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Product No. 2001-L0424-001

BULLETIN
INFORMATION

JANUARY 2001
U. S. D E P A R T M E N T O F J U S T I C E

OxyContin Diversion and Abuse

Overview
Diversion and abuse of the prescription pain re-

Photo courtesy of Roger Kerekes, Johnstown Tribune-Democrat

liever OxyContin is a major problem, particularly in
the eastern United States. The Drug Enforcement Ad-
ministration (DEA) reports that, in the United States,
oxycodone products, including OxyContin, are fre-
quently abused pharmaceuticals. The pharmacologi-
cal effects of OxyContin make it a suitable substitute
for heroin; therefore, it is attractive to the same abuser
population. Law enforcement reports indicate heroin
abusers are obtaining OxyContin because the pharma-
ceutical drug offers reliable strength and dosage levels.
In addition, if the abusers’ health insurance covers an
illness that the drug treats, the insurance provider may
cover the cost of the drug. Conversely, OxyContin
abusers who have never used heroin may be attracted
to the lower priced heroin when their health insur-
ance no longer pays for OxyContin prescriptions or
when they cannot afford the high street-level price
of OxyContin. For example the West Virginia, Bottles of OxyContin
Hancock-Brooke-Weirton Drug Task Force reports that
a local couple, recently sentenced for conspiracy to sell reporting. OxyContin Tablet, commonly referred to as
heroin, turned to heroin after their doctor refused to OxyContin, has become the oxycodone product of
continue prescribing OxyContin and they could not af- choice in Maine, Ohio, and West Virginia, and in por-
ford the street price of the pharmaceutical. OxyContin tions of eastern Kentucky, Maryland, western Pennsylva-
abusers sometimes commit theft, armed robbery, and nia, and rural southwestern Virginia.
fraud to sustain their habits.
nKentucky-The Kentucky State Police reports that
The illegal diversion, distribution, and abuse of OxyContin is the drug of choice in eastern Ken-
oxycodone products, particularly OxyContin, appear to tucky. The Kentucky State Police in Hazard report
be concentrated most heavily in the East, according to re- a significant shift from cocaine and methamphet-
spondents to the National Drug Intelligence Center amine abuse to OxyContin and Tylox abuse. Tylox
(NDIC) National Drug Threat Survey 2000 and DEA is another trade name oxycodone product.
This document may contain dated information.
It has been made available to provide access to historical materials.
 ARCHIVED
OxyContin Diversion and Abuse

n Maine-The U.S. Attorney, District of Maine, lower back and cancer pain. It is also used post-
identifies OxyContin as the most significant drug operatively and for pain relief after childbirth.
threat in the state. Percocet, Percodan, and Tylox are other trade name
oxycodone products.
n Maryland-The Maryland Drug Early Warning
System, a real-time substance abuse monitoring Oxycodone is a central nervous system depres-
program, identifies oxycodone as a leading sant. Oxycodone’s action appears to work through
emerging drug of abuse in 2000. The DEA stimulating the opioid receptors found in the central
reports nearly 85 percent of 1999 arrests for writing nervous system that activate responses ranging from
false prescriptions in Maryland involved analgesia to respiratory depression to euphoria. People
oxycodone products, including OxyContin. who take the drug repeatedly can develop a tolerance
or resistance to the drug’s effects. Thus, a cancer patient
n Ohio-The Cincinnati Police Department’s Phar- can take a dose of oxycodone on a regular basis that
maceutical Diversion Squad reports a growing would be fatal in a person never exposed to oxycodone
OxyContin threat. From January to October 2000, or another opioid. Most individuals who abuse
illicit drug dealers in Cincinnati diverted over oxycodone seek to gain the euphoric effects, mitigate
9,000 doses of OxyContin (31 percent of all di- pain, and avoid withdrawal symptoms associated with
verted oxycodone products). During the same time oxycodone or heroin abstinence.
period, 49 of the squad’s 341 diversion investiga-
tions targeted OxyContin, resulting in 22 arrests. OxyContin is an oral, controlled-release
oxycodone that acts for 12 hours, making it the longest
n Pennsylvania-The Cambria County Drug Task lasting oxycodone on the market. Patients taking
Force reports that, as of September 2000, almost shorter acting oxycodone products, such as Percocet,
30 percent of its undercover drug purchases in- may need to take the product every 4 to 6 hours. While
volved OxyContin, and 31 suspects were accused drug doses vary by individual, the typical OxyContin
of distributing tens of thousands of dollars’ worth dose prescribed by physicians ranges from two to
of OxyContin. four tablets per day. OxyContin was developed and
n West Virginia-The Gilbert Police Department patented in 1996 by Purdue Pharma L.P. and was
reports OxyContin is the “worst” drug the originally available in 10 milligram (mg), 20 mg, 40 mg,
department has ever encountered, with OxyContin and 80 mg tablets. A 160 mg tablet became available
abuse even surpassing marijuana abuse. in July 2000. By comparison, Percocet and Tylox
contain 5 mg of oxycodone and Percodan-Demi con-
Background tains just 2.25 mg. The strength, duration, and known
dosage of OxyContin are the primary reasons the drug
OxyContin is a trade name product for the generic is attractive to both abusers and legitimate users.
narcotic oxycodone hydrochloride, an opiate agonist.
Opiate agonists provide pain relief by acting on opioid Abuse
receptors in the spinal cord, brain, and possibly in the tis-
sues directly. Opioids, natural or synthetic classes of The abuse of oxycodone products in general has
drugs that act like morphine, are the most effective pain increased in recent years. In April 2000, The Journal of
relievers available. Oxycodone is manufactured by the American Medical Association (JAMA) published a
modifying thebaine, an alkaloid found in opium. study, which examined two data collection sources. The
Oxycodone has a high abuse potential and is prescribed DEA Automation of Reports and Consolidated Orders
for moderate to high pain relief associated with injuries, System (ARCOS) data tracks the distribution of
bursitis, dislocation, fractures, neuralgia, arthritis, and oxycodone and other opioid analgesics and the Drug

