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The strong marketing of oxycodone (See: The oxycodone marketing campaign), along with its rapid rise in popularity, means that many aspects of its pharmacology and general use may be misunderstood. There are few head-to-head trials comparing oxycodone with morphine or other opioids, yet several claims have been made about its alleged superiority, many of which are not entirely accurate. There is no debating that oxycodone is an effective analgesic, however, there is no compelling clinical reason to choose it over morphine, and the associated risks and problems with its use, clearly place oxycodone as a second-line option.

Despite its name, oxycodone is not a natural version of codeine or a gentle analgesic it is approximately twice as potent as morphine, i.e. 10 mg of oxycodone is equivalent to 1520 mg of morphine.6, 7 A clinical trial reported that oral controlled-release oxycodone was twice as potent as oral controlled-release morphine in patients who received single doses for post-operative pain following hysterectomy.8 For total and peak analgesic effects, the doses of 20 mg and 40 mg oxycodone were comparable to morphine doses of 45 mg and 90 mg, respectively.8

Oxycodone is approximately 7.5 20 times more potent than codeine, i.e. 10 mg of oxycodone is equivalent to 75-200 mg of codeine.6

The stigma associated with morphine is a reason that some patients are reluctant to use it, however, the same patients are comfortable using oxycodone. When discussing appropriate analgesic treatments with patients, clinicians need to ensure that patients understand that oxycodone is used for the same purpose as morphine and is actually more potent.

Addictive potential: oxycodone rates higher than morphine
All opioid analgesics (including weak opioids) are potentially addictive, but the marketing campaign for oxycodone promoted the belief that it had a lower addictive potential than other strong opioids. However, the literature suggests that oxycodone actually has a higher addictive potential than morphine.

A systematic review of nine randomised trials compared the likeability and likelihood of misuse of oral oxycodone, morphine and other selected opioids in recreational drug users and people with a history of opioid misuse. It was found that oxycodone was more favoured and more likely to be misused than either morphine or hydrocodone (not available in New Zealand).9 Oxycodone demonstrated high subjective attractiveness ratings with a few negative ratings across the majority of studies included in the review. Oxycodone was also associated with consistently higher take again ratings than morphine.9
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