Editing Oxycodone (section)

===Opioid epidemic===
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{{See also|Opioid epidemic}}
Oxycodone, like other opioid analgesics, tends to induce feelings of euphoria, relaxation, and reduced anxiety in those who are occasional users.<ref>{{cite web|title=OxyContin: Pain Relief vs. Abuse|url=http://www.webmd.com/pain-management/features/oxycontin-pain-relief-vs-abuse|access-date=11 February 2018|archive-date=24 October 2017|archive-url=https://web.archive.org/web/20171024093615/https://www.webmd.com/pain-management/features/oxycontin-pain-relief-vs-abuse|url-status=live}}</ref> These effects make it one of the most commonly abused pharmaceutical drugs in the United States.<ref>{{cite web|date=28 April 2014|title=Top 10 Most Commonly Abused Prescription Medications|url=http://newlifehouse.com/top-10-commonly-abused-prescription-medications/|url-status=dead|archive-url=https://web.archive.org/web/20180102052056/https://newlifehouse.com/top-10-commonly-abused-prescription-medications/|archive-date=2 January 2018|access-date=11 February 2018}}</ref> The abuse of Oxycodone, as well as related opioids more broadly, is not unique to the United States and is a common drug of abuse globally.<ref>{{Cite web |title=Opioid overdose |url=https://www.who.int/news-room/fact-sheets/detail/opioid-overdose |access-date=11 November 2023 |website=World Health Organization }}</ref><ref>{{Cite web |title=WHO Expert Committee on Drug Dependence: forty-third report |url=https://www.who.int/publications-detail-redirect/9789240023024 |access-date=11 November 2023 |website=World Health Organization }}</ref>

====United States====
{{See also|Opioid epidemic in the United States}}

Oxycodone is the most widely recreationally used opioid in America. In the United States, more than 12 million people use opioid drugs recreationally.<ref name="Girioin">{{cite news|date=11 September 2013|title=FDA to require stricter labeling for pain drugs|pages=A1 and A9|newspaper=Los Angeles Times|vauthors=Girioin L, Haely M}}</ref> The [[U.S. Department of Health and Human Services]] estimates that about 11 million people in the U.S. consume oxycodone in a non-medical way annually.<ref>[http://www.sfchronicle.com/news/article/Now-a-counselor-she-went-from-stoned-to-straight-6605620.php Now a counselor, she went from stoned to straight], [[San Francisco Chronicle]], 2 November. 2015.</ref>

Opioids were responsible for 49,000 of the 72,000 [[drug overdose]] deaths in the U.S. in 2017.<ref name="NIDA-deaths">{{cite web|date=29 January 2019|title=Overdose Death Rates|url=http://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates|access-date=11 May 2019|website=www.drugabuse.gov|archive-date=28 November 2015|archive-url=https://web.archive.org/web/20151128091723/http://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates|url-status=live}}</ref> In 2007, about 42,800 emergency room visits occurred due to "episodes" involving oxycodone.<ref>{{Cite web|title=Oxycontin and Addiction|url=http://consumer.healthday.com/encyclopedia/substance-abuse-38/drug-abuse-news-210/oxycontin-and-addiction-648264.html|access-date=24 April 2016|website=consumer.healthday.com|archive-date=15 April 2016|archive-url=https://web.archive.org/web/20160415210939/http://consumer.healthday.com/encyclopedia/substance-abuse-38/drug-abuse-news-210/oxycontin-and-addiction-648264.html|url-status=dead}}</ref> In 2008, recreational use of oxycodone and hydrocodone was involved in 14,800 deaths. Some of the cases were due to overdoses of the acetaminophen component, resulting in fatal liver damage.<ref>[https://web.archive.org/web/20120105112147/http://www.cdc.gov/HomeandRecreationalSafety/pdf/PolicyImpact-PrescriptionPainkillerOD.pdf Policy Impact: Prescription Pain Killer Overdoses] Centers for Disease Control and Prevention. Retrieved 24 December 2013.</ref>

