U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Substance Abuse and Mental Health Services Administration 

Center for Substance Abuse Treatment 

www.samhsa.gov 

ADVISOR

Substance Abuse Treatment 

News for the Treatment 

Y

Field 

Summer 2008 

Volume 7 

Issue 1 

OxyContin®:
 

Prescription Drug Abuse—
 

2008 Revision
 

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 medications such as Percodan® and 

Tylox®. However, OxyContin contains between 10 

and 80 milligrams (mg) of oxycodone in a timedrelease tablet. Painkillers such as Tylox® contain 5 

mg 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.,” 

“Killer,” “Ox,” “Oxy Cotton,” “Oxy80,” and 

“kicker” on the street, is legitimately prescribed 

as a timed-release tablet, providing as many as 

12 hours of pain relief. It is often prescribed for 

cancer patients or those with chronic, long-lasting 

pain. The benefit of the medication to people who 

suffer from chronic pain 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. 

Q: How is OxyContin abused? 

A: People who abuse OxyContin 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. Those who abuse OxyContin 

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. 

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 medication that contains 

a much larger amount of the active ingredient, 

oxycodone, than other prescription pain relievers. 

It was designed as a controlled release tablet. 

However, by crushing the tablet and either ingesting 

or snorting it or by injecting diluted OxyContin, 

people who abuse the opioid feel its powerful effects 

in a short time, rather than over a 12-hour span. 

Second, great profits can be made in the illegal sale 

of OxyContin. A 40-mg pill costs approximately $4 

by prescription, yet it may sell for $40 on the street, 

...continued on page 2 
OxyContin® Frequently Asked Questions

Summer 2008, Volume 7, Issue 1 

Substance Substance Abuse Treatmentreatment

ADVISOR ADVISORY .............................................................................. 
 

...continued from front cover 

depending on the area of the country in which the drug is 

sold.5 

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 people who abuse OxyContin 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.4 

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 medication 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. According to the National Institute on 

Drug Abuse and a review on oxycodone, opioid analgesics 

can be used to treat pain safely with proper medical 

management.6, 7 

One review found, “A multitude of studies indicate that 

the rate of opioid addiction in populations of chronic 

pain sufferers is similar to the rate of opioid addiction 

within the general population, falling in the range 

of 1 to 2 percent or less.”3 

In short, most individuals who are prescribed OxyContin, 

or any other opioid, will not become addicted, although 

they may become dependent on the medication and will 

need to be withdrawn by a qualified physician. Individuals 

who are taking the medication as prescribed should 

continue to do so, as long as they and their physician 

agree that taking the medication is a medically appropriate 

way for them to manage pain. 

Q: What is the difference between addiction to and 

dependence on OxyContin? 

A: When pain patients take an opioid 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, 

psychological, 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 

physiological 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, diarrhea, flulike symptoms, restlessness, tearing, 

runny nose, yawning, sweating, muscle spasms, back aches, 

abdominal cramps, and vomiting. 

...continued on page 3 

2 
ADVISORY

Summer 2008, OxyContin

..............................................................................

Substance Abuse Treatment

3

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 medication-free state without any craving for repeated 

doses of the medication. This is the difference between 

the patient treated for pain who was formerly dependent 

and has now been withdrawn from medication and the 

patient who is opioid addicted: 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. 

This uncontrollable craving for another “rush” of the drug 

differentiates the patient who has completed detoxification 

for opioid addiction from the patient being treated for 

pain who is not opioid addicted. Theoretically, a person 

who abuses opioids might develop a physical dependence 

but would obtain treatment in the first few months of 

abuse, before becoming addicted. In this case, supervised 

withdrawal (detoxification) followed by a few months of 

abstinence-oriented treatment might be sufficient for the 

patient who is not addicted to but who abuses opioids. 

If, however, this patient subsequently relapses to opioid 

abuse, then that behavior would support a diagnosis of 

opioid addiction. If the patient has several relapses to 

opioid abuse, he or she will require long-term treatment 

for the opioid addiction. (See the section titled Treatment 

and Detoxification Protocols on page 5 to learn more about 

treatment options.)

