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Oxycodone: how did we get here and how do we fix it?
Following on from the interview with Dr Jeremy McMinn in the last edition of Best Practice Journal, we examine in more detail what the actual problem is with oxycodone, and how we ended up in this situation.
There is also a Peer Group Discussion on this article
In this article View / Download pdf version of this article
How did the problem with oxycodone evolve?
When oxycodone was first introduced into New Zealand in the early 2000s, it was regarded by many as a new and improved strong analgesic, with fewer adverse effects and perhaps none of the stigma associated with morphine. As a result, prescribing of oxycodone increased significantly over the next few years, reaching its peak in 2011/12. The number of prescriptions for morphine remained relatively stable over this same time period, suggesting that a new patient population being treated with oxycodone had been created.
Paralleling this surge in oxycodone use, reports of misuse and addiction emerged in New Zealand, following the trend observed in other countries with a longer history of oxycodone use. It has now become apparent that there is little or no advantage of oxycodone over morphine in terms of managing pain. Oxycodone is associated with the same adverse effects as morphine, and appears to be even more addictive than morphine. Therefore, there is no reason to continue to prescribe oxycodone instead of morphine (unless intolerable adverse effects have occurred with morphine), or to prescribe it when a less potent analgesic would be more appropriate.