediate-release oxycodone products because of the former's strength, potential for rapid release, and high absorption when chewed or snorted, the NDIC report said.

Some OxyContin abusers crush the tablets, dissolve the powder in water, and then inject the solution, according to the report.

Kentucky Computer System Tracks Prescription Drug Abuse

Danna Droz, manager of the drug enforcement branch of the Kentucky department of public health, said every state in the nation has a problem with prescription drug abuse.

Droz said her state has received a lot of national media attention because of a serious problem with the illicit use of oxycodone products, specifically OxyContin.

"Kentucky is not unique," she said. "We just have a better idea of how bad the problem is in our state because we have a better way to track things."

Droz said Kentucky is one of 18 states with an automated database that pharmacists, physicians, and law enforcement officials can use to track whether a person is filling multiple prescriptions for the same drug at various locations.

The Kentucky All-Schedule Prescription Electronic Reporting system helps to identify people who are obtaining high volumes of a particular drug, a sign that they might possibly be overusing or illegally selling the drug, Droz said. All pharmacies, including mail-order pharmacy programs that ship into Kentucky, must report prescription information to the state.

Droz said her state passed legislation in 1998 to implement the system. And by the following year, the system was up and running.

Kentucky officials looked at other systems already installed in several other states, including Massachusetts, Nevada, Utah, Indiana, and Hawaii.

"We had to make sure our system was secure because it contains highly confidential information," she added. "We think we have the best system available."

Oklahoma was the first state in the nation to have a prescription tracking system, Droz said. It was implemented in the early 1990s.

Kentucky and Utah are the only states that have systems that monitor all Schedule II–V controlled substances, according to Droz.

"The good thing about all of the talk surrounding OxyContin is that it has brought attention to the overall problem of prescription drug abuse," Droz said.

The Justice Department said OxyContin and heroin have similar effects.

But James Heins, spokesman for Purdue, disputed that claim. "It's unfortunate that they are making comparisons of a legal prescription drug to an illicit drug," Heins said. "That creates barriers for patients to receive effective pain care."

The Justice Department said state police in Kentucky have seen a major shift from the abuse of cocaine and methamphetamine to OxyContin and other oxycodone products. In Maine, the U.S. district attorney has identified OxyContin as the most significant drug threat in the state, according to the report. And nearly 85% of arrests in 1999 for writing false prescriptions in Maryland involved oxycodone products, including OxyContin, the report stated.

Beyond abuse. Pharmacies have seen an increase in robberies and thefts in which suspects sought OxyContin, according to the Justice Department.

In Virginia's Tazewell County, thieves demanding only OxyContin have robbed at least 10 pharmacies since February 1999, according to the NDIC report. Some Tazewell pharmacies have ceased dispensing OxyContin and have posted signs telling customers that the product is no longer stocked.

Tablets sell on the street for between 50 cents to $1 per milligram of oxycodone hydrochloride, according to federal reports. Drug dealers can illegally sell a 40-mg tablet for $25–$45.

Patients who "doctor shop," or go from physician to physician, to obtain numerous prescriptions of oxycodone are another source of the drug's introduction to illegal sales, according to federal accounts.

DEA said forged prescriptions and the unscrupulous practices of pharmacists, physicians, and dentists are other ways oxycodone products have made it to the streets.

Bret Crow, spokesman for Ohio Attorney General Betty D. Montgomery, said a physician in his state was recently convicted of illegally selling prescriptions of oxycodone products and was sentenced to three years in prison, fined $20,000, and had to forfeit $5,000 in cash and possessions.

"Most of the problems with illegal selling of OxyContin and oxycodone in Ohio are in Cincinnati and around the border of Kentucky," Crow said.

From January to October 2000, illicit drug dealers in Cincinnati diverted over 9000 doses of OxyContin, according to the Justice Department. The department noted that a local newspaper in Hocking County, Ohio, reported that four residents overdosed on OxyContin over an 18-day period.

Death toll. The NDIC report said several deaths have resulted from the abuse of OxyContin in Kentucky, Ohio, Virginia, and West Virginia. In Pike County, Kentucky, the coroner reported 19 OxyContin-related deaths during 2000, according to the report. And in Southeastern Kentucky, the state police reported seven overdose-related deaths from OxyContin.

But Purdue argues in a recent statement that "one difficulty in obtaining accurate data on the reported drug overdose deaths is that blood tests only determine the presence and amount of oxycodone; they cannot differentiate between the many frequently prescribed analgesics that contain this ingredient. Last year, those other products accounted for approximately 75% of the prescriptions written for oxycodone-containing medications."

Purdue said the company has been unable to determine the exact number of deaths caused by the abusive misuse of OxyContin, but it has "sound reasons to conclude that the actual number is fewer than is reported in the media."

Heins added that media reports have caused some physicians not to prescribe OxyContin because they fear scrutiny. "We are getting calls from patients that are being cut off from the drug because their doctor is afraid of being targeted by law enforcement and regulatory agencies."

There were 262 deaths in 1999 that occurred from the abuse of oxycodone products, according to a recent report by the federal Substance Abuse and Mental Health Services Administration. Emergency room visits related to the abuse of oxycodone have more than doubled—from 3190 in 1996 to 6429 in 1999, the report said. Every age, ethnic, and economic group has been part of the increase in oxycodone abuse. Of the 262 reported deaths in 1999, however, most were 35- to 44-year-old white men.

Randy Davis, spokesman for former Virginia Attorney General Mark Earley, said that since 1997, there have been 42 deaths in the state from the abuse of oxycodone products.

Earley was the chairman of the NAAG Prescription Drug Abuse Task Force before he stepped down to run for governor of Virginia. He had established a task force to investigate the problem of abuse and illicit sales of prescription drugs in his state.

The Virginia task force includes pharmacists, physicians, and law enforcement officials who are actively providing guidance, according to Davis. The task force is working in association with regulatory boards and professional associations to build consensus support for the task force's recommendations, he said.

Davis said Purdue has pledged to cosponsor, with the attorney general's office, a series of continuing-education programs for health care professionals in Southwest Virginia, focusing on the nature and extent of OxyContin abuse. On the national level, he said, Purdue is working with law enforcement groups in other states to help educate professionals and the public.

Purdue said it has distributed more than 400,000 brochures to pharmacists and health care professionals to help educate them on how to prevent diversion. The company said it has pledged $100,000 to fund a study of the best practices in prescription monitoring programs to develop a system that will thwart "doctor shopping" while not interfering with the delivery of medical services.

Purdue also said it made a $25,000 challenge grant to the Appalachian Pain Foundation for multistate education and outreach efforts and a $20,000 grant to another nonprofit group in Virginia to support drug-abuse prevention programs for teens.

On an international level, Davis said Purdue will be marking OxyContin tablets destined for Mexico with an "M" and tablets shipped to Canada with a "C," so law enforcement can determine whether tablets seized in the United States are coming across the international borders.

Representative W. J. Tauzin, chairman of the House Committee on Energy and Commerce, noted in a March committee correspondence that customs inspectors had expressed concern about the importation of controlled substances, such as OxyContin, by people crossing the border from Tijuana into the United States at the port of San Ysidro, California.

Maryland's Curran said the NAAG task force has asked Purdue to investigate ways to decrease the potency of crushed OxyContin to make it less appealing to the illegal market. The NAAG task force, he said, plans to meet with medical school faculties, pharmacy and physician associations, and law enforcement groups to develop prescription-drug-abuse education programs for the public.

"What we face now is, where do we go from here?" Curran said.