This Pulse Check's special topic discusses
the illegal diversion and abuse
of synthetic opioids. The topic was
selected after several respondents providing
information for the last Pulse
Check issue expressed concern about
the diversion and abuse of synthetic
opiates, with several specifically citing
OxyContin®. The category synthetic
opioids was used for the current special
topic as it includes a wide range
of prescription pain medication, and
ONDCP was interested in learning to
what extent such medications were
being diverted and abused. However,
while respondents were asked about
the diversion and abuse of synthetic
opiods in general for this Pulse
Check, sources who discussed this
emerging issue specifically cited the
diversion and abuse of one particular
prescription opiate, OxyContin®. As
a result, the bulk of this section refers
specifically to OxyContin®.
OxyContin® (oxycodone hydrochloride
controlled-release) tablets are
prescribed to patients suffering from
severe persistent pain—a legitimate
medical need. However, concern has
increased about the diversion and
abuse of OxyContin® and other analgesics
in some areas of the country.
The manufacturer, Purdue Pharma,
has been working proactively with
law enforcement and the medical
community to provide education on
the appropriate use of OxyContin®
and has recently launched a pilot
campaign in several cities to warn
youth about the dangers of prescription
drug abuse. This special topic
section presents findings on the
diversion and illegal use or abuse of
OxyContin® as reported by Pulse
Check sources, not on legitimate medical use by patients who use these
products at the direction of their
physicians.
OxyContin® is the trade name for a
high-dose, 12-hour-time-release form
of oxycodone, an opoid analgesic,
often prescribed for relief from
chronic pain and taken orally. Oxycodone
is also the active ingredient in
other schedule II prescription drugs,
such as Percodan®, Percocet® and
Tylox®; however, OxyContin®
contains a higher concentration of
oxycodone (currently 10-, 20-, 40-,
and 80-milligram tablets are available)
than similar pain relievers.
Since the drug became available in
1996, there have been reports on the
diversion and abuse of OxyContin®,
especially in rural areas of Northeastern
and Southeastern States, such
as Kentucky, Maine, Maryland,
Pennsylvania, Virginia, and West
Virginia, and in rural areas of Ohio.
OxyContin® is often referred to by
the media as "hillbilly heroin" or
"poor main's heroin" for its heroinlike
effects and for the initial abuse
of the drug in low SES rural areas.
These terms, however are misnomers
because it is more expensive than
heroin when bought illicitly and
because its abuse has moved from
only lower SES rural areas to include
metropolitan areas in 2001.
Reports of crimes committed in order
to obtain OxyContin® (such as
pharmaceutical burglaries, home
invasions, and prescription fraud)
and negative health consequences
(including deaths, overdoses requiring
emergency department visits, and
addiction requiring treatment)
increased through 2000 and 2001.
Although the nonmedical use of
OxyContin® was rare in 2000, the
most recent (2000) National Household Survey on Drug Abuse
(NHSDA) shows a significant increase
(p<0.01) in the number and
percentage of lifetime nonmedical
use of OxyContin® since 1999.
Finally, the most recent data from
emergency department mentions of
the synthetic opiate, oxycodone, which
includes OxyContin®, Percocet®,
Percodan®, and Tylox®, increased 68
percent (from 6,429 to 10,825)
between 1999 and 2000, according to
the Drug Abuse Warning Network
(DAWN).
| Pulse Check sources reflect mixed views on the accuracy of media attention:
Although most responding Pulse Check sources believe that the media has portrayed the
diversion of OxyContin® accurately in their communities, several sources believe that the
media has either underplayed or overemphasized the problem. For example, the New
Orleans law enforcement source states, "The media hasn't given it (diverted Oxy-Contin®)
much media time, but it is a big problem." The Baltimore non-methadone source, the
Memphis epidemiologic source, and the Philadelphia non-methadone source agree that the
media has underplayed the problem in their communities. However, two sources in
Portland (ME) (law enforcement and methadone treatment) state that initially the media
underplayed the problem, but that now it is addressed adequately. They also believe that
media attention has helped prompt legislation to make it harder to forge prescriptions.
