Reason for advisory: Because a growing number of reports indicate that the the long-acting opioid oxycodone hydrochloride (OxyContin) is being abused, the US Food and Drug Administration (FDA) has issued stronger warnings and precautions about when to prescribe it (see accompanying article on this page).
The drug: Oxycodone, an opioid analgesic approved for the treatment of moderate and severe pain, is approximately twice as potent as an equivalent dose of morphine when taken orally. It is usually taken every 12 hours because the intact tablet works 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.
On July 18, 2001, the FDA issued a warning to physicians that the drug should not be used as a prn medication or to treat mild or temporary pain or pain that develops in the immediate postoperative period (www.fda.gov/medwatch/safety/2001/oxycontin.htm).
Overdose is characterized by respiratory depression, extreme somnolence and coma, muscle flaccidity, cold and clammy skin and, occasionally, bradycardia and hypotension; severe overdose may lead to apnea, circulatory collapse, cardiac arrest and death. For other adverse effects, consult the product monograph.
Physicians are reminded of the potential for abuse, misuse and diversion of oxycodone. In Canada oxycodone exists in regular oral, controlled-release oral and combination preparations sold under various trade names, including OxyContin, Supeudol, Endocet and Oxycocet.
What to do: Appropriate pain management is important. Oxycodone should be reserved for expected moderate or severe persistent pain. Physicians should be aware of the potential for abuse of this specific preparation and stress to patients that the drug is to be swallowed whole and not chewed or crushed. The opioid antagonist naloxone HCl is a specific antidote for opioid-induced respiratory depression. However, in people physically dependent on opioids, opioid antagonists should be used with caution (see product monograph for details) because of the potential for serious acute withdrawal syndrome.