OxyContin® reported as emerging in fall 2001

OxyContin® not reported as emerging in fall 2001

Comments by Pulse Check sources highlight that OxyContin® diversion and abuse are increasing in many cities across the Nation: Billings, MTL,N: According to the law enforcement source, diverted OxyContin® availability and abuse are up dramatically. Both Billings nonmethadone treatment sources agree that OxyContin® abuse continues to increase, and one points out that the emergence of an illegal market for the drug underscores its increasing abuse. Columbia, SCN: Most of the younger abusers have been using it for a few years, but now they actively seek it, whereas previously they were just using it when it was available. Honolulu, HIL: “Honolulu’s drug market is slowly keeping up with national trends with diverted OxyContin®.” Memphis,TNL: Since the last reporting period, diverted OxyContin® sales have increased markedly, and the drug is often associated with the use of club drugs. Miami, FLL,E: OxyContin® has shifted from limited sales in private residences to being a “street drug,” according to the epidemiologic source. Similarly, according to the law enforcement source, OxyContin® is now available in the same neighborhoods and settings where crack is available. New Orleans, LAL: “OxyContin® is emerging, and we would like to get a grip on it before it becomes a problem like crack cocaine did in 1987.” New Orleans, LAM,N: Most of the clients in treatment for OxyContin® abuse are there because their doctors, who had been writing their prescriptions, have been arrested. Now that abusers’ sources are dry they have to come in for treatment. New York, NYE: “During this reporting period, OxyContin® has been sighted on the street for the first time, in two incidents where field researchers were approached by sellers.” By contrast, in two cities (both in the Northeast), OxyContin® diversion or abuse may be declining: Philadelphia, PAL: Media coverage and publicity, increased law enforcement focus, and arrests of key violators may have made potential diverters reconsider selling the drug. Portland, MEE: Diverted OxyContin® availability has declined, most likely because “tightened controls have made it more difficult to obtain OxyContin® than in the past.”

DIVERTED OXYCONTIN®: THE DRUG

How available is diverted OxyContin®? (Exhibits 2 and 3) Across the Nation, more than half (51 percent) of law enforcement and epidemiologic/ ethnographic sources report OxyContin® as somewhat or widely available. Moreover, OxyContin® availability continues to increase markedly: 45 percent of respondents report increasing availability, and only one (the Portland [ME] epidemiologic source) reports declining availability. Sources in the Northeast and South continue to report wider availability than sources elsewhere, and more southern sources report increases in availability than do their northeastern, midwestern, and western counterparts. The Philadelphia epidemiologic source adds that demand for the drug in that city is higher than supply, particularly because of law enforcement crackdowns.

Exhibit 2.

How available is diverted OxyContin® across the 20 Pulse Check cities (fall 2001)?

*The law enforcement source in Baltimore did not respond, and the epidemiologic/ethnographic sources in Columbia (SC), Denver, and Honolulu did not provide this information.

How much does diverted OxyContin® cost, and how is it referred to and packaged?
According to law enforcement and epidemiologic/ethnographic sources, OxyContin® continues to cost $1 per milligram in most reporting Pulse Check cities (Boston, Detroit, Miami, Philadelphia, Portland [ME], and Washington DC), with no price changes reported since the last Pulse Check. Pills cost $100 per 40 milligrams in New Orleans and $40 per 20 milligrams in Billings. According to the Memphis epidemiologic source, OxyContin® is often bartered rather than sold, sometimes for crack, other prescription drugs, or ecstasy.

Exhibit 3. How has diverted OxyContin® availability changed (spring 2001 vs fall 2001)?*

*The Baltimore law enforcement source did not respond, and the Columbia (SC), Denver, Honolulu, and New Orleans epidemiologic/ ethnographic sources did not provide this information.

Where available, diverted OxyContin® continues to be referred to as “oxy” or “OCs.” Other slang terms vary by city: in Philadelphia it is referred to simply as “O”; in New Orleans, it is referred to as “ox”; and in Columbia (SC), it is referred to as “kicker,” a new term since the last reporting period. In some cities, slang terms refer to the number of milligrams in a pill; for example, in Miami, an OxyContin® pill is often called a “40” or an “80,” and in New Orleans, a pill is called a “40-bar.”