By contrast, many sources (the law enforcement source in Birmingham and Washington,
DC; the epidemiologic sources in Boston, New Orleans, Philadelphia, Seattle, and Sioux
Falls; and the non-methadone source in Sioux Falls) believe that the media has overemphasized
the problem. Several admit that the reason the media might be emphasizing the
problem is that "such drugs are very addictive." However, the opinion of several sources
is that not only has the media overplayed the problem of diverted synthetic opiates like
OxyContin® in their communities, but also they have helped encourage abuse. For
example, the Boston epidemiologic source states, "Large amounts of media coverage
have probably led to increased use by alerting opiate addicts to a possible market….it
has probably increased illicit (OxyContin®) sales." The Portland (ME) epidemiologic
source reports that the intense press coverage is accurate for the area, but that media
attention "may have increased the value of illicit OxyContin®; it may have increased the
desire to obtain it." |
In summer 2001, increased reports of
abuse of the drug and related crimes
prompted the FDA to strengthen
warnings and precautions in the
labeling of the product. Purdue
Pharmaceuticals undertook a number
of activities aimed at reducing diversion
and abuse, including issuing a
warning in the form of a letter distributed
widely to physicians, pharmacists,
and other health care professionals,
and the suspension of sales of the
strongest formulation of the tablet
(160 milligrams).
This Pulse Check special section
corroborates increased levels of
OxyContin® diversion and abuse and
finds that its diversion and abuse are
reported as highest in the Northeast
and eastern parts of the South and
lowest in the Midwest. Furthermore,
sources who provided demographic
information about OxyContin®
abusers and sellers were mostly from
the Northeast and (to a lesser extent)
the Southeast, highlighting that it is
not yet a large problem in the West
and Midwest. This section also supports
reports that although OxyContin® diversion and abuse occur
mostly in rural areas, they have also
recently emerged in metropolitan
areas (especially those in the Northeast and Southeast), such as
Baltimore, Boston, Denver, Detroit,
Miami, Philadelphia, St. Louis, and
Washington, DC.
OXYCONTIN®: THE PERCEPTION
How serious a problem is
OxyContin® abuse and diversion
in Pulse Check cities? (Exhibit 1)
Nearly one-third (32 of 83) of Pulse
Check sources (law enforcement, epidemiologic,
ethnographic, methadone treatment, and non-methadone
treatment) perceive OxyContin®
diversion or abuse as a somewhat
serious or very serious problem in
their communities, 23 percent (19)
perceive it as not a very serious
problem, 20 percent (17) perceive it
as not a problem, and 18 percent (15)
did not respond to the question.
Sources in the Northeast perceive
OxyContin® diversion and abuse as a
more serious problem than in other regions, with 35 percent of those
sources reporting it as a very serious
problem and 24 percent reporting it
as a somewhat serious problem.
Seventeen percent of sources in the
South report the problem as very
serious, and 27 percent report it as
somewhat serious. By contrast, only
10 percent of western sources report
it as very serious and 25 percent as
somewhat serious; and finally, no
midwestern sources report it as very
serious and only 13 percent report it
as somewhat serious.
Exhibit 1.
How much of a problem is OxyContin® diversion and abuse, by U.S. region?
Sources: Law enforcement, epidemiologic, ethnographic, and methadone and non-methadone
treatment repondents
How has the perceived problem
changed between fall 2000 and
spring 2001? (Exhibits 2 and 3)
Nearly half (37 of 83) of Pulse Check
sources perceive OxyContin®
diversion and abuse as escalating in
their communities since the last
reporting period, and no sources
report the problem as declining. As
with perceived levels of seriousness,
increases in OxyContin® diversion
and abuse are largest in the Northeast,
with 65 percent of sources
reporting increases. Increases were
lowest in the Midwest, with 31 percent
of sources reporting increases.
Moreover, among sources who report
the diversion and abuse of OxyContin® as a very serious problem
(in Billings, Birmingham, Boston,
Columbia [SC], Honolulu, Miami,
New Orleans, Philadelphia, and Portland
[ME]), all report an intensification
of the perceived problem except in
Honolulu, where it remained stable
since the last reporting period.
Exhibit 2.
How has the perceived OxyContin® problem changed since the last
reporting period, by U.S. region?
Sources: Law enforcement, epidemiologic, ethnographic, and methadone and non-methadone
treatment respondents
Exhibit 3.
How serious a problem is OxyContin® diversion and abuse in Pulse Check
cities and how has the problem changed (fall 2000 vs spring 2001?)*
LLaw enforcement respondents
MMethadone treatment respondents
EEpidemiologic and ethnographic respondents
NNon-methadone treatment respondents
*Information was not provided by law enforcement sources in Los Angeles, St. Louis, and Seattle;
epidemiologic sources in Chicago, El Paso, and Honolulu; methadone treatment sources in Detroit,
Los Angeles, Miami, New Orleans, and New York; and non-methadone treatment sources in Los
Angeles, Memphis, Sioux Falls, and Washington, DC.
