Maine Analysis Demonstrates Far-Reaching Harm From Oxycontin

from Alcoholism & Drug Abuse Weekly

Maine's first attempt to explore the scope of its "newest epidemic" -- Oxycontin abuse -- has shown that treatment admissions for narcotic abuse have jumped 500 percent since 1995, and that opiate-related arrests now account for more than 40 percent of the Maine Drug Enforcement Agency's (MDEA's) caseload.

But despite anecdotal accounts to the contrary, there has been no great surge in overdose deaths due to Oxycontin abuse, the study shows.

The state's Substance Abuse Services Commission and the Maine Office of Substance Abuse conducted the six-month study, released last month. The research stems from the publicity the state received for being among the first to identify a problem with Oxycontin, in 2000.

Kimberly Johnson, director of the Maine Office of Substance Abuse, said that from a treatment perspective, the findings held few surprises.

But what was striking, she told ADAW , was how the study pulled together all the ways in which abuse of the prescription painkiller can ravage lives, including those of entire families and communities. The study links increased use of synthetic narcotics with increases in crime rates and emergency medical treatment, and with the spread of hepatitis C.

Also noteworthy, Johnson said, is the young age of those abusing prescription opiates. Unlike many heroin addicts -- people in their late 30s and 40s who turn to heroin "at the end of the line" -- many young adults and adolescents are developing addictions to opiates.

"In some circles, it appears that prescription opiates may be one of the first drugs abused," the study says.

For Johnson's counterparts in other states, especially those "on the early side of the problem," the study can help them think about their prevention efforts and anticipate needs, she said.

State's Experience

In 1996, a year after Oxycontin was introduced by Purdue Pharma L.P. of Stamford, Conn., Maine treatment providers began seeing a slow, steady increase in the number of people entering treatment for prescription drug abuse. In 1998, annual admissions for such addictions "began an exponential growth curve which continued through July 2001, the most recent data available," the study states.

The total number of clients treated for opiate abuse in Maine jumped from 230 in 1995 to 475 in 1998, and to 1,292 in 2001. Opiate addicts accounted for 2 percent of the treatment population in 1995; last year, they constituted 12 percent.

Meanwhile, the percentage of MDEA investigations that resulted in arrest for use and sale of opiates rose from 15 percent of its cases in 1998 to 43 percent last year. Heroin seizures last year rose 171 percent over 2000 amounts, and 622 percent over 1999 amounts.

The study makes the link between Oxycontin use and heroin use in this way:

"While many recreational drug users will shy away from heroin, with its negative image, there is none of that negative connotation with Oxycontin. In the initial stages of use it can be chewed or crushed and snorted. When users become tolerant, they eventually dissolve the pill in water and inject it. Once they become injection-drug users, they have overcome a primary barrier to trying heroin ...

"It is only when other preferable drugs like Oxycontin or Dilaudid become unavailable or too costly that addicts turn to heroin. Over ... the past two years, everything has moved into place for Oxycontin addicts to move toward heroin: growing use of injection as a means of delivery, decreasing supply and increasing cost of prescription drugs, and increasing supply of heroin."

Reports of Oxycontin abuse and diversion are occurring nationwide. But infestation is especially prevalent in regions that are economically depressed, have labor-intensive employment such as fishing and coal mining, and have limited access to specialized medical care.

Oxycodone HCl has long been available in lower-dose forms or in combination with aspirin. Oxycontin tablets contain amounts of Oxycodone ranging from 20 to 80 milligrams in a time-release form that can last up to 12 hours.

Abusers of Oxycontin are thought to crush the pill, bypassing the time-release mechanism. One Drug Enforcement Administration (DEA) study found that the vast majority of 110 people identified in the previous two years as having overdosed on Oxycontin took the drug orally as opposed to snorting or injecting a crushed tablet (see ADAW, Nov. 19, 2001). Rapid release of the medication in people who are not tolerant can be fatal.

In Maine, nine of 66 overdose deaths in 2000 involved the use of Oxycodone, according to state medical examiner data. It's impossible to say how many of those were due to Oxycontin because of the difficulty of determining what Oxycodone-containing product was used, and because some of the deaths included multiple drugs.

Washington County, in north eastern Maine, is the county hardest hit, with per-capita use of Oxycontin significantly higher than elsewhere in the state. "Anecdotal accounts led us to believe that no one in the area had been untouched," the report states.

To view the study, visit www.state.me.us/bds/osa/oxy and click on "New Report: Oxycontin Abuse: Maine's Newest Epidemic."

Alcoholism & Drug Abuse Weekly 14(6):1,4, 2002. © 2002 Manisses Communications Group, Inc

For information about outpatient OXYCONTIN treatment at Sinclair Method Call 941-321-4104