As reported in the last Pulse Check, most diverted OxyContin® is sold as loose pills, although prescription containers are also used in Honolulu, Memphis, and Portland. In Boston, the diverted pills are packaged in small, brown envelopes; and in Billings, they continue to be packaged in miniature coin zipper bags. Packaging has not changed since the last Pulse Check, according to law enforcement and epidemiologic/ ethnographic respondents.

DIVERTED OXYCONTIN®: THE SELLERS

How is OxyContin® diverted?
According to law enforcement sources, OxyContin® continues to be diverted from pharmacies in a variety of ways within Pulse Check communities. The most frequently mentioned diversion method is forging prescriptions, as reported in Boston, Columbia (SC), Denver, Miami, New Orleans, New York, Philadelphia, Portland (ME), and Washington, DC; followed by doctor shopping in Billings, Boston, Honolulu, New York, Philadelphia, Portland, and Sioux Falls; patients filling legal and legitimate prescriptions but selling some of the pills in Billings, Detroit, New Orleans, New York, and Washington, DC; doctors prescribing it illegally for a fee or misprescribing it in Boston, Honolulu, New York, Philadelphia, and Seattle; and pharmaceutical robberies in Boston, Detroit, New York, and Portland. In some southern cities, including Columbia and Memphis, diverted OxyContin® may be shipped from the Northeast. Additionally, in Boston, some OxyContin® is being stolen from people with legitimate prescriptions. In Portland, pharmacists are targeting elderly people with valid prescriptions and burglarizing their homes.

Most diversion methods have remained the same since the last Pulse Check, except in Boston, where robberies have increased, and people are now paying others to rob pharmacies for them. Moreover, diversion has increased in Billings, Boston, and New York; however, in Portland, after increasing during the last year, diversion may have leveled off.

How is diverted OxyContin® sold?
Diverted OxyContin® is sold in a variety of ways, depending on the city in which it is sold. For example, in Billings, Memphis, and New Orleans, private meetings between buyers and sellers take place via introductions, using beepers and cell phones. In Philadelphia and Washington, DC, most sales take place in open-air markets outside treatment centers or homeless shelters. According to the Columbia (SC) law enforcement source, buyers go to “pill houses,” residences where pills are illicitly sold, to buy the drug. According to the Boston law enforcement source, dealers have a small set of customers with whom they are familiar, customers page dealers to place an order, and dealers and customers meet at customers’ houses where the exchange takes place. According to the Boston epidemiologist, buyers find elderly, minority heroin or cocaine users in poor health. These older drug users obtain OxyContin® prescriptions from doctors and then sell the pills to young Whites.

Who sells diverted OxyContin®?
According to nearly all law enforcement and epidemiologic/ethnographic respondents, sellers of diverted Oxy- Contin® are mostly independent. Exceptions are in Miami, where the sellers are organized, and in New Orleans, where they are loosely organized gangs. Sellers tend to be young adults (18–30 years) or adults (>30 years), according to all respondents, with both age groups mentioned an equal number of times. Sellers are often chronic drug users in many Pulse Check cities, including Honolulu and Washington, DC (where they use heroin) and Memphis (where emerging sellers tend to abuse pharmaceutical depressants and opiates). Similarly, according to 11 of 16 law enforcement and epidemiologic/ethnographic respondents, diverted OxyContin® sellers are somewhat or very likely to use the drug themselves.

The only reported change in diverted OxyContin® sellers’ characteristics is that they are increasingly younger, as reported by two sources: the law enforcement source in Boston and the epidemiologic source in Memphis.

In what other crimes are diverted OxyContin® sellers involved?
Besides the ones mentioned above, diverted OxyContin® sellers continue to be involved in a wide array of crimes, specifically prostitution, gangrelated activities, and violent crimes in Baltimore; theft, burglaries, and prostitution in Billings; burglary, theft, purse snatching, and drugassisted rape in New Orleans; domestic violence in Portland (ME); and theft in Washington, DC.

What other drugs do diverted OxyContin® sellers sell?
Diverted OxyContin® sellers often sell additional drugs, according to all law enforcement and epidemiologic/ethnographic respondents. As reported in the last Pulse Check, other prescription opiates and heroin are the most common other drugs sold, as reported in eight cities: Boston, Columbia (SC), Honolulu, Memphis, Miami, Philadelphia, Portland (ME), and Washington, DC. Other drugs sold include marijuana and methamphetamine in Billings; cocaine in Boston; crack, powder cocaine, and marijuana in Detroit; crack in Miami; and club drugs (ecstasy and GHB) in New Orleans, where OxyContin® is typically associated with the club drug scene.

Where is diverted OxyContin® sold?
The geographical location of OxyContin® sales varies by city: central city areas predominate in five cities, suburbs predominate in four cities, and all areas are equally dominant in three cities. Diverted OxyContin® continues to be sold most often in private residences, followed by streets and around treatment clinics. Sales are also common around public housing developments, inside cars, and in nightclubs and bars. The reported number of diverted OxyContin® sales settings is highest in Memphis and Miami. The settings for OxyContin® sales have remained relatively stable since the last reporting period, with one notable exception: according to the epidemiologic source in Miami, OxyContin® has shifted from limited sales in private residences to being a “street drug.” Furthermore, according to the law enforcement source in Miami, OxyContin® is available in the same neighborhoods and settings (mostly the street) where crack is available.

OXYCONTIN®: THE ABUSERS

Exhibit 4. How has the number of novice OxyContin® treatment clients changed (spring 2001 vs fall 2001)?

*Billings has two non-methadone treatment sources.

Where has OxyContin® abuse increased?
(Exhibit 4) Continuing an upward trend, according to nearly all (16 of 18) methadone and nonmethadone treatment respondents, the number of novice abusers of OxyContin® in treatment (defined as any drug treatment client who has recently begun abusing OxyContin®) has increased since the last reporting period. However, unlike the last reporting period, when most increases were reported in the South, during fall 2001, increases occurred in all U.S. regions and most often in the West.

Epidemiologic/ethnographic respondents also report increases in OxyContin® abuse:

• Boston, MA: OxyContin® abuse has become more prevalent, especially among young, working class polydrug users of low socioeconomic backgrounds.

• Memphis, TN: The drug is increasingly abused, especially among young adult polydrug users.

• Philadelphia, PA: The numbers of abusers and adverse reactions have increased.

• Seattle, WA: Indicators point to increasing abuse, and the number of rural treatment clients has increased.

• Sioux Falls, SD: The number of emerging abusers has increased.

Who abuses OxyContin®?
According to most epidemiologic/ ethnographic and treatment respondents, the young adult (18–30 years) and adult (>30 years) age groups predominate among OxyContin® abusers, especially among novice abusers in the West. Adolescents (13–17) predominate, especially among emerging or novice abusers, according to three sources in three cities: Columbia (SC), New Orleans, and Sioux Falls. Males predominate in most areas, but females predominate and are emerging in Columbia, St. Louis, and Seattle. Whites predominate in most cities, and socioeconomic status varies by city and ranges from low in Honolulu and Washington, DC, to upper-middle (especially among novice abusers) in El Paso, New Orleans, and Seattle.

The geographic residence of OxyContin® abusers also varies by city. Central city residences predomnate in seven cities across the Nation. Suburbs predominate in several western cities and in New Orleans, St. Louis, and Sioux Falls. Both rural areas and suburbs predominate in four cities across the Nation. And rural areas predominate in Columbia and Portland (ME). According to the non-methadone treatment source in Philadelphia, OxyContin® spread from Montgomery County into the city this reporting period, and according to the methadone treatment source in Columbia, rural areas have overtaken the suburbs as predominant abuser residences this reporting period.

Where is OxyContin® taken?
Similar to reports in the last Pulse Check, epidemiologic/ethnographic and treatment respondents state that OxyContin® abuse in private is more common than its abuse in public, and the drug is more often abused alone than in groups or among friends. Also similar to the last Pulse Check, Oxy- Contin® is reportedly most often abused in private residences, followed by private parties and around public housing developments. According to epidemiologists/ethnographers and treatment providers, emerging settings include shopping malls in Billings and Seattle, cars in Portland (ME), raves in New Orleans, and nightclubs and parties in Memphis. The Sioux Falls epidemiologic source reports that increased abuse in hotel/motel and private party settings might be related to methamphetamine labs: during lab busts, sometimes OxyContin® is also found.