Where is OxyContin® abuse
emerging across the country?
(Exhibit 4) More sources (law enforcement,
epidemiologic, ethnographic,
and methadone and non-methadone
treatment) report OxyContin® as the
emerging drug of abuse in their communities than any other drug this
reporting period. For example, 31 of
84 sources in most (14) Pulse Check
cities report OxyContin® as an emerging
drug of abuse, compared with 25
sources in 15 cities who report ecstasy
as an emerging drug of abuse. By stark
contrast, in the last Pulse Check,
OxyContin® was reported as the
emerging drug of abuse only by the
epidemiologic source in Portland (ME).
During this reporting period, more
sources in northeastern and southern
(especially southeastern) cities report
OxyContin® as an emerging drug of
abuse than in cities elsewhere.
Exhibit 4.
Where is the diversion and abuse of OxyContin® emerging?
LLaw enforcement respondent
EEpidemiologic/ethnographic respondent
MMethadone treatment respondent
NNon-methadone treatment respondent
OXYCONTIN®: THE DRUG
How available is diverted
OxyContin®? (Exhibit 5) Across the
country, more than two-thirds (18 of
26) of law enforcement, epidemiologic,
and ethnographic respondents in 12
cities (Billings, Birmingham, Boston,
Chicago, Detroit, Honolulu, Miami,
New Orleans, Philadelphia, Portland
[ME], Seattle, and Washington, DC) report diverted the OxyContin®
as somewhat or widely available.
Furthermore, most (17 of 23) respondents
report increased availability of
the diverted product since the last
reporting period, 5 report it as stable,
and only 1 (the Portland [ME] epidemiologic
source) reports declining
availability. In general, sources in the
Northeast report higher levels of
diverted OxyContin® than those
elsewhere.
Exhibit 5.
How available is diverted OxyContin® in 17 Pulse Check cities, and how has availability changed (fall 2000 vs
spring 2001)?*
See larger version of Exhibit 5
*Sources did not provided information in Columbia (SC), Denver, El Paso, and Los Angeles.
How is diverted OxyContin®
referred to across the country?
(Exhibit 6) Diverted OxyContin® is
most often referred to as "oxy" or
"OC's," according to law enforcement,
epidemiologic, ethnographic,
and methadone and non-methadone
treatment respondents. Additionally,
the pills are referred to as "blues" in
Miami, "forties" and "horse pills" in
Boston, and "O's" in Philadelphia.
Exhibit 6.
How is diverted OxyContin®
referred to in Pulse Check cities?
| Slang Term |
City |
| Oxy |
Billings,
Boston, Detroit, Honolulu, Philadelphia, Portland (ME), Washington,
DC |
| OC's |
Birmingham,
Boston, Miami, Portland (ME) |
| Oxy-cotton |
Memphis,
Philadelphia |
| Blues |
Miami |
| Forties,
horse pills |
Boston |
| O's |
Philadelphia |
Sources: Law enforcement, epidemiologic, ethnographic,
methadone treatment, and non-methadone treatment respondents
DIVERTED OXYCONTIN®: SALES
How is OxyContin® diverted and
sold illicitly? According to law
enforcement sources, OxyContin® is
diverted in a variety of ways within
Pulse Check communities, including
fraudulent prescriptions, "doctor
shopping," legitimately obtained pills
sold illicitly, and pharmaceutical robberies.
The most common way to
divert the drug (as reported in
Billings, Boston, Honolulu, New
Orleans, Philadelphia, Portland [ME],
Sioux Falls, and Washington, DC) is
through filling fraudulent prescriptions:
diverted OxyContin® sellers
either make their own prescription
forms or steal blank prescription pads
and write their own prescriptions to
obtain the drug. Another frequently
reported method of diverting OxyContin® (as reported in Boston,
Detroit, New Orleans, Philadelphia,
and Portland) is doctor shopping:
people, posing as patients, fake legitimate
pain to numerous doctors, and
doctors prescribe the drug. Often,
people who doctor shop use some of the pills obtained through the prescriptions.
Patients who obtain and
use the drug legitimately, as prescribed
by doctors for pain, but sell
some of the pills illicitly, are also frequently
mentioned by sources (in
Birmingham, Boston, Detroit, and
Washington, DC). Pharmaceutical
robberies are mentioned in Billings,
Boston, New Orleans, and Portland
(ME). Additionally in Portland (ME),
where armed robberies of pharmacies
for OxyContin® have increased
drastically, doctors and pharmacy
employees have been involved in
OxyContin® theft and may help
plan the robberies. Also in that city,
home invasions of clients who have
legitimately filled OxyContin® prescriptions
have been reported, with
the suspicion that pharmacists are
involved in obtaining patient information.