Q: What treatments, other than medication-assisted 

treatment, should be provided to individuals addicted 

to or dependent on OxyContin?

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

medication-assisted treatment. However, because of 

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 relapse to OxyContin 

use or to seek heroin. In addition, these individuals, if 

injecting drugs, may also expose themselves to HIV and 

hepatitis C. 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 medication all at once. Instead, 

their dosages should be tapered down until medication is 

no longer needed. Professionals who work in a drug-free 

or abstinence-based treatment facility should refer patients 

to facilities where they can receive appropriate treatment. 

(See SAMHSA Resources on this page.) n

OxyContin® Frequently Asked Questions

...continued from page 2

Other CSAT Resources

Prescription Medications: Misuse, Abuse, 

Dependence, and Addiction, Substance Abuse 

Treatment Advisory, May 2006, Volume 5, Issue 2. 

MS987

Pain Management Without Psychological 

Dependence: A Guide for Healthcare Providers, 

Substance Abuse in Brief Fact Sheet, Summer 

2006, Volume 4, Issue 1. MS993

SAMHSA Resources

To find a substance abuse treatment facility 

near you, visit the Substance Abuse Treatment 

Facility Locator at http://www.findtreatment.

samhsa.gov. Call the Substance Abuse and 

Mental Health Services Administration, Substance 

Abuse Treatment Hotline at 1-800–662–HELP for 

substance abuse treatment referral information.
ADVISORY ..............................................................................

Summer 2008, Volume 7, Issue 1

Substance Abuse Treatment

4

From the CSAT Director

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

OxyContin® was initially heralded as a miracle medication 

that allowed patients with chronic pain to resume a normal 

life. Unfortunately, the abuse of OxyContin continues to 

grow. According to the National Survey on Drug Use and 

Health, misuse of OxyContin among people in the United 

States ages 12 and older significantly increased every year 

from 2002 to 2006.9 In 2006, approximately 4 million 

people ages 12 and older reported using OxyContin for 

nonmedical uses at least once in their lifetime, and more 

than 500,000 were new nonmedical users.9 Among youth, 

although past-year use of OxyContin in the 12th grade 

decreased from 5.5 percent in 2005 to 4.3 percent in 2006, 

it increased among 8th graders from 1.3 percent in 2002 

to 2.6 percent in 2006. Drug Abuse Warning Network data 

indicated a 17-percent increase in emergency hospital 

visits for nonmedical use of oxycodone products from 

2004 to 2005.10

Because of this increasing misuse of OxyContin in the 

United States, it is important for professionals on the front 

line of substance abuse treatment to have the facts about 

OxyContin, its use and abuse, and how to treat individuals 

who present for treatment of OxyContin use and abuse. 

Perhaps these individuals are taking medically prescribed 

OxyContin to manage pain and are concerned about their 

physical dependence on the medication. Perhaps they are 

young adults 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 the 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 people are young adults unaware of the dangers of 

OxyContin. Many of these individuals mix OxyContin with 

alcohol and drugs, and the result is all too often tragic.

Abuse of prescription medications is not a new phenomenon. There have long been concerns about abuse of 

Percocet®, hydrocodone, and a host of other medications. 

What sets OxyContin abuse apart is the potency of the 

medication. Treatment providers in affected areas say 

that they were unprepared for the speed with which an 

OxyContin “epidemic” developed in their communities.

It is important to be prepared for the increasing number 

of clients who are dependent on OxyContin. This revised 

issue of the original Substance Abuse Treatment Advisory

on OxyContin:

• 

• 

• 

• 

Answers frequently asked questions about OxyContin

Provides general information about semisynthetic 

opioids and their addiction potential

Summarizes evidence-based protocols for treatment

Provides resources for further information.