Changes in abuser characteristics include increasing numbers of younger abusers and increasing numbers of females. OxyContin® abusers are increasingly younger in three cities: Boston, MAN: Although young adults predominate, the emerging age is 13–17 years. Memphis, TNE: Young adults have overtaken adults as the predominant group. New Orleans, LAN: OxyContin® abuse dramatically increased, especially among young adults in their twenties. Females are increasing in two cities: Memphis, TNE Philadelphia, PAN

How is OxyContin® taken?
According to most epidemiologic/ ethnographic sources, OxyContin® is ingested orally. Exceptions include Baltimore, where injecting predominates followed by snorting; Detroit, where snorting predominates; and Washington, DC, where injecting predominates. According to the epidemiologic source in Boston, where oral use predominates, some users wash or peel off the coating, fold it in a piece of paper, crush it, and snort the powder. Similar to their epidemiologic counterparts, most treatment providers report oral ingestion as the predominant route of OxyContin® administration. Exceptions include snorting in Boston, Columbia (SC), Denver, and Portland (ME); snorting and injecting in Miami and New York; injection in New Orleans; and injecting and oral use in St. Louis.

How are heroin and OxyContin® abuse related?
Heroin is reported as a common OxyContin® substitute in 10 Pulse Check cities: Baltimore, Boston, Detroit, Miami, New Orleans, New York, Philadelphia, Portland (ME), St. Louis, and Washington, DC. The use of heroin as a substitute for OxyContin® is a new phenomenon in New Orleans and St. Louis.

By contrast, OxyContin® is used as a heroin substitute in many cities:

• Baltimore, MD^E: OxyContin® abuse has increased, and diverted OxyContin® is more available, especially because heroin is less available.

• New Orleans, LA^N: OxyContin® addicts tend to already be “pill poppers,” but some heroin addicts are trying the drug or switching to it, which has caused several overdoses. Heroin is less pure, so when they inject OxyContin®, they often overdose.

• Philadelphia, PA^E: OxyContin® is in great demand by heroin users because it eliminates the need for needles and it comes in a controlled measured amount, so users don’t have to worry about adulterants.

• Philadelphia, PA^N: OxyContin® abusers have characteristics similar to those of heroin users and tend to be heroin or crack users.

• Portland, ME^E: OxyContin® abusers in northern rural Maine are shifting to heroin because it is more cheap and available. In Portland, by contrast, some heroin users are shifting to OxyContin®.

• Portland, ME^M: OxyContin® abusers aren’t necessarily switching to heroin, but some heroin users are switching to OxyContin®.

How are OxyContin® and other drug abuse related?
OxyContin® is used in combination with marijuana in Billings, Columbia (SC), Detroit, and Memphis. It is combined with methamphetamine or powder cocaine in Memphis, a new phenomenon in that city this reporting period.

Other prescription drugs, particularly benzodiazepines, are often used in combination with OxyContin®, as reported in four Pulse Check cities: Boston, where the trend is increasing; Miami; New Orleans; and Philadelphia. Moreover, other prescription drug abuse may be related to OxyContin® abuse in other ways:

• Billings, MT^N: OxyContin® abusers tend to be former users of pills such as benzodiazepines or other prescription drugs for pain.

• Boston, MA^E: “Young working and lower working-class polydrug users are adding it to their repertoire of pills. These users have been taking other prescription opiates for many years.”

• Denver, CO^M: Novice abusers in treatment tend to be people who start using OxyContin® for chronic pain, are not typically heroin users, but may have used other prescription opiates for several years.

• Los Angeles, CA^M: “‘Pill poppers’ are switching from whatever prescription opiate they typically take to OxyContin®.”

• Sioux Falls, SD^N: OxyContin® abusers are not heroin users, but they tend to be abusers of other prescription drugs.

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⁺ The following symbols appear throughout this chapter to indicate type of respondent: ^LLaw enforcement respondent, ^EEpidemiologic/ethnographic respondent, ^NNon-methadone treatment respondent, and ^MMethadone treatment respondent.

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