Oxycodone and hydrocodone are the “drugs of choice” for abusers of opioid pain medication, according to a new survey of thousands of opioid addicts entering drug treatment programs across the United States.
While the results are not altogether surprising because oxycodone and hydrocodone are the two most commonly prescribed painkillers, the survey results do provide some insights into why abusers prefer them.
Oxycodone, for example, is preferred for the quality of the high it gives. It is also more likely to be tampered with – inhaled or injected – by a drug abuser.
Hydrocodone is less popular because it has a lesser euphoric effect. But it is also cheaper and easier to obtain because it is so widely prescribed.
“The data show that hydrocodone is popular because it is relatively inexpensive, easily accessible through physicians, friends, and families, and is perceived as relatively safe to use, particularly by risk-averse users. This group includes generally risk-averse women, elderly people, non-injectors, and those who prefer safer modes of acquisition than dealers, such as doctors, friends, or family members,” says Theodore Cicero, PhD, of the Department of Psychiatry at Washington University in St. Louis.
“In contrast, we found that oxycodone is much more attractive to risk-tolerant young male users who prefer to inject or snort their drugs to get high and are willing to use riskier forms of diversion despite paying twice as much for oxycodone than hydrocodone.”
Cicero and other researchers at Washington University in St. Louis and the Center for Applied Research on Substance Use and Health Disparities at Nova Southeastern University in Miami surveyed over 3,500 opioid addicts, asking about their drug use, health care coverage and other factors involved in their choice of opioids.
The researchers found “compelling evidence” that over half of the addicts abused opioids not only to get high, but to help relieve their pain — suggesting that the drugs they were introduced to as pain patients led to their abuse.
“Participants who used hydrocodone as a primary drug, in addition to having far more associations with pain management than oxycodone users, also indicated that the ‘high’ was not euphoria in the typical meaning of the word. Rather, the relief of pain resulted in an increase in mood and energy, and it was this that led them to use opioids to alter their mood,” the researchers wrote.
Despite its high abuse rate among prescription opioid abusers, hydrocodone is viewed as less attractive than oxycodone by active abusers because hydrocodone is frequently combined with acetaminophen in combination products such as Vicodin. Acetaminophen overdoses are one of the leading causes of liver failure.
“One of the reasons I was abusing oxycodone in the end more than hydrocodone was because I was too scared about the APAP (acetaminophen) damage to my liver,” one drug abuser answered in the survey.
Hydrocodone is the most widely prescribed drug in the U.S. Over 130 million prescriptions were filled for Vicodin alone in 2010. The Food and Drug Administration recently said it would seek tighter restrictions on hydrocodone by reclassifying it as Schedule II controlled substance, making it harder to obtain for both addicts and legitimate pain patients.
Oxycodone users in the survey were more likely to tamper with the drug in order to inhale or inject it, one reason why Purdue Pharma introduced a “tamper resistant” formula of OxyContin in 2010. Although the new formulation OxyContin was harder to crush or liquefy – many addicts said they continued to abuse it or switched to heroin.
“I was a user that did shoot them but if I couldn’t do it that way then I would have just swallowed them. Yes the initial rush would not be there but I would still get the after-effects of it and wouldn’t be sick from withdrawals so it really wouldn’t have changed my usage, just the route administered,’’ one addict said.
“Because of the change in the OxyContin formulation, I tried heroin for the first time,” another addict said. “I did that in part because you couldn’t smoke or snort the OxyContin pills anymore so I resorted to something you could do that with. EVERY single person I know now that used pills, now uses heroin because of the change in formulation.”
The study is published in the current issue of PAIN.