2 This document may contain dated information.

It has been made available to provide access to historical materials.
 ARCHIVED
National Drug Intelligence Center

Abuse Warning Network (DAWN) Medical Exam- OxyContin abusers often chew the tablets or crush the
iner (ME) and Emergency Department (ED) data as- tablets and snort the powder. Because oxycodone is
certained the health consequences associated with water soluble, crushed tablets can be dissolved in wa-
its abuse from 1990 to 1996. The JAMA study found ter and the solution injected. The latter two methods
a 23 percent increase in the medical use of oxycodone lead to the rapid release and absorption of oxycodone.
with no corresponding increase in the illicit abuse of The alcohol and drug treatment staff at the Mountain
the drug. However, 1998 DAWN ME data reported a Comprehensive Care Center, Prestonsburg, Kentucky,
93 percent increase in oxycodone mentions between reports individuals who have never injected drugs are
1997 and 1998 and the number of oxycodone-related using OxyContin intravenously and they have never seen
DAWN ED mentions increased 32.4 percent from a drug “proliferate like OxyContin has since May 2000.”
1997 (4,857) to 1999 (6,429). The staff at this center has over 90 cumulative years’
experience conducting drug evaluations.
Opioids, Pain, and Addiction
Addiction to opioids used for legitimate medical OxyContin and heroin have similar effects;
purposes under a qualified physician’s care is therefore, both drugs are attractive to the same
rare. According to the National Institute on abuser population. OxyContin is sometimes referred
Drug Abuse, however, many physicians limit to as “poor man’s heroin,” despite the high price it
prescribing powerful opioid pain medications commands at the street level. A 40 mg tablet of
because they believe patients may become ad- OxyContin by prescription costs approximately $4
dicted to the drugs. Recent evidence suggests or $400 for a 100-tablet bottle in a retail pharmacy.
that, unlike opioid abusers, most healthy, Street prices vary depending on geographic location,
nondrug–abusing patients do not report eupho- but generally OxyContin sells for between 50 cents
ria after being administered opioids, possibly be- and $1 per milligram. Thus, the same 100-tablet
cause their level of pain may reduce some of the bottle purchased for $400 at a retail pharmacy can
opioid’s euphoric effects making patients less sell for $2,000 to $4,000 illegally.
likely to become abusers. (Source: NIDA Licit Retail Illicit Retail
INFOFAX Pain Medications) Strength
Price per tablet Price per tablet

10 mg $1.25 $5 to $10
Several deaths have resulted specifically from the
abuse of OxyContin in Kentucky, Ohio, Virginia, and 20 mg $2.30 $10 to $20
West Virginia. The Pike County, Kentucky, Coroner 40 mg $4.00 $25 to $40
reported 19 OxyContin-related deaths during calendar 80 mg $6.00 $65 to $80
year 2000. In December 2000, seven OxyContin over- 160 mg $14.00 unknown
dose deaths were reported in Southeastern Kentucky Source: Cincinnati Police Department Pharmaceutical Diversion
by two Kentucky State Police posts. The Logan Daily Squad, November 2000
News reported in October 2000 that four Hocking
OxyContin is, however, relatively inexpensive for
County, Ohio, residents overdosed on OxyContin over
those covered by health insurance, since the insurance pro-
an 18-day period. Two of the four died. There have been
vider covers most costs associated with doctor visits
at least four OxyContin overdose deaths in Pulaski,
and the prescription. Unfortunately, many OxyContin
Virginia, since 1998. In July 2000, The Williamson Daily
abusers whose health insurance will no longer pay for
reported five OxyContin-related overdose deaths in
prescriptions and who cannot afford the high street-level
southwestern West Virginia since May 2000.
prices are attracted to heroin. For example, in West Vir-
OxyContin is designed to be swallowed whole; ginia the availability of lower cost heroin is attracting
however, abusers ingest the drug in a variety of ways. many OxyContin abusers who have never used heroin.

This document may contain dated information. 3

It has been made available to provide access to historical materials.
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OxyContin Diversion and Abuse

Related Criminal Activity n Virginia-The Police Chief in Pulaski reported

and Diversion in October 2000 that approximately 90 percent
of all thefts, burglaries, and shoplifting incidents
OxyContin abuse has led to an increased in the area were linked to the OxyContin trade.
number of pharmacy robberies, thefts, shoplifting n Virginia-Prosecutors in Tazewell County reported
incidents, and health care fraud incidents, as in October 2000 that more than 150 people have
illustrated by the following: been charged with felonies associated with
n Maine-In June 2000, the Bangor Daily News OxyContin abuse. Since February 1999, thieves
reported the arrest of an individual charged with reportedly demanded only OxyContin in at least
selling approximately $8,000 worth of OxyContin 10 pharmacy robberies. The high number of
weekly. The OxyContin was prescribed to the robberies prompted some pharmacies in
individual’s wife to control cancer-related pain. Tazewell County to discontinue selling
The husband illegally diverted some of the pills, OxyContin and post signs stating they no longer
which allegedly were paid for by Medicaid, for a would carry the drug.
substantial profit. Drugs such as OxyContin are diverted in a vari-
n Maine-In August 2000, the Portland Press Herald ety of ways including pharmacy diversion, “doctor shop-
reported that law enforcement authorities dis- ping,” and improper prescribing practices by physicians.
mantled a drug ring accused of obtaining Pharmacy diversion occurs when individuals working
OxyContin by forging prescriptions, having them in pharmacies take products directly from the shelves,
filled at pharmacies in southern Maine and New or when people make fraudulent prescriptions. Two
Hampshire, and covering the costs with their pharmacists in Mercer County, West Virginia, were
Medicaid cards. charged in September 2000 with illegally obtaining pain
relieving hydrocodone pills. They allegedly took the
n Ohio-A heroin addict who learned about pills directly off the pharmacy shelves and created
OxyContin at a methadone clinic committed at fraudulent prescriptions. They then traded the drugs for
least seven aggravated robberies in early 2000 sexual favors.
attempting to finance his 800-mg-a-day
OxyContin habit. The most widely used diversion technique at
the street level is doctor shopping. Individuals, who
n Pennsylvania-The Cambria County Drug Task may or may not have a legitimate ailment requiring
Force views prescription fraud as the fastest a doctor’s prescription for controlled substances, visit
growing crime in Cambria County; an increase numerous doctors, sometimes in several states, to
in the number of pharmacy burglaries in the acquire large amounts of controlled substances they
county is directly related to OxyContin abuse. abuse or sell to others. This problem is pronounced
For example, on January 1, 2001, a robber stole in southwestern Virginia and southern West Virginia.
more than $1,000 worth of OxyContin from a
local pharmacy. Improper prescribing practices by unscrupulous
physicians are another way of diverting pharmaceu-
n Pennsylvania-In December 2000, the Penn- ticals, according to law enforcement sources sur-
sylvania State Police reported an attempted veyed by the NDIC. For example, a White Sulphur
armed robbery at a pharmacy in Clearfield Springs, West Virginia, physician was sentenced on
County, where the suspect sought OxyContin. October 24, 2000, and will spend more than 2 years in
federal prison for Medicaid fraud and for dispensing
prescription sedatives and painkillers in exchange for

4 This document may contain dated information.

It has been made available to provide access to historical materials.
 ARCHIVED
National Drug Intelligence Center

sex. Also in October 2000, a Grundy, Virginia, physi- pharmacists, and representatives of Purdue Pharma
cian was arrested and charged with 79 counts of ille- L.P. are working together to find methods to limit
gally dispensing prescription drugs, including diversion and abuse. Legislative initiatives are also
OxyContin. being drafted to make OxyContin distribution less
appealing by creating more stringent penalties.
The abuse of OxyContin, as with the abuse of
most prescription drugs, creates a cycle of health care Sources
fraud. For example, a corrupt physician writes a
patient a prescription for a pain reliever for a nonex- Cambria County Drug Task Force, Pennsylvania
istent injury. The physician bills the insurance company
Community Epidemiology Work Group,
for that, and subsequent, visits. The patient uses a
National Institutes of Health, National Institute
portion of the prescribed pills and sells the rest for a
on Drug Abuse
substantial profit. This type of health care fraud is quite
prominent in West Virginia, where the Huntington Darryl S. Inaba, Pharm. D. and William E.
Drug and Violent Crime Task Force reports “there are Cohen, Uppers, Downers, All Arounders,
too many doctors (in West Virginia) supplementing CNS Productions, Inc., 1993
their income by writing improper prescriptions.” Department of Health and Human Services,
Substance Abuse and Mental Health Services
Sentencing and Legislation Administration, Drug Abuse Warning Network,
Emergency Department Data
Oxycodone, including OxyContin, are Schedule
II drugs under the Federal Comprehensive Drug Abuse Department of Health and Human Services,
Prevention and Control Act. Federal sentencing guide- Substance Abuse and Mental Health Services
lines for diverted Schedule II pharmaceuticals are de- Administration, Drug Abuse Warning Network,
termined by the total weight of the tablets, not Medical Examiner Data
strength. Similar drugs of lower strength like Percocet Drug Enforcement Administration Boston
and Tylox may weigh more than OxyContin, thus Field Division
distributing the same quantities may result in stiffer
Drug Enforcement Administration Washington
penalties than for distributing OxyContin.
Field Division
Authorities in Maine, in conjunction with the U.S. Gilbert Police Department, West Virginia
Government, launched a new initiative in 2000 regard-
Grant, Dominick, Diversion Investigator, Drug
ing OxyContin abuse. The Maine Attorney General’s
Enforcement Administration
Office has proposed legislation seeking to make pos-
session of a large number of OxyContin tablets a felony; Haddox, J. David, MD, DDS, Senior Medical
such possession is currently a misdemeanor. Director, Health Policy, Purdue Pharma, L.P.
Hancock-Brooke-Weirton Drug Task Force,
Outlook West Virginia
Continued increases in the diversion and abuse Huntington Drug and Violent Crime Task
of OxyContin are likely. Reliable strength, potential Force, West Virginia
prescription cost coverage, and significant profit Kentucky State Police
potential make OxyContin attractive to both illicit
Luken, Dennis, Detective,
distributors and abusers. Authorities have recognized
Cincinnati Police Department,
the increasing problems associated with diversion
Pharmaceutical Diversion Squad, Ohio
of the drug. Law enforcement officials, physicians,

This document may contain dated information. 5

It has been made available to provide access to historical materials.
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OxyContin Diversion and Abuse

Maine Attorney General’s Office The Journal of American Medical Association

McCloskey, Jay, U.S. Attorney, The Logan Daily News, Hocking County, Ohio
District of Maine The Maryland Drug Early Warning System
Mountain Comprehensive Care Center, The Portland Press Herald, Portland, Maine
Prestonburg, Kentucky
The Roanoke Times, Roanoke, Virginia
Pennsylvania State Police
The Tribune-Democrat, Johnstown, Pennsylvania
Physician’s Desk Reference 54 Edition 2000
The Williamson Daily, Williamson,
Pulaski Police Department, Virginia West Virginia
Ramseyer, Randy, Assistant U.S. Attorney, Times-Dispatch, Richmond, Virginia
Western District of Virginia
The Bangor Daily News, Bangor, Maine

319 Washington Street 5th Floor, Johnstown, PA 15901-1622 • (814) 532-4601

This document may contain dated information.

It has been made available to provide access to historical materials.