Finally, in New Orleans, some
shipments of the drug are thought to
come via U.S. mail from Mexico.
Except in Boston and Miami, epidemiologic
and ethnographic sources did
not provide information about the
sources of diverted OxyContin®.
According to the Boston epidemiologic
source and in agreement with the law
enforcement source in that city, low
SES patients with legal OxyContin®
prescriptions sell some of the pills
illicitly. In Miami, organized diversion
efforts are conducted by dealers who
recruit patients from substance abuse
treatment and mental health facilities.
Dealers drive these patients in vans to
doctors who prescribe OxyContin®.
After the prescriptions have been
written and filled, patients return to
the vehicles, give most of the pills to
the dealers, and keep a few pills for
themselves. Dealers often target and
recruit methadone and other treatment clients because of their vulnerability to
addiction.
Once OxyContin® is diverted, it is
sold hand-to-hand, mostly through
acquaintance networks, according to
law enforcement respondents.
Additionally, beepers and deliverytype
services are used to distribute
the drug illicitly in Billings, Boston,
Honolulu, and New Orleans.
What are diverted OxyContin®
prices across the country, what
are the most common units sold,
and how is it packaged? (Exhibit 7)
Diverted OxyContin® costs $1 per
milligram in most cities where law
enforcement, epidemiologic, and
ethnographic sources responded (in
Boston, Chicago, Miami, and
Philadelphia). In Billings, prices are
$1–$1.50 per milligram, and in
Washington, DC, they are $1–$2 per
milligram.
The most common pill unit of
diverted OxyContin®, according to
law enforcement, epidemiologic,
ethnographic, and treatment sources,
is the 40-milligram tablet, followed
by the 20- and 80-milligram tablets.
Interestingly, methadone and nonmethadone
treatment sources report
higher milligram units (typically 80
milligrams) sold than their law
enforcement and epidemiologic
counterparts.
According to eight of nine law
enforcement, epidemiologic, and
ethnographic respondents (in
Baltimore, Boston, Detroit, Miami,
Philadelphia, Portland [ME], and
Washington, DC), diverted
OxyContin® is sold as loose pills.
Additionally, law enforcement respondents
in Boston and Portland (ME)
report that it is sold in prescription
bottles, and the Billings law enforcement
source reports that it is sold in
small zipper coin bags.
Exhibit 7.
What are the most commonly sold
units of diverted OxyContin®?
| City |
Most common
unit sold (in milligrams) |
 |
Boston, MA |
10, 40 |
| Philadelphia,
PA |
20, 40, 80 |
| Portland,
ME |
20, 40, 80,
160 |
 |
Baltimore,
MD |
20, 40 |
| Birmingham,
AL |
80 |
| Columbia,
SC |
40, 80 |
| Miami, FL |
20 |
| Washington,
DC |
20, 40 |
 |
Detroit,
MI |
40, 80 |
| St. Louis,
MO |
40 |
 |
Billings,
MT |
20, 40 |
| Honolulu,
HI |
20, 80 |
Sources: Law enforcement, epidemiologic, ethnographic,
methadone treatment, and nonmethadone treatment respondents
How often is diverted OxyContin®
available? According to the Portland
(ME) law enforcement and epidemiologic
sources and the New Orleans law
enforcement source, for the past year,
OxyContin® has been available continually
on the illicit drug market. By
contrast, according to epidemiologic
sources in Birmingham and Washington,
DC, and the law enforcement
source in Honolulu, the drug has
been available on the illicit drug
market only periodically. Other
respondents claim that the drug is so
new to the illicit drug market that
they cannot assess whether the drug is
available continually or periodically.
Who sells diverted OxyContin®?
According to all (nine) responding
law enforcement sources, diverted
OxyContin® sellers are independent.
The law enforcement sources in New
Orleans, Portland (ME), Seattle, and
Washington, DC, add that they tend
to be heroin addicts or often associate
with heroin users.
According to law enforcement,
epidemiologic, and ethnographic
respondents in Billings, Honolulu,
Memphis, Philadelphia, and
Washington, DC, diverted OxyContin®
sellers tend to be adults (>30 years).
Young adults (18–30 years) predominate
in two cities: Birmingham
and Portland (ME). Furthermore,
according to the New Orleans law
enforcement source, participants in
the club scene are starting to become
involved with the sale and use of
diverted OxyContin®.
What other drugs do diverted
OxyContin® dealers sell?
According to all law enforcement,
epidemiologic, and ethnographic
respondents (11 of 11), diverted
OxyContin® dealers sell other drugs,
most commonly heroin (as reported
in Baltimore, Boston, Honolulu, New
Orleans, Portland [ME], and Washington,
DC) and other diverted
prescription drugs, especially other
opiates (as reported in Honolulu,
New Orleans, Philadelphia, Portland
[ME], and Washington, DC). Diverted
OxyContin® dealers also sell
cocaine in Baltimore, and marijuana
and methamphetamine in Billings.
Do diverted OxyContin® sellers
use the drug? According to seven
of eight law enforcement respondents
(in Birmingham, Honolulu, New
Orleans, Philadelphia, Portland [ME],
Sioux Falls, and Washington, DC),
OxyContin® sellers are somewhat or
very likely to use the drug. Three
epidemiologic sources responded to
the question: the Portland and
Washington, DC, respondents agree
with their law enforcement counterparts
that OxyContin® sellers are
very likely to use the drug, but the
Memphis respondent cites sellers as
not very likely to use the drug.
In what types of other crimes
are diverted OxyContin® sellers
involved? According to most law
enforcement, epidemiologic, and
ethnographic respondents (8 of 12),
sellers of diverted OxyContin® are
somewhat or very likely to be
involved in other crimes, including
the following: nonviolent crimes in
Billings, Boston, New Orleans,
Portland (ME), and Washington, DC;
violent crimes in Honolulu and
Portland; prostitution in Boston and
Portland; and gang-related crimes in
Portland, where crimes involving
diverted OxyContin® have increased
according to the law enforcement
source. Only by respondents in
Birmingham, Memphis, and Philadelphia
are diverted OxyContin® sellers
regarded as not involved in other
crimes.
Where is diverted OxyContin®
sold? (Exhibit 8) Diverted OxyContin® is sold in the central city
and rural areas, according to most
law enforcement and epidemiologic
respondents. However, suburbs are
the predominant sales locales in
Philadelphia, and the drug is sold
throughout all areas of Boston and
Portland (ME). According to the
law enforcement source in Washington,
DC, most sales occur in the
central city, but the buyers reside in
the suburbs.
According to law enforcement,
epidemiologic/ethnographic, and
treatment respondents, diverted
OxyContin® is sold most often in
private residences, followed by streets
and around methadone treatment
clinics. The reported number of
diverted OxyContin® sales settings is
highest in Boston and New Orleans.
Sources: Law enforcement, epidemiologic, ethnographic, and methadone and non-methadone treatment respondents
*For sales settings seven law enforcement sources responded (in Billings, Birmingham, Boston, Honolulu, New Orleans, Philadelphia, Portland [ME],
and Washington, DC) and three epidemiologic and ethnographic sources responded (in Baltimore, Boston, Portland [ME], and Washington, DC). For
users settings, nine epidemiologic and ethnographic sources responded (in Baltimore, Detroit, Memphis, Miami, Philadelphia, Portland [ME], St.
Louis, and Washington, DC), seven methadone treatment sources responded (in Boston, Columbia [SE], Denver, Portland [ME], St. Louis, Seattle
and Washington, DC), and eight non-methadone treatment sources responded (in Billings, Birmingham, Baltimore, El Paso, Miami, Philadelphia,
Portland [ME] and St. Louis).
OXYCONTIN®: THE ABUSERS
How has the number of novice
OxyContin® treatment clients
changed? (Exhibit 9) According to
most (12 of 16) methadone and nonmethadone
treatment respondents,
the number of novice users of diverted
OxyContin® in treatment (defined
as any drug treatment client who has
recently begun using diverted
OxyContin®) has increased since the
last reporting period, mainly in the
South. The remaining respondents
reporting stable trends.
Exhibit 9.
How has the number of novice
OxyContin® treatment clients
changed (fall 2000 vs spring
2001)?
MMethadone treatment respondents
NNon-methadone treatment respondents
Notes: Billings has two non-methadone
treatment sources.
Who abuses OxyContin® and
where do they reside? (Exhibits
10 and 11) This section refers to
those who abuse diverted
OxyContin®, not those who are
prescribed the drug for a legitimate
medical need. Most OxyContin®
abusers are young adults (18–30
years) or adults (>30 years),
according to most epidemiologic,
ethnographic, and methadone and
non-methadone treatment respondents.
However, according to the
epidemiologic and methadone treatment
sources in Portland (ME) and
the epidemiologic source in Miami,
adolescent (13–17 years) and young
adult abusers are increasing.
Males are the predominant OxyContin® abusers, according to most
(5 of 9) epidemiologic and ethnographic
respondents (in Baltimore,
Detroit, Memphis, Miami, and
Philadelphia). However, males and
females are equally likely to abuse
the drug in Birmingham, Columbia
(SC), Portland (ME), and Washington,
DC. Treatment respondents agree that
males are the predominant users or
that they are evenly split between the
genders. Females predominate,
however, in treatment programs in
Baltimore, St. Louis, and two Western
cities (Billings and Denver).
Whites are the predominant OxyContin® abusers and are overrepresented
compared with the general
population, according to nearly all
epidemiologic and ethnographic
respondents. Blacks, however, are the
predominant abusers and overrepresented
in Baltimore and Washington,
DC. Most treatment respondents
agree that Whites predominate as
OxyContin® abusers. Additionally, Whites from rural areas are increasingly
abusing the drug, according to
the epidemiologic sources in
Birmingham and Washington, DC.
Most OxyContin® abusers are of low
or middle SES, according to nearly all
epidemiologic, ethnographic, and
methadone and non-methadone
treatment respondents. Additionally,
according to treatment respondents,
OxyContin® abusers in the Northeast
are more likely to be of low SES than
those in other regions.
The locations of OxyContin® abusers'
residences vary by city, according to
epidemiologic and ethnographic
respondents: in Baltimore, Philadelphia,
and Washington, DC, they reside
in central city areas; in Detroit,
Birmingham, and Memphis, they
reside in rural areas and the suburbs;
and in Columbia (SC) and Miami, they reside in the suburbs. Most treatment
respondents concur with their
epidemiologic counterparts.
| OxyContin® users in treatment:
Referral sources, education, and
employment
The most common referral sources for
OxyContin® treatment clients, according
to methadone and non-methadone
treatment respondents, are individual
referrals (in Baltimore, Birmingham,
Boston, Columbia [SC], Denver, Miami,
Philadelphia, Portland [ME], St. Louis,
Seattle, and Washington, DC), followed
by courts or the criminal justice system
(in Philadelphia, Portland [ME], and
St. Louis) and health care providers (in
Billings, El Paso, and Portland). According
to the Denver methadone source,
doctors are a common referral source:
doctors who have been prescribing
OxyContin® to their patients for pain
refer them to treatment when they believe
their patients may have an addiction.
Nearly all (14 of 17) treatment respondents
report that most OxyContin®
abusers have a high school education.
Only the methadone source in Seattle
and the methadone and non-methadone
sources in Philadelphia report that most
OxyContin® users have less than a high
school education. The employment status
of OxyContin® abusers varies widely
according to treatment respondents, with
most reporting full-time employment or
unemployment. Additionally, the nonmethadone
source in El Paso reports that
most are retired or disabled, and the
methadone treatment source in Boston
reports that most are unemployed due to
chronic pain.
OxyContin® abuse among health
care professional and adolescents...
Only 5 of 23 epidemiologic, ethnographic,
and methadone and non-methadone
treatment respondents (in Baltimore,
Billings, Portland (ME), St. Louis, and
Seattle) report health care professionals as
involved in OxyContin® abuse.
Seven respondents in six cities report
OxyContin® abuse among opioid-naďve
adolescents (in Billings, Boston, Detroit,
Miami, Portland (ME), and St. Louis). |
Where and in what contexts do
OxyContin® abusers tend to use
the drug? (Exhibit 8) Most OxyContin® abusers use the drug indoors
and in private, according to all (eight
of eight) epidemiologic respondents
(in Baltimore, Birmingham, Detroit,
Memphis, Miami, Philadelphia,
Portland (ME), and Washington, DC).
Treatment respondents agree that
diverted OxyContin® is primarily
used indoors and in private, but the
Birmingham non-methadone source
cites both indoor and outdoor use
because, "you can take a pill anywhere."
According to the epidemiologic
sources in Memphis, Philadelphia,
and Washington, DC, they primarily
use the drug in groups or among
friends, but in Baltimore, Miami, and
Portland (ME), most use the drug
alone. By contrast, most (8 of 12)
treatment respondents (in Billings,
Birmingham, Columbia (SC), Denver,
Portland (ME), St. Louis, and Washington,
DC) report that most OxyContin®
abusers take the drug alone.