In September 2013, the US [[Food and Drug Administration]] (FDA) released updated labeling guidelines for long-acting and extended-release opioids requiring manufacturers to remove moderate pain as an indication for use, instead stating the drug is for "pain severe enough to require daily, around-the-clock, long term opioid treatment".<ref>{{cite web|title=ER/LA Opioid Analgesic Class Labeling Changes and Postmarket Requirements|url=https://www.fda.gov/media/86875/download | format=PDF |access-date=12 September 2013|publisher=U.S. [[Food and Drug Administration]] (FDA)|archive-date=18 September 2013|archive-url=https://web.archive.org/web/20130918062419/http://www.fda.gov/downloads/Drugs/DrugSafety/InformationbyDrugClass/UCM367697.pdf|url-status=live}}</ref> The updated labeling does not restrict physicians from prescribing opioids for moderate pain, as needed.<ref name="Girioin" />

Reformulated OxyContin is causing some recreational users to change to [[heroin]], which is cheaper and easier to obtain.<ref>[http://www.pharmaceutical-journal.com/news-and-analysis/news/reformulated-oxycontin-reduces-abuse-but-many-addicts-have-switched-to-heroin/20068119.article Reformulated OxyContin reduces abuse but many addicts have switched to heroin] {{Webarchive|url=https://web.archive.org/web/20171120051037/http://www.pharmaceutical-journal.com/news-and-analysis/news/reformulated-oxycontin-reduces-abuse-but-many-addicts-have-switched-to-heroin/20068119.article |date=20 November 2017 }}, The Pharmaceutical Journal, 16 March 2015.</ref>

=====Lawsuits=====
In October 2017, ''[[The New Yorker]]'' published a story on [[Mortimer Sackler]] and [[Purdue Pharma]] regarding their ties to the production and manipulation of the oxycodone markets.<ref name="eop" /> The article links Raymond and Arthur Sackler's business practices with the rise of direct pharmaceutical marketing and eventually to the rise of addiction to oxycodone in the United States. The article implies that the [[Sackler family]] bears some responsibility for the [[opioid epidemic in the United States]].<ref name="NewYorker_Keefe_20171023">{{Cite magazine|vauthors=Keefe PR|date=23 October 2017|title=The Family That Built an Empire of Pain|magazine=[[The New Yorker]]|url=https://www.newyorker.com/magazine/2017/10/30/the-family-that-built-an-empire-of-pain|access-date=18 November 2017|issn=0028-792X|archive-date=22 January 2018|archive-url=https://web.archive.org/web/20180122073308/https://www.newyorker.com/magazine/2017/10/30/the-family-that-built-an-empire-of-pain|url-status=live}}</ref> In 2019, ''[[The New York Times]]'' ran a piece confirming that [[Richard Sackler]], the son of Raymond Sackler, told company officials in 2008 to "measure our performance by Rx's by strength, giving higher measures to higher strengths".<ref>{{Cite news|vauthors=Meier B|date=31 January 2019|title=Sackler Scion's Email Reveals Push for High-Dose OxyContin, New Lawsuit Disclosures Claim|work=The New York Times|url=https://www.nytimes.com/2019/01/31/health/opioids-purdue-pharma-sackler.html|access-date=3 February 2019|issn=0362-4331|archive-date=2 February 2019|archive-url=https://web.archive.org/web/20190202180610/https://www.nytimes.com/2019/01/31/health/opioids-purdue-pharma-sackler.html|url-status=live}}</ref> This was verified with documents tied to a lawsuit – which was filed by the Massachusetts attorney general, [[Maura Healey]] – claiming that Purdue Pharma and members of the Sackler family knew that high doses of OxyContin over long periods would increase the risk of serious side effects, including addiction.<ref>{{cite news|vauthors=Bebinger M, Willmsen C|date=15 January 2019|title=Mass. AG Implicates Family Behind Purdue Pharma In Opioid Deaths|work=WBUR Boston|url=https://www.wbur.org/commonhealth/2019/01/15/healey-purdue-oxycontin-sacklers-unredacted-complaint|access-date=19 September 2019|archive-date=16 October 2019|archive-url=https://web.archive.org/web/20191016135025/https://www.wbur.org/commonhealth/2019/01/15/healey-purdue-oxycontin-sacklers-unredacted-complaint|url-status=live}}</ref> Despite Purdue Pharma's proposal for a US$12 billion settlement of the lawsuit, the attorneys general of 23 states, including Massachusetts, rejected the settlement offer in September 2019.<ref>{{cite news|vauthors=DeCosta-Klipa N|date=17 September 2019|title=Maura Healey explains why she refused to join the Purdue Pharma settlement|work=Boston.com|publisher=Boston Globe Media Partners, LLC|url=https://www.boston.com/news/politics/2019/09/17/maura-healey-purdue-settlement|access-date=19 September 2019|archive-date=17 October 2019|archive-url=https://web.archive.org/web/20191017195611/https://www.boston.com/news/politics/2019/09/17/maura-healey-purdue-settlement|url-status=live}}</ref>

