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The Wellington psychiatrist and addiction specialist Dr Jeremy McMinn commented in his interview in BPJ 61 (Jun, 2014), that in terms of the misuse of oxycodone in New Zealand, we are looking at a disaster in the making. Clinicians are urged to assess whether oxycodone is appropriate when initiating or continuing a prescription and, if necessary, make changes to their prescribing behaviour. How is it best to manage the problem with oxycodone? According to Dr McMinn: Dont get there in the first place.
The international experience
Oxycodone was first synthesised in Germany in 1916 and became available for use in the United States in 1939. For many years it was used overseas as a component of combination short-acting analgesics, including paracetamol and NSAIDs. The controlled-release oxycodone-only formulation, OxyContin, was approved by the Food and Drug Administration (FDA) in the United States in 1996. In New Zealand, oxycodone was approved by Medsafe in 2001 and the oral forms (controlled and immediate-release) were subsidised on the New Zealand Pharmaceutical Schedule from 2005.
Since its release, the use of oxycodone has increased dramatically and many countries are now dealing with misuse and addiction issues. For example, in Ontario, Canada, the number of prescriptions for oxycodone increased by 850% between 1991 and 2007.1 After controlled-release oxycodone was added to the Ontario state drug formulary there was a five-fold increase in oxycodone-related mortality, along with a 41% increase in overall opioid-related mortality.1 Similar increases in the prescribing rates for oxycodone have also been observed in the USA. The national estimates for drug-related emergency department visits for oxycodone-containing medicines increased from 27.6 per 100 000 people in 2004 to 88.5 visits per 100 000 in 2009.2 In Australia, the oxycodone supply increased 22-fold between 1997 and 2012, and oxycodone became the seventh most commonly prescribed medicine in general practice.3 By 2007, a national sample of injecting drug users found that 51% had reported using oxycodone.4