The most frequently mentioned
settings for abuse of diverted Oxy-
Contin®, according to epidemiologic,
ethnographic, and non-methadone
and methadone treatment respondents,
are private residences, followed
by public housing developments,
inside cars, and private parties. Other
common settings include streets (in
Baltimore, Billings, Philadelphia, and
Washington, DC), nightclubs and bars
(in Billings, Boston, Philadelphia, and
St. Louis), and concerts and raves (in
Boston, Miami, and St. Louis).
How is OxyContin® taken, and
what other drugs do OxyContin®
users take? Unlike those with a
legitimate medical need for OxyContin® who injest the pill orally by
swallowing it whole, OxyContin®
abusers seek to deactivate the timerelease
formula by injecting, chewing,
or snorting the crushed pill or tablet
to achieve rapid release and absorption
of oxycodone, according to
epidemiologic and ethnographic
respondents. Injection (by crushing
the pill, dissolving it in water or
cooking it, and typically injecting it
through cotton balls or cotton pads—hence, its street name "oxycotton") is
reported in seven cities (Baltimore,
Birmingham, Detroit, Portland [ME],
Philadelphia, St. Louis, and Washington,
DC). The diverted drug is taken
orally (often chewed) in three cities
(Memphis, Miami, and Philadelphia),
and it is crushed and snorted in
Columbia (SC) and Detroit. Unlike
epidemiologic and ethnographic
respondents, treatment sources overwhelmingly
(16 of 20 respondents)
cite oral ingestion as the predominant
mode of OxyContin® administration
by hardcore drug users. Injecting the
drug is only mentioned by the Billings
non-methadone treatment source, and
snorting crushed pills is mentioned
only by three sources: the methadone
treatment source in Boston and the
methadone and non-methadone
sources in Portland (ME). According
to the epidemiologic source in
Washington, DC, oral ingestion of
the drug is increasing.
Few epidemiologic, ethnographic, or
treatment respondents report other
drugs used in combination with
diverted OxyContin®, and most
drugs mentioned are other prescription
drugs that have been diverted. For example, benzodiazepines are
taken in combination with OxyContin® in Baltimore, Boston,
Columbia (SC), Philadelphia, and
Seattle. Other diverted prescription
opiates are combined with OxyContin® in Billings (Percocet®,
meperidine [Demerol®] or morphine),
Philadelphia® (Percocet®), and Miami
(hydrocodone [Vicodin® or Lorcet®],
or carisoprodol [Soma®]). Heroin is
used with diverted OxyContin® in
Boston, Billings, and St. Louis, and
crack in Billings and Philadelphia. In
Boston, diverted OxyContin® is sometimes
used with ecstasy to assuage the
effects of ecstasy.
Several sources report that OxyContin® abusers have previously
used drugs other than opiates.
According to the law enforcement
source in Billings, methamphetamine
users who are unable to obtain
methamphetamine or are looking for
a more sustained high may begin
using diverted OxyContin®, and
according to the Boston methadone
treatment source, OxyContin® users
tend to have already experimented
with marijuana and sometimes
cocaine.
How often do OxyContin®
abusers use the drug? Most
OxyContin® abusers take the drug at
least daily, according to most (11 of
15) treatment respondents (in
Birmingham, Boston, Columbia [SC],
Denver, Philadelphia, Portland [ME],
St. Louis, and Washington, DC). The
methadone treatment sources in
Boston and Philadelphia report that
OxyContin® abusers begin using the
drug occasionally or on weekends,
but they often quickly progress to
daily use.
| How is heroin related to
OxyContin® abuse?
According to many Pulse Check sources,
heroin users often abuse diverted
OxyContin®, mostly as a heroin
substitute. Seven respondents (the law
enforcement sources in New Orleans
and Philadelphia; the epidemiologic
source in Miami, the methadone treatment
sources in Philadelphia and Seattle;
and the non-methadone treatment
sources in Birmingham and St. Louis)
report that heroin users often replace
heroin with diverted OxyContin®,
especially when heroin is scarce. Four
respondents (the Portland (ME) law
enforcement source, the Boston
methadone treatment source, and the
Billings and St. Louis non-methadone
treatment sources) state that diverted
OxyContin® may be used in combination
with heroin to enhance the effects
of heroin. And the methadone treatment
sources in Columbia (SC) and Washington,
DC, report that heroin users often
take illegally obtained OxyContin® to
"tide them over" until their next dose of
heroin or methadone.