====Australia====
The non-medical use of oxycodone existed since the early 1970s, but by 2015, 91% of a national sample of injecting drug users in Australia had reported using oxycodone, and 27% had injected it in the last six months.<ref>{{cite book|url=http://ndarc.med.unsw.edu.au/NDARCWeb.nsf/resources/DRUG_TRENDS_1_NAT/$file/DT001.PDF |title=Australian drug trends 2007. Findings from the Illicit Drug Reporting System (IDRS)|vauthors=Black E|publisher=National Drug and Alcohol Research Centre, University of New South Wales|year=2008|isbn=978-0-7334-2625-4|location=Sydney|archive-url= https://web.archive.org/web/20080721045101/http://ndarc.med.unsw.edu.au/NDARCWeb.nsf/resources/DRUG_TRENDS_1_NAT/$file/DT001.PDF |archive-date=21 July 2008|url-status=dead}}</ref>

====Canada====
Opioid-related deaths in Ontario had increased by 242% from 1969 to 2014.<ref name="The_Star_2014">{{cite web|vauthors=Boyle T|title=Opioid deaths soaring, study finds Opioid-related deaths in Ontario jumped by a whopping 242 per cent over two decades, according to a study by ICES and St. Mike's|date=7 July 2014|url=https://www.thestar.com/life/health_wellness/2014/07/07/opioid_deaths_soaring_study_finds.html|work=The Star|location=Toronto, Ontario|access-date=23 January 2015|archive-date=23 January 2015|archive-url=https://web.archive.org/web/20150123191050/http://www.thestar.com/life/health_wellness/2014/07/07/opioid_deaths_soaring_study_finds.html|url-status=live}}</ref> By 2009 in Ontario there were more deaths from oxycodone overdoses than from cocaine overdoses.<ref name="The_Star_2009">{{cite web|vauthors=Donovan K|title=Oxycodone found to be more deadly than heroin|date=10 February 2009|url=https://www.thestar.com/life/health_wellness/2009/02/10/oxycodone_found_to_be_more_deadly_than_heroin.html|work=The Star|location=Toronto, Ontario|access-date=23 January 2015|archive-date=23 January 2015|archive-url=https://web.archive.org/web/20150123191054/http://www.thestar.com/life/health_wellness/2009/02/10/oxycodone_found_to_be_more_deadly_than_heroin.html|url-status=live}}</ref> Deaths from opioid pain relievers had increased from 13.7 deaths per million residents in 1991 to 27.2 deaths per million residents in 2004.<ref>{{cite news|title=Study finds huge rise in oxycodone deaths|publisher=[[CTV News]]|url=https://www.ctvnews.ca/study-finds-huge-rise-in-oxycodone-deaths-1.461899|access-date=7 December 2009|archive-date=28 June 2012|archive-url=https://web.archive.org/web/20120628112202/http://www.ctvnews.ca/study-finds-huge-rise-in-oxycodone-deaths-1.461899|url-status=live}}</ref> The non-medical use of oxycodone in Canada became a problem. Areas where oxycodone is most problematic are [[Atlantic Canada]] and [[Ontario]], where its non-medical use is prevalent in rural towns and in many smaller to medium-sized cities.<ref name="Oxyabuse">{{cite web|title=OxyContin Fact Sheet|url=http://www.ccsa.ca/2006%20CCSA%20Documents/ccsa-003642-2006.pdf|archive-url=https://web.archive.org/web/20081117203212/http://www.ccsa.ca/2006%20CCSA%20Documents/ccsa-003642-2006.pdf|archive-date=17 November 2008|access-date=10 May 2012|website=ccsa.ca|url-status=dead}}</ref> Oxycodone is also widely available across [[Western Canada]], but [[methamphetamine]] and [[heroin]] are more serious problems in larger cities, while oxycodone is more common in rural towns. Oxycodone is diverted through [[doctor shopping]], prescription forgery, pharmacy theft, and overprescription.<ref name="Oxyabuse" /><ref>{{cite web|date=11 January 2010|title=Health Canada – Misuse and Abuse of Oxycodone-based Prescription Drugs|url=http://www.hc-sc.gc.ca/hc-ps/pubs/precurs/oxycodone/fs-fi/index-eng.php|archive-url=https://web.archive.org/web/20111126013544/http://www.hc-sc.gc.ca/hc-ps/pubs/precurs/oxycodone/fs-fi/index-eng.php|archive-date=26 November 2011|access-date=10 May 2012|website=Hc-sc.gc.ca}}</ref>

The recent formulations of oxycodone, particularly Purdue Pharma's crush-, chew-, injection- and dissolve-resistant OxyNEO<ref>{{cite news| vauthors = Kirkey S |date=23 May 2012|title=OxyNEO another prescription for disaster?|newspaper=Globe and Mail|location=Toronto, Ontario}}</ref> which replaced the banned OxyContin product in Canada in early 2012, have led to a decline in the recreational use of this opiate but have increased the recreational use of the more potent drug fentanyl.<ref>{{cite web|vauthors=Criger E|date=17 August 2015|title=Death of OxyContin behind rise of fentanyl?|url=https://toronto.citynews.ca/2015/08/17/death-of-oxycontin-behind-rise-of-fentanyl/|access-date=7 February 2019|website=CityNews|publisher=Rogers Digital Media|archive-date=9 February 2019|archive-url=https://web.archive.org/web/20190209180023/https://toronto.citynews.ca/2015/08/17/death-of-oxycontin-behind-rise-of-fentanyl/|url-status=live}}</ref> According to a Canadian Centre on Substance Abuse study quoted in [[Maclean's]] magazine, there were at least 655 fentanyl-related deaths in Canada in five years.<ref>{{cite web|vauthors=Gatehouse J, Macdonald N|date=22 June 2015|title=Fentanyl: The King of all Opiates, and a Killer Drug Crisis|url=http://www.macleans.ca/society/health/fentanyl-the-king-of-all-opiates-and-a-killer-drug-crisis/|access-date=15 December 2015|website=Maclean's|publisher=Rogers Media|archive-date=15 December 2015|archive-url=https://web.archive.org/web/20151215045912/http://www.macleans.ca/society/health/fentanyl-the-king-of-all-opiates-and-a-killer-drug-crisis/|url-status=live}}</ref>

