OxyContin® Frequently 

Asked Questions

Q: What Is OxyContin?

A: OxyContin is a semisynthetic opioid analgesic

prescribed for chronic or long-lasting pain. The

medication’s active ingredient is oxycodone, which

is also found in drugs like Percodan and Tylox.

However, OxyContin contains between 10 and 

160 milligrams of oxycodone in a timed-release

tablet. Painkillers such as Tylox contain 5 milligrams

of oxycodone and often require repeated doses to

bring about pain relief because they lack the timedrelease formulation.

Q: How Is OxyContin Used?

A: OxyContin, also referred to as “Oxy,” “O.C.,”

and “killer” on the street, is legitimately prescribed

as a timed-release tablet, providing as many as 12

hours of relief from chronic pain. It is often

prescribed for cancer patients or those with chronic,

long-lasting back pain. The benefit of the

medication to chronic pain sufferers is that they

generally need to take the pill only twice a day,

whereas a dosage of another medication would

require more frequent use to control the pain. The

goal of chronic pain treatment is to decrease pain

and improve function.

ADVISORY

April 2001, Volume 1, Issue 1

OxyContin®:

Prescription Drug Abuse

From the CSAT Director

by H. Westley Clark, M.D., J.D., M.P.H., CAS, FASAM

Recently, the media have issued numerous reports

about the apparent increase in OxyContin® abuse

and addiction. These reports have included the 

following:

• An alliance of hospitals in the greater Cincinnati

area has restricted the use of OxyContin to cancer patients, although exceptions will be granted.

The new policy calls for using other pain medications with less potential for abuse.1

• A treatment facility in southwest Virginia

received Federal and State approval to provide

methadone treatment in December 1999.

Halfway through the licensure process, staff

began receiving telephone calls from people

seeking information about OxyContin addiction.

Recently, 80 percent of the 290 people in this

outpatient treatment program named OxyContin

as their primary drug of abuse.2

• Pharmacies and homes in some rural areas have

been robbed by individuals seeking OxyContin.3

• Maine, one of the first States to report the

increase in OxyContin abuse, is the second

largest consumer of OxyContin in the United

States.4

These reports may reflect some of your own experiences: We know many of you are actually treating

patients addicted to OxyContin.

continued on reverse...

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration

Center for Substance Abuse Treatment

www.samhsa.gov

Breaking News for the Treatment Field

...continued on page 4

...continued on page 3
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Treatment and Detoxification Protocols

OxyContin® is a powerful drug that contains a much larger amount of the active ingredient, oxycodone, than other

prescription opiate pain relievers. While most people who take OxyContin as prescribed do not become addicted, those

who abuse their pain medication or obtain it illegally may find themselves becoming rapidly dependent on, if not

addicted to, the drug.

Two types of treatment have been documented as effective for opioid addiction. One is a long-term, residential,

therapeutic community type of treatment and the other is long-term, medication-assisted outpatient treatment. 

Clinical trials using medications to treat opioid addiction have generally included subjects addicted to diverted

pharmaceutical opioids as well as to illicit heroin. Therefore, there is no medical reason to suppose that the patient

addicted to diverted pharmaceutical opioids will be any less likely to benefit from medication-assisted treatment 

than the patient addicted to heroin.

Some opioid-addicted patients with very good social supports may occasionally be able to benefit from antagonist

maintenance with naltrexone. This treatment works best if the patient is highly motivated to participate in treatment and

has been adequately detoxed from the opioid of abuse. Most opioid-addicted patients in outpatient therapy, however, will

do best with medication that is either

an agonist or a partial agonist.

Methadone and levo alpha acetylmethadol (LAAM) are the two agonist

medications currently approved for

addiction treatment in this country.

Presently there is no partial agonist

approved by the Food and Drug

Administration (FDA) for use in

narcotic treatment, although

buprenorphine holds great promise.

The guidelines for treating OxyContin

addiction or dependency are basically

no different than the guidelines the

Center for Substance Abuse Treatment

(CSAT) uses for treating addiction or

dependency to ANY opioid. There is

one important thing to remember,

however: Because OxyContin contains

higher dose levels of opioid than are

typically found in other oxycodonecontaining pain medications, higher

CSAT Advisory

Editor: Edwin M. Craft, Dr. P.H., LCPC, Center for Substance Abuse Treatment

Managing Editor: Cheryl L. Serra, Johnson, Bassin & Shaw, Inc.

Associate Editor: Liz Zylwitis, Johnson, Bassin & Shaw, Inc.