By contrast, in Chicago, the diversion
and abuse of other prescription opiates
abuse continues to be low because
heroin is readily available and less
expensive there. Sources also point out
that many OxyContin® abusers use the
drug exclusively. For example, in
Birmingham, most OxyContin® abusers
use the drug rather than heroin or other
diverted prescription drugs because they
believe it is more potent. And the law
enforcement source in Boston reports
that most Oxy-Contin® abusers do not
use heroin, but that they may start to use
heroin if they are unable get their
OxyContin® "fix." |
Exhibit 10.
Who abuses diverted OxyContin®, according to epidemiologic and ethnographic respondents?
| City |
Age |
Gender |
Race/Ethnicity;
representation compared with the general population |
Socioeconomic
Status |
Residence |
|
Philadelphia,
PA
|
Young adults
(18–30) and adults (>30) |
Male |
White; underrepresented |
Low |
Central city |
|
Portland,
ME
|
Young adults |
Split evenly |
White; equal |
Low |
All |
|
Baltimore,
MD
|
Adults |
Male |
Black; overrepresented |
Low |
Central city |
|
Birmingham,
AL
|
Adolescents
(13–17) |
Split evenly |
White; overrepresented |
Low and middle |
Suburbs and
rural areas |
|
Columbia,
SC
|
Young adults |
Split evenly |
White; equal |
Middle |
Suburbs |
|
Memphis,
TN
|
Young adults |
Male |
White; overrepresented |
Middle |
Suburbs and
rural areas |
|
Miami,
FL
|
Adults |
Male |
White; overrepresented |
Low |
Suburbs |
|
Washington,
DC
|
Adults |
Split evenly |
Black; overrepresented |
Low |
Central city |
|
Detroit,
MI
|
Young adults
and adults |
Male |
White; overrepresented |
Middle and
high |
Suburbs and
rural areas |
Exhibit 11.
Who abuses diverted OxyContin®, according to methadone and non-methadone treatment respondents?
| City |
Treatment
source |
Age |
Gender |
Race/Ethnicity;
representation compared with the general population |
Socioeconomic
Status |
Residence |
|
Boston,
MA
|
Methadone |
Adults
(>30) |
Split
evenly |
White;
equal |
Low |
Suburbs |
|
Philadelphia,
PA
|
Methadone |
Young adults
|
Split evenly |
White; NR |
Low |
Central city |
| Non-methadone |
(18–30)
Young adults |
Split evenly |
White, Black, Hispanic; equal |
Low |
Central city |
Portland, ME
|
Methadone
|
Young
adults
|
Split
evenly |
White;
NR |
Low and middle |
Central city |
| Non-methadone |
Adults |
Male |
White;
NR |
Low |
Rural |
|
Baltimore,
MD
|
Non-methadone |
Young
adults |
Female |
White;
underrepresented |
High |
Central
city
|
|
|
Birmingham,
AL
|
Methadone |
Young
adults |
Male |
White;
equal |
Middle |
Suburbs |
|
Non-methadone |
Young adults |
Split evenly |
White; equal |
Low and middle |
Suburbs |
|
Columbia,
SC
|
Methadone |
Young
adults |
Male |
White;
equal |
Middle |
Rural |
|
El
Paso, TX
|
Non-methadone |
Adults |
Male |
White,
Black, Hispanic; equal |
All |
Central
city and suburbs |
|
Miami,
FL
|
Non-methadone |
Adults |
Split
evenly |
White;
overrepresented |
Middle |
Suburbs |
|
New
Orleans, LA
|
Non-methadone |
Adults |
Male |
White;
NR |
Middle |
Central
city |
|
Washington,
DC
|
Methadone |
Adults |
Male |
White,
Black; NR |
Low |
Central
city |
|
St.
Louis, MO
|
Methadone
|
Young
adults
|
Split
evenly
|
Multi-racial;
NR
|
Middle
|
Suburbs
and central city
|
| Non-methadone |
Young
adults |
Female |
White;
NR |
Middle |
Suburbs |
|
Billings,
MT
|
Non-methadone |
Young
adults |
Female |
White;
NR |
Low |
Suburbs |
|
Denver,
CO
|
Methadone |
Adults |
Female |
White;
NR |
Middle |
Suburbs |
|
Honolulu,
HI
|
Non-methadone |
Adults |
Male |
Asian/Pacific
Islander; NR |
Middle |
Suburbs |
|
Seattle,
WA
|
Methadone |
Adults |
Split
evenly |
White;
equal |
Low |
Central |