In Alberta, the Blood Tribe police claimed that from the fall of 2014 through January 2015, oxycodone pills or a lethal fake variation referred to as Oxy 80s<ref name="Southwick">{{cite news| vauthors = Southwick R |date=2 December 2015|title=Fentanyl brings tragedy to Blood Tribe|newspaper=Calgary Herald|location=Calgary, Alberta|url=https://calgaryherald.com/news/crime/fentanyl-brings-tragedy-to-blood-tribe|url-status=dead|access-date=15 December 2015|archive-url=https://web.archive.org/web/20151222143028/http://calgaryherald.com/news/crime/fentanyl-brings-tragedy-to-blood-tribe|archive-date=22 December 2015}}</ref> containing [[fentanyl]] made in illegal labs by members of organized crime were responsible for ten deaths on the [[Blood Indian Reserve No. 148|Blood Reserve]], which is located southwest of [[Lethbridge]], [[Alberta]].<ref name="Calgary_Herald_2015">{{citation|title=Police believe organized crime is flooding the Blood Tribe reserve with an illegal drug that has been linked to 10 deaths|date=23 January 2015|url=https://calgaryherald.com/storyline/police-believe-organized-crime-is-behind-flooding-the-blood-tribe-reserve-with-an-illegal-drug-that-has-been-linked-to-10-deaths|archive-url=https://web.archive.org/web/20160124073724/http://calgaryherald.com/storyline/police-believe-organized-crime-is-behind-flooding-the-blood-tribe-reserve-with-an-illegal-drug-that-has-been-linked-to-10-deaths|location=Alberta|publisher=Calgary Herald|access-date=23 January 2015|archive-date=24 January 2016|url-status=dead}}</ref> Province-wide, approximately 120 Albertans died from fentanyl-related overdoses in 2014.<ref name="Southwick" />

====United Kingdom====
Prescriptions of Oxycodone rose in Scotland by 430% between 2002 and 2008, prompting fears of usage problems that would mirror those of the United States.<ref>{{cite news|vauthors=Gordon T|date=30 March 2008|title=Huge rise in Scots misuse of painkiller|work=Sunday Times (London)|url=https://www.thetimes.com/best-law-firms/profile-legal/article/huge-rise-in-scots-misuse-of-painkiller-q5bl8rlpb6b|access-date=12 April 2022|archive-date=10 October 2022|archive-url=https://web.archive.org/web/20221010053102/https://www.thetimes.co.uk/article/huge-rise-in-scots-misuse-of-painkiller-q5bl8rlpb6b|url-status=live}}</ref> The first known death due to overdose in the UK occurred in 2002.<ref>{{cite news|vauthors=Thompson T|date=24 March 2002|title=Epidemic fear as 'hillbilly heroin' hits the streets|work=Society Guardian|url=https://www.theguardian.com/society/2002/mar/24/drugsandalcohol|access-date=16 April 2009|archive-date=26 August 2013|archive-url=https://web.archive.org/web/20130826005512/http://www.theguardian.com/society/2002/mar/24/drugsandalcohol|url-status=live}}</ref>

===={{anchor|OxyContin}}Preventive measures====
In August 2010, [[Purdue Pharma]] reformulated their long-acting oxycodone line, marketed as OxyContin, using a polymer, Intac,<ref name=DDD13.8>{{cite web |date=2010 |title=New Abuse Deterrent Formulation Technology for Immediate-Release Opioids |url=http://www.grunenthal.com/cms/cda/file/Drug+Development+%26+Delivery+October+2013+Vol+13+No+8.pdf?fileID=273800346&cacheFix=1383822554000&__k=3870fc7ab9c0252c7a9c8547fb47de75 |url-status=dead |archive-url=https://web.archive.org/web/20151222103656/http://www.grunenthal.com/cms/cda/file/Drug+Development+%26+Delivery+October+2013+Vol+13+No+8.pdf?fileID=273800346&cacheFix=1383822554000&__k=3870fc7ab9c0252c7a9c8547fb47de75 |archive-date=22 December 2015 |access-date=15 December 2015 |website=Grünenthal Group |publisher=Grünenthal Group Worldwide}}</ref> to make the pills more difficult to crush or dissolve in water<ref>{{cite web|vauthors=Diep F|date=13 May 2013|title=How Do You Make a Painkiller Addiction-Proof|url=https://www.popsci.com/science/article/2013-05/science-un-crushable-oxycontin|access-date=30 January 2019|website=Popular Science|publisher=Bonnier Corporation|archive-date=14 December 2019|archive-url=https://web.archive.org/web/20191214154207/https://www.popsci.com/science/article/2013-05/science-un-crushable-oxycontin/|url-status=live}}</ref> to reduce non-medical use of OxyContin.<ref>{{Cite conference|vauthors=Coplan P|year=2012|title=Findings from Purdue's Post-Marketing Epidemiology Studies of Reformulated OxyContin's Effects|url=http://www.nascsa.org/Conference2012/Presentations/Coplan.pdf|conference=NASCSA 2012 Conference|location=Scottsdale, Arizona|archive-url=https://web.archive.org/web/20130614115419/http://www.nascsa.org/Conference2012/Presentations/Coplan.pdf|archive-date=14 June 2013|conference-url=https://web.archive.org/web/20130512052124/http://www.nascsa.org/conference2012.htm|url-status=dead|accessdate=23 May 2013}}</ref> [[Inactive ingredient|Inactive ingredients/excipients]] are [[butylated hydroxytoluene]] (BHT), [[hypromellose]], [[PEG 400|polyethylene glycol 400]], polyethylene oxide, magnesium stearate, and titanium dioxide.<ref name="OxyContin FDA label">{{cite web | title=Oxycontin- oxycodone hydrochloride tablet, film coated, extended release | website=DailyMed | date=5 December 2024 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=bfdfe235-d717-4855-a3c8-a13d26dadede | access-date=7 February 2025}}</ref><ref name="rxlist">{{cite web |title=Oxycontin (Oxycodone HCl): Side Effects, Uses, Dosage, Interactions, Warnings |url=https://www.rxlist.com/oxycontin-drug.htm |website=RxList |language=en}}</ref><ref name=DDD13.8 /> The FDA approved relabeling the reformulated version as abuse-resistant in April 2013.<ref>{{cite press release |title=FDA approves abuse-deterrent labeling for reformulated OxyContin|url=https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm348252.htm|url-status=dead|archive-url=https://web.archive.org/web/20130520025104/http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm348252.htm|archive-date=20 May 2013|access-date=23 May 2013|publisher=U.S. [[Food and Drug Administration]] (FDA) }}</ref>

[[Pfizer]] manufactures a preparation of short-acting oxycodone, marketed as Oxecta, which contains inactive ingredients, referred to as tamper-resistant Aversion Technology.<ref>{{cite web|title=Pfizer and Acura Announce FDA Approval of Oxectatm (Oxycodone HCL, USP) CII|url=http://press.pfizer.com/press-release/pfizer-and-acura-announce-fda-approval-oxectatm-oxycodone-hcl-usp-cii|url-status=dead|archive-url=https://web.archive.org/web/20151222111749/http://press.pfizer.com/press-release/pfizer-and-acura-announce-fda-approval-oxectatm-oxycodone-hcl-usp-cii|archive-date=22 December 2015|access-date=15 December 2015|website=Pfizer News and Media|publisher=Pfizer Inc.}}</ref> Approved by the FDA in the U.S. in June 2011, the new formulation, while not being able to deter oral recreational use, makes crushing, chewing, snorting, or injecting the opioid impractical because of a change in its chemical properties.<ref>{{cite web| vauthors = Fiore K |date=20 June 2011|title=FDA Okays New Abuse-Resistant Opioid|url=http://www.medpagetoday.com/ProductAlert/Prescriptions/27157|url-status=dead|archive-url= https://web.archive.org/web/20151222095414/http://www.medpagetoday.com/ProductAlert/Prescriptions/27157|archive-date=22 December 2015|access-date=15 December 2015|website=MedPage Today}}</ref>