Design and Layout: Sharon Hodgson, Johnson, Bassin & Shaw, Inc.

For further information or to request information about the CSAT Advisory, please

contact Edwin M. Craft, Editor, at ecraft@samhsa.gov.

The CSAT Advisory was written and produced by the Center for Substance Abuse

Treatment’s (CSAT’s) Knowledge Application Program (KAP), a Joint Venture of

Johnson, Bassin & Shaw, Inc., and The CDM Group, Inc. CSAT is a center within the

Substance Abuse and Mental Health Services Administration (SAMHSA), U.S.

Department of Health and Human Services (DHHS). This publication was produced

under contract number 270–99–7072.

A fully referenced version of the CSAT Advisory is available on CSAT’s Web site:

www.samhsa.gov/csat/csat.htm. Feel free to reproduce additional copies or reference

this publication; citation of the source is appreciated. The CSAT Advisory is designed

to relay information that has significant and immediate impact on patients seeking

alcohol or substance abuse treatment. The publication will be distributed to alcohol or

substance abuse treatment providers and other interested individuals on an as-needed

basis.

Suggested citation for the CSAT Advisory: Center for Substance Abuse Treatment.

OxyContin®: Prescription Drug Abuse. CSAT Advisory. Volume 1, Issue 1, April 2001.

...continued on page 6
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3

OxyContin has been heralded as a miracle drug that allows patients with chronic pain to resume a normal life. It has also been

called pharmaceutical heroin and is thought to have been responsible for a number of deaths and robberies in areas where its

abuse has been reported. Patients who legitimately use OxyContin fear that the recent controversy will mean tighter restrictions

on the drug. Abusers will reportedly go to great lengths—legal or illegal—to obtain the powerful drug.

At the Center for Substance Abuse Treatment (CSAT), we are not interested in fueling the controversy about the use or abuse of

OxyContin. As the Federal Government’s focal point for addiction treatment information, CSAT is instead interested in helping

professionals on the front line of substance abuse treatment by providing you with the facts about OxyContin, its use and abuse,

and how to treat individuals who present at your treatment facility with OxyContin concerns. Perhaps these individuals are taking medically prescribed OxyContin to manage pain and are concerned about their physical dependence on the medication.

Perhaps you will be faced with a young adult who thought that OxyContin was a “safe” recreational drug because, after all, doctors prescribe it. Possibly, changes in the availability or quality of illicit opioid drugs in your community have led to abuse of

and addiction to OxyContin.

Whatever the reason, OxyContin is being abused, and people are becoming addicted. And in many instances, these abusers are

young adults unaware of the dangers of OxyContin. Many of these individuals mix OxyContin with alcohol and other drugs and

the result is all too often tragic.

Abuse of prescription drugs is not a new phenomenon. You have undoubtedly heard about abuse of percocet, hydrocodone, and

a host of other medications. What sets OxyContin abuse apart, however, is the potency of the drug. Treatment providers in

affected areas say that they were unprepared for the speed with which an OxyContin “epidemic” has developed in their 

communities.

We at CSAT want to make sure that you are prepared if OxyContin abuse becomes a problem in your community. This first

issue of the CSAT Advisorywill prepare you by:

• Answering frequently asked questions about OxyContin

• Providing you with general information about semisynthetic opioids and their addiction potential

• Summarizing evidence-based protocols for treatment

• Providing you with a referral source for further information: www.samhsa.gov

• Introducing you to our Substance Abuse Treatment Facility Locator, an online database that can assist you in 

making referrals to treatment facilities.

For more information about OxyContin abuse and treatment, please see our resources boxes on pages 5 and 7, and the back

cover. Please also feel free to copy any of the articles in the CSAT Advisory and share them with colleagues so that they, too,

may have the most current information about this critically important topic. n

From the Director 

...continued from front cover

Notes

1. Bonfield, Tim, “OxyContin users wary of backlash,” Cincinnati Enquirer, February 26, 2001, retrieved March 2, 2001, from the World Wide Web,

www.enquirer.com/editions/2001/02/26/loc_oxycontin_users_wary.html.

2. Tina Renee Bullins, CEO, Life Center of Galax, interview by Cheryl Serra, March 2, 2001.

3. Roch, Timothy, “The potent perils of a miracle drug.” Time, February 28, 2001.

4. Ibid.
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Q: How Is OxyContin Abused?

A: OxyContin abusers either crush the tablet and ingest

or snort it or dilute it in water and inject it. Crushing or

diluting the tablet disarms the timed-release action of the

medication and causes a quick, powerful high. Abusers

have compared this feeling to the euphoria they experience

when taking heroin. In fact, in some areas, the use of

heroin is overshadowed by the abuse of OxyContin.

Purdue Pharma, OxyContin’s manufacturer, has taken

steps to reduce the potential for abuse of the medication.

Its Web site lists the following initiatives aimed at curbing

the illicit use of OxyContin: providing physicians with

tamper-proof prescription pads, developing and

distributing more than 400,000 brochures to send to

pharmacists and healthcare professionals to help educate

them about how to prevent diversion, working with

healthcare and law enforcement officials to address the

problem of prescription drug abuse, and helping to fund a

study of the best practices in Prescription Monitoring

Programs. In addition, the company is attempting to

research and develop other pain management products that

will be more resistant to abuse and diversion. The

company estimates that it will take significant time for

such products to be brought to market. For more

information, visit Purdue Pharma’s Web site at

www.purduepharma.com or call them at 203–588–8069.

Q: How Does OxyContin Abuse Differ From Abuse 

of Other Pain Prescriptions?

A: Abuse of prescription pain medications is not new.

Two primary factors, however, set OxyContin abuse apart

from other prescription drug abuse. First, OxyContin is a

powerful drug that contains a much larger amount of the

active ingredient, oxycodone, than other prescription pain

relievers. By crushing the tablet and either ingesting or

snorting it, or by injecting diluted OxyContin, abusers feel

the powerful effects of the opioid in a short time, rather

than over a 12-hour span. Second, great profits are to be 

made in the illegal sale of OxyContin. A 40-milligram pill

costs approximately $4 by prescription, yet it may sell for

$20 to $40 on the street, depending on the area of the

country in which the drug is sold.1

OxyContin can be comparatively inexpensive if it is

legitimately prescribed and if its cost is covered by

insurance. However, the National Drug Intelligence Center

reports that OxyContin abusers may use heroin if their

insurance will no longer pay for their OxyContin

prescription, because heroin is less expensive than

OxyContin that is purchased illegally. 2

Q: Why Are So Many Crimes Reportedly Associated

With OxyContin Abuse?

A: Many reports of OxyContin abuse have occurred in

rural areas that have housed labor-intensive industries,

such as logging or coal mining. These industries are often

located in economically depressed areas, as well.

Therefore, people for whom the drug may have been

legitimately prescribed may be tempted to sell their

prescriptions for profit. Substance abuse treatment

providers say that the addiction is so strong that people

will go to great lengths to get the drug, including robbing

pharmacies and writing false prescriptions.

Q: What Is the Likelihood That a Person for Whom

OxyContin Is Prescribed Will Become Addicted?

A: Most people who take OxyContin as prescribed do not

become addicted. The National Institute on Drug Abuse

(NIDA) reports: “With prolonged use of opiates and

opioids, individuals become tolerant...require larger doses,

and can become physically dependent on the drugs....

Studies indicate that most patients who receive opioids for

pain, even those undergoing long-term therapy, do not

become addicted to these drugs.”3

One NIDA-sponsored study found that “only four out of

more than 12,000 patients who were given opioids for

OxyContin Frequently Asked Questions

...continued from front cover
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CENTER FOR SUBSTANCE ABUSE TREATMENT

5

OxyContin Frequently Asked Questions 

acute pain actually became addicted to the drugs.... 

In a study of 38 chronic pain patients, most of whom

received opioids for 4 to 7 years, only 2 patients actually

became addicted, and both had a history of drug abuse.”4

In short, most individuals who are prescribed OxyContin, or

any other opioid, will not become addicted, although they

may become dependent on the drug and will need to be

withdrawn by a qualified physician. Individuals who are

taking the drug as prescribed should continue to do so, as

long as they and their physician agree that taking the drug is

a medically appropriate way for them to manage pain.

Q: How Can I Determine Whether a User Is

Dependent on Rather Than Addicted to OxyContin? 

A: When pain patients take a narcotic analgesic as

directed, or to the point where their pain is adequately

controlled, it is not abuse or addiction. Abuse occurs when

patients take more than is needed for pain control, especially

if they take it to get high. Patients who take their medication

in a manner that grossly differs from a physician’s directions

are probably abusing that drug.

If a patient continues to seek excessive pain medication after

pain management is achieved, the patient may be addicted.

Addiction is characterized by the repeated, compulsive use

of a substance despite adverse social, psychologic, and/or

physical consequences. Addiction is often (but not always)

accompanied by physical dependence, withdrawal

syndrome, and tolerance. Physical dependence is defined as

a physiologic state of adaptation to a substance. The absence

of this substance produces symptoms and signs of

withdrawal. Withdrawal syndrome is often characterized by

overactivity of the physiologic functions that were

suppressed by the drug and/or depression of the functions

that were stimulated by the drug. Opioids often cause

sleepiness, calmness, and constipation, so opioid withdrawal

often includes insomnia, anxiety, and diarrhea. 

Pain patients, however, may sometimes develop a physical

dependence during treatment with opioids. This is not an

addiction. A gradual decrease of the medication dose over

time, as the pain is resolving, brings the former pain patient

to a drug-free state without any craving for repeated doses

of the drug. This is the difference between the formerly

dependent pain patient who has now been withdrawn from

medication and the opioid-addicted patient: The patient

addicted to diverted pharmaceutical opioids continues to

have a severe and uncontrollable craving that almost always

leads to eventual relapse in the absence of adequate

treatment. It is this uncontrollable craving for another “rush”

of the drug that differentiates the “detoxified” but opioidaddicted patient from the former pain patient. Theoretically,

an opioid abuser might develop a physical dependence, but

obtain treatment in the first few months of abuse, before

becoming addicted. In this case, supervised withdrawal

(detoxification) followed by a few months of abstinenceoriented treatment might be sufficient for the nonaddicted

patient who abuses opioids. If, however, this patient

Treatment Improvement 

Protocols (TIPs) Addressing 

Opioid Addiction Treatment

TIP 1 State Methadone Treatment Guidelines

BKD98

TIP 19 Detoxification From Alcohol and 

Other Drugs BKD172

TIP 20 Matching Treatment to Patient Needs

in Opioid Substitution Therapy

BKD168

TIP 22 LAAM in the Treatment of Opiate

Addiction BKD170

See back cover for ordering information.

...continued on page 6
ADVISORY ..............................................................................

April 2001, Volume 1, Issue 1

CENTER FOR SUBSTANCE ABUSE TREATMENT

6

Treatment and Detoxification

Protocols

...continued from page 2

subsequently relapses to opioid abuse, then that would

support a diagnosis of opioid addiction. After several

relapses to opioid abuse, it becomes clear that a patient will

require long-term treatment for the opioid addiction.

(Please see the section of this CSAT Advisory titled

Treatment and Detoxification Protocols on page 2 to learn

more about treatment options.)

Q: I Work at a Facility That Does Not Use

Medication-Assisted Treatment. What Treatment

Should I Provide to Individuals Addicted to or

Dependent on OxyContin?

A: The majority of U.S. treatment facilities do not

offer medication-assisted treatment. However, due to the

strength of OxyContin and its powerful addiction

potential, medical complications may be increased by

quickly withdrawing individuals from the drug.

Premature withdrawal may cause individuals to seek

heroin, and the quality of that heroin will not be known.

In addition, these individuals, if injecting heroin, may

also expose themselves to HIV and hepatitis. Most

people addicted to OxyContin need medication-assisted

treatment. Even if individuals have been taking

OxyContin legitimately to manage pain, they should not

stop taking the drug all at once. Instead, their dosages

should be tapered down until medication is no longer

needed. If you work in a drug-free or abstinence-based

treatment facility, it is important to refer patients to

facilities where they can receive appropriate treatment.

(See SAMHSA Resources, page 7.) n

OxyContin Frequently Asked

Questions

...continued from page 5

Notes

1. National Drug Intelligence Center, “Information Bulletin: OxyContin

Diversion and Abuse,” retrieved March 7, 2001, from the World Wide

Web, www.usdoj.gov/ndic/pubs/651/index.htm.

2. Ibid.

3. National Institute on Drug Abuse, “Pain Medications: 13553,” retrieved

February 15, 2001, from the World Wide Web, 165.112.78.61/Infofax/

PainMed.html.

4. Ibid.

dosages of methadone may be needed to appropriately

treat patients who abuse OxyContin.

Methadone or LAAM may be used for OxyContin

addiction treatment or, for that matter, treatment for

addiction to any other opioid, including the semisynthetic opioids. This is not a new treatment

approach. For instance, Alaska estimates that there

are 15,000 prescription opioid abusers in the State

and that most methadone patients are not heroinaddicted individuals. In addition, a significant

percentage of patients in publicly supported

methadone programs were not being treated for

heroin addiction but for abuse of semisynthetic

opioids (e.g., hydrocodone).The Substance Abuse and

Mental Health Services Administration Drug Abuse

Warning Network emergency room data show that

both oxycodone and hydrocodone mentions increased

dramatically between 1990 and 1999.1 And when

Arkansas opened its first methadone maintenance

clinic in December 1993, the vast majority of its

clients were not admitted for heroin addiction, but 

for semisynthetic opioid abuse. These individuals

had been traveling to other States because methadone

treatment was not available near their homes.

Using the criteria on page 5 of this CSAT Advisory

describing the difference between addiction to and

dependence on OxyContin, you may be able to

determine if a patient requires treatment for opioid

addiction. If this is the case, methadone may be used

for withdrawal. For certain patient populations,

including those with many treatment failures,

methadone is the treatment of choice.2

“As substance abuse treatment professionals, we have

the responsibility for learning as much as we can about

OxyContin, and then providing appropriate treatment

for people addicted to it. Appropriate treatment will
ADVISORY ..............................................................................

April 2001, OxyContin

CENTER FOR SUBSTANCE ABUSE TREATMENT

7

nearly always involve prescribing methadone, or in some cases, LAAM,” says H. Westley Clark, M.D., J.D., Director

of the Center for Substance Abuse Treatment. “Programs that do not offer medication-assisted treatment will need to

refer patients who are addicted to OxyContin to programs that do,” he adds.

It is important to assess an individual’s eligibility for medication-assisted treatment with methadone or LAAM to

determine if an individual is eligible for this type of treatment and if it would be appropriate. The assessment may

take place in a hospital emergency department, central intake unit, or similar place. Final assessment of an

individual’s eligibility for medication-assisted treatment must be completed by treatment program staff. The

preliminary assessment should include the

following areas:

• Determining the need for emergency care

• Diagnosing the presence and severity of

opioid dependence

• Determining the extent of alcohol and drug

abuse

• Screening for comorbid medical and

psychiatric conditions

• Evaluating an individual’s living situation, family and social problems, and legal problems.3 n

Treatment and Detoxification Protocols

Notes

1. Sowder, Barbara, and Beschner, George, “Heroin Use in the United States: A

Working Paper” (unpublished), The CDM Group.

2. Center for Substance Abuse Treatment (CSAT), Detoxification From Alcohol and

Other Drugs, Treatment Improvement Protocol (TIP) Series, Number 19, DHHS

Pub. No. (SMA) 00–3404, Rockville, MD: CSAT, pp. 22 and 23, 2000.

3. CSAT, Matching Treatment to Patient Needs in Opioid Substitution Therapy, TIP

19, DHHS Pub. No. (SMA) 95–3049, Rockville, MD: CSAT, pp. 17 and 18,

1995.

“...we have the responsibility for

learning as much as we can

about OxyContin,

and then providing appropriate

treatment for people who are

addicted to it.”

H. Westley Clark, M.D., J.D.,

Director, CSAT

SAMHSA Resources

To find a substance abuse treatment

facility near you, see the Substance

Abuse Treatment Facility Locator on the

drop-down menu titled “CSAT Data

Resources” on CSAT’s Web site,

www.samhsa.gov/centers/csat/csat.html.

Call the CSAT Substance Abuse

Treatment Hotline at 1–800–662–HELP

for substance abuse treatment referral

information.
ADVISORY ..............................................................................

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CENTER FOR SUBSTANCE ABUSE TREATMENT

Sign up for SAMHSA’s Information Mailing System (SIMS) to receive information about the following topics:

• Grant announcements

• Funding opportunities such as competitive contract announcements

• Prevention materials and publications

• Treatment- and provider-oriented materials and publications

• Research findings and reports

• Announcements of available research data sets

• Policy announcements and materials.

To sign up for this free service, use one of the following methods to contact SIMS:

Web: sims.health.org/Admins/default.asp

Mail: SAMHSA’s National Clearinghouse for Alcohol and Drug Information (NCADI)

Attn: Mailing List Manager

P.O. Box 2345

Rockville, MD 20847–2345

Phone: 800–729–6686

Fax: 301–468–6433, Attn: Mailing List Manager

For More Information About Treatment for Opioid Addiction

There Are Three Ways To Obtain Free Copies of All TIP Products

1. Call SAMHSA’s NCADI at 800–729–6686; TDD (hearing impaired) 800–487–4889.

2. Visit NCADI’s Web site, www.samhsa.gov/centers/clearinghouse/clearinghouses.html.

3. Access TIPs online at SAMHSA’s Web site, www.samhsa.gov/csat/csat.htm.

DHHS Publication No. (SMA) 02–3636

NCADI Publication No. MS726

Substance Abuse and Mental Health Services Administration

Printed 2001

Reprinted 2002