For more information about OxyContin abuse and 

treatment, see the resource box on page 3. Feel free to 

copy the information in the Substance Abuse Treatment 

Advisory and share it with colleagues so that they, too, 

can have the most current information about this critically 

important topic. n

Three Ways To Obtain Free Copies of CSAT Products:

1. Call SAMHSA’s Health Information Network (SHIN) at 1-877-SAMHSA-7 (1-877-726-4727) 

(English and Español), TTY (hearing impaired) 1-800-487-4889

2. Visit SHIN’s Web site, http://www. samhsa.gov/shin

3. Access products on line at http://www.kap.samhsa.gov
Summer 2008, OxyContin 

Substance Abuse Treatment 

.............................................................................. 
 ADVISORY

Treatment and Detoxification Protocols
 

OxyContin® is a powerful medication that contains a 

much larger amount of the active ingredient, oxycodone, 

than other prescription opioid pain relievers. Whereas 

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 most 

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 is any 

less likely to benefit from medication-assisted treatment 

than the patient addicted to heroin. 

Some patients who are opioid addicted who have very 

good social supports may occasionally be able to benefit 

from antagonist treatment with naltrexone. This treatment 

works best if the patient is highly motivated to participate 

in treatment and has undergone adequate detoxification 

from the opioid of abuse. Most patients who are opioid 

addicted in outpatient therapy, however, do best with 

medication that is either an agonist or a partial agonist. 

Methadone is the agonist medication most commonly 

prescribed for opioid addiction treatment in this country. 

Buprenorphine is the only partial agonist approved by 

the Food and Drug Administration for opioid addiction 

treatment. 

The guidelines for treating OxyContin addiction or 

dependence are basically no different from the guidelines 

the Center for Substance Abuse Treatment (CSAT) uses 

for treating addiction to or dependence on any opioid. 

However, because OxyContin contains higher dose levels 

of opioid than are typically found in other oxycodonecontaining pain medications, higher dosages of methadone 

or buprenorphine may be needed to appropriately treat 

patients who abuse OxyContin. 

Methadone or buprenorphine may be used for OxyContin 

addiction treatment or, for that matter, treatment for 

addiction to any other opioid, including the semisynthetic 

opioids. Medication-assisted treatment for prescription 

opioid abuse is not a new treatment approach. A study 

of people entering methadone maintenance treatment 

programs conducted in several States found that 

oxycodone was the prescription opioid medication used 

most frequently by people whose drug of choice was 

heroin and who abused prescription opioids.8 

The information in this issue on OxyContin can help 

providers determine whether a patient requires treatment 

for opioid addiction. If treatment is necessary, methadone 

or buprenorphine may be used for withdrawal. For certain 

patient populations, including those with many treatment 

failures, methadone or buprenorphine is the treatment of 

choice.2 

It is important to conduct a careful preliminary assessment 

to determine whether medication-assisted treatment 

with methadone or buprenorphine would be appropriate 

for a patient. This assessment can be done in a hospital 

emergency department, central intake unit, or similar 

place. The preliminary assessment should include the 

following areas:1 

•		 Determining the need for emergency care 

•		 Diagnosing the presence and severity of opioid 

dependence
 

•		 Determining the extent of alcohol and drug abuse 

...continued on page 6 

5 
 

 

 

 

 

 

Summer 2008, Volume 7, Issue 1 

Substance Abuse Treatment 

ADVISORY ..............................................................................

Treatment and Detoxification Protocols 

...continued from page 5 

•		 Screening for co-occurring medical and psychiatric 

conditions
 

•		 Evaluating an individual’s living situation, family and 

social problems, and legal problems. 

The final assessment of an individual’s eligibility for 

medication-assisted treatment must be completed by 

experienced staff of an opioid treatment program. 

Federal regulations on eligibility for admission to opioid 

pharmacotherapy exist.1 

“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 who are addicted to it. Appropriate treatment 

will nearly always involve prescribing methadone, 

buprenorphine, or, in some cases, naltrexone,” says 

H. Westley Clark, M.D., J.D., Director of CSAT. 

“Programs that do not offer medication-assisted treatment will need to refer patients who are addicted to 

OxyContin to programs that do,” he adds. n

“...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
 

Treatment Improvement 

Protocols (TIPs) and 

Collateral Products 

Addressing Opioid Addiction 

Treatment 

TIP 40 Clinical Guidