Dr. Inaba,
One of my students sent this LA Times Investigation article that claims oxycontin wears off hours early and does not sustain pain relief the advertised 12 hours.
I have not heard about this report, published in May, 2016. What is your take on it? Is it true Oxycontin doesn’t last the full 12 hours, and is that a major cause of the increase in opioid addiction?
http://www.latimes.com/projects/oxycontin-part1/
Wanda Urban, MS, CADC III, MAC
Human Services Program
Chemeketa Community College
Hi Wanda,
Thanks you for this question as it sheds more light on the manipulations of Purdue Pharma that pretty much initiated this horrible opioid epidemic we are now in.
The LA Times article, You Want a Description of Hell? Oxycontin’s 12-Hour Problem is accurate and a great example of investigative journalism. It is much like the expose of the tobacco industry work to promote that addiction and suppress or confuse that fact while developing more addictive products targeted for newer populations to exploit.
Note that even if Purdue Pharma honestly reported that only 30% to 50% of test subjects got a full 12 hour relief from pain rather than the 90% they were touting, that would have been sufficient enough for the FDA to approve it as a 12 hour pain reliever. Many medications are only effective on a small portion of their claims but as long they do what they were supposed to do for some % of patients, the FDA often does approve it for that purpose.
Purdue Pharma also concentrated on the pain issues and may have purposely ignored the addiction issues with Oxycontin. What sells more drugs? Pain relief or addiction. Using alcohol as a model, only 15-20% of those who drink purchase 80% of the alcohol sold. Once a person develops addiction, nothing will stop them for taking more and more of the substance they are addicted to. With Oxycontin, if the pain comes back before the next dose of Oxy is scheduled (often misrepresented by medicine as “break through pain”) more is taken earlier that increases risk for tissue dependence (physical addiction). The shorter action of the alleged 12 hour medication would also allow for withdrawal symptoms to start before the next dose is scheduled increasing the potential for emotional as well as physical dependence. If instead, physicians and patients do what Purdue Pharma recommended, higher dose of Oxycontin to control pain it will actually have greater risk of resulting in tissue dependence. Prior to Oxycontin, the FDA/DEA only allowed 5 mg of its active chemical, oxycodone per pill (Percodan, Percocet). This was because it was known to be a strongly addictive substance especially at higher doses. With Purdue Pharma’s assurance that each molecule of the active chemical, oxycodone in an Oxycontin tablet would be bound to a time released material to prevent a large addictive bolus of that chemical from hitting the brain, the company was allowed having up to 120 mg. of oxycodone per pill. The greater the dose again increases the risk of addiction, People who fell in love with the euphoric effects of Oxycontin learn to modify the pill for abuse themselves by crushing, freezing, or other pill modifications to make it available as a bolus for a greater high. This also made it more addictive. Then, people have different enzyme system that more easily dissolve the protective coating of the molecule making the higher dosage forms more addictive to them. There are also differences in metabolism of the chemical by some making them more or less apt to develop addiction.
So, your student is correct, though for some oxycontin may provide a full 12 hour pain coverage while, I suspect for most, it doesn’t and more and more reports link our current opiate epidemic on the release of more potent oxycodone tablets like Oxycontin in the 1990s.
Dr. Darryl S. Inaba, PharmD, CATC V, CADC III
Director of Clinical and Behavioral Health Service, Addictions Recovery Center
Director of Research and Education, CNS Productions