OxyContin-abuse problem appears limited to US
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* Patrick Sullivan

The US Food and Drug Administration warning about oxycodone (OxyContin) abuse that appears elsewhere on this page is the result of an abuse epidemic in several poor regions of the US, particularly the Appalachian states.

The opioid analgesic, which is approved for treating moderate and severe pain, operates on a controlled-release principle. The FDA says abusers are circumventing this by crushing the pills and either injecting or snorting the resulting powder. At least 100 deaths have been linked to the drug in the US.

The FDA-mandated changes mean that the drug's packaging will now contain a “black box warning,” the strongest type available for an FDA-approved drug. (This means that the warning is placed within a black box in physician and patient labelling to make it more noticeable.) It is being done to ensure that physicians prescribe the drug only to patients in serious and continuous pain. In a letter sent to 800 000 US doctors in July, US manufacturer Purdue Pharmaceuticals said it should not be used to treat pain resulting from surgical procedures, or for mild or temporary pain.

In Canada, several preparations containing oxycodone are available for prescription, including OxyContin, and many are diverted for street use. In a 1998 report, Dr. Brian Goldman said the relatively high street price of controlled-release opioids (“peelers” in street parlance) “should ring alarm bells” (*CMAJ* 1998;159[2]:149-50).

Goldman, an expert in the diversion of prescription drugs, warned: “Now that controlled-release oxycodone has been licensed in Canada, we can expect that it and other controlled-release opioid analgesics will also find their way onto the black market.” (In July, the College of Physicians and Surgeons of Ontario announced that it had suspended the licence of Dr. Galdino Pontarini of Mississauga for 9 months; he was convicted of trafficking in oxycodone in 1999.)

In an interview, Goldman said he has heard of no OxyContin-related overdoses in Toronto, where he practises part time as an emergency physician. “But any opioid can be abused. The flavour of the week [for drug diversion] in the US used to be Vicodin [hydrocodone /acetaminophen], and now it's OxyContin. Here it's still the usual suspects: Percocet, Percodan and Tylenol 3s.”

Dr. Janet Griffiths of Health Canada's Bureau of Licensed Product Assessment said the department is currently reviewing the product monograph for OxyContin and will likely be introducing changes, which will be publicized. She said Health Canada conducted adverse drug report searches in May and July and found no reports involving the drug.