In the past 15 years, prescription opioid abuse has reached epidemic levels. Researchers investigating why abusers favor one prescription medication over another have discovered that oxycodone and hydrocodone are the drugs of choice for 75 percent of opioid-dependent people.
Oxycodone is the most popular drug over all, according to a study published in the journal PAIN, because of the high quality of the high for those who were after such effects. Hydrocodone has lower euphoric qualities; however it remains one of the most popular primary drugs. Users also say they are concerned about acetaminophen poisoning since, until recently, all hydrocodone products contained non-steroidal anti-inflammatory drugs.
Opioids are used to manage pain in general medicine and dentistry and are well known for their analgesic properties and their ability to produce a high. Misuse has risen in most opioid classes. Hydrocodone and oxycodone, which are the most commonly prescribed opioids in the US, both have a long history of non-therapeutic purposes and are by far the most popular drugs of choice among abusers.
A team of researchers from the Department of Psychiatry at Washington University in St. Louis and the Center for Applied Research on Substance Use and Health Disparities at Nova Southeastern University investigated the factors that influence the choice of primary drugs of abuse in 3,250 opioid-dependent patients entering drug-treatment programs across America.
Study participants were identified through the ongoing nationwide Survey of Key Informants’ Patients (SKIP) program, which is a key element of the post-marketing surveillance system, Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS®) System. More than 150 public and privately funded treatment centers, geographically balanced between urban, suburban and rural patients, are part of the SKIP system.
The team used anonymous, self-administered surveys to assess the influence of sex, age, race/ethnicity, area of residence, source of income, health-care coverage, drug-use patterns, and other decision-related factors in order to determine the choice of one opioid over another. To enrich the study, the team recruited an additional 200 patients who previously had completed the SKIP survey and indicated that they were willing to give up their anonymity to participate in a follow-up study using non-structured, qualitative interviews, dubbed Researchers and Participants Interacting Directly (RAPID).
The results showed that significantly more users chose oxycodone (47 percent) than hydrocodone (29.4 percent). For the most part, this was because the quality of the high was viewed to be much better by oxycodone users (54 percent) than hydrocodone users (20 percent). When asked why they chose a particular primary drug, 90 percent selected mood alteration. A very large percentage of both sample groups — 50 percent and 60 percent — indicated that the treatment of pain was also a factor in their use. This finding suggests that, in the view of many patients, pain was inadequately managed.
Hydrocodone is viewed as less attractive than oxycodone by active abusers despite its high abuse rates among prescription opioid abusers. This is because, unlike many oxycodone products that are 100 percent oxycodone, hydrocodone is frequently combined with acetaminophen, which can deter users from increasing the dose to get high.
In contrast, oxycodone users are more likely to tamper with their drugs in order to inhale or inject the drug. In 2010, the introduction of an OxyContin abuse-deterrent formulation led to a significant drop in the use of OxyContin. The overall impact on total oxycodone users, however, was not sufficiently significant to change the rank of order of abuse rates; oxycodone products remained more popular than hydrocodone products.
One of the essential questions for this study is why hydrocodone remains one of the most popular primary drugs even though it produces a lower quality of high and raises the potential for acetaminophen poisoning.
“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 J. 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.
“It is clear that not all drug abusers share the same characteristics,” he continues. “The decision to use one drug over another is a complex one, largely attributable to individual differences such as personality, gender, age, and other factors. Prevention and treatment approaches should benefit from this because it may help prescribing physicians determine which drug to prescribe and monitor for abuse.”
redOrbit (April Flowers reporting)
3rd December 2013
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