Oxycontin: rural communities face their own issues

Jeff Green | Feb 03, 2011

Call it what you want, “hillbilly heroin”, “oxy” or “OC”, Oxycontin, a time-release formulation of the opium-based painkiller oxycodone, has been identified with an addiction problem that crosses age and socio-economic boundaries.

It also crosses geographic barriers, and at a seminar on January 17 in Perth, some of the issues around prescription opiate addiction were given a forum at a talk sponsored by the Lanark chapter of the Canadian Federation of University Women. After screening a film about the impact of street level Oxycontin, a panel discussion took place featuring Rebecca Bellamy, a pharmacist in Perth; Elaine Riddick, a Westport-based doctor; David North from Tri-County Addiction Services; and Paula Stewart, the Medical Officer of Health for Lanark County. The panel discussion was moderated by Jennifer Barr, from the Centre for Addiction and Mental Health.

“It is not overstating it to say over-use of pharmaceuticals has become a crisis in Ontario,” said Jennifer Barr. Addiction services have seen an increase in their patient load and there have been health and social impacts: addictions; loss of jobs, loss of homes, family disruptions, disabilities, and increased health costs.

Jennifer Barr said that the non-medical use of opioids has overtaken tobacco as a drug that students report they have taken at least once in the past year.

She referred to a survey that was done in 2009 across Ontario. It reported that while a majority of students, 58.2%, report they have tried alcohol within the previous year, and 25.6% have tried cannabis, 17.8% claim to have taken opioid pain relievers for non-medical use, and 11.7% said they had smoked cigarettes.

In looking more closely a the study, it turns out that Oxycontin was taken by only 2% of the students in the study, the other 15% had tried a variety of other opioid pharmaceuticals, including codeine (Tylenol 1 and 3) Percocet, Percodan, and Demerol.

There are a couple of specific reasons why the Oxycontin variation has become popular as a pain medication, and has become a street drug as well.

The other formulations mentioned above all include acetaminophen (the active drug in Tylenol pills), which can cause organ damage if taken in large doses. Oxycontin does not contain acetaminophen, so it can be taken in higher doses. Oxycontin is also a time-release formulation, so the pills last longer as a pain medication. However, Oxycontin, which is available in 10, 20, 40 and 80 mg doses, can be chewed or crushed into a powder and eaten or snorted, releasing the entire dose at one time.

Like opium, morphine, and heroin, Oxycontin can induce a feeling of euphoria, drowsiness, and relaxation, but the body develops tolerance rather quickly, and more and more of the drug is needed to get the same effect. Opiates also foster a physical dependency.

When used as a pain medication, the same realities apply. The amount required for pain management increases over time, and after using the drugs for a period of time withdrawal symptoms are almost inevitable.

Whether drugs are taken medicinally or recreationally, medical professionals make a distinction between dependency and addiction.

Addiction is described by the Centre for Addiction and Mental Health as occurring “when a drug becomes central to a person’s thoughts, emotions and activities, and he or she feels a craving or compulsion to continue using the drug. This may or may not include physical dependence, which is the result of the body adapting to the presence of the drug, and is not the same as addiction.”

Oxycontin pills have a value as a street drug, but since they are available as a pharmaceutical some people with drug plans and a prescription they are not using can turn the pills not cash

This has led some, such as Doctor Elaine Riddick of Westport, to advocate for a ban on the drug. “No one in this town, or in this country, needs Oxycontin to manage pain. I’d like to remove Oxycontin from use, with the only exception being for palliative care. The government needs to address those issues. It is not something a community can do. The government has to remove it from circulation.”

While Doctor Riddick takes a hard line, I interviewed a number of the health professionals in preparation of this article and they all acknowledged that Oxycontin represents a serious problem.

In talking to health professionals in Frontenac County after the forum in Perth, it was also clear that Oxycontin and other opioids are as much a problem in Frontenac as they are in Lanark.

It is unclear, however, what alternatives there are that can provide the kind of relief that Oxycontin brings to a number of patients.

(There are a number of related issues raised in researching this story, which we will attempt to look at in future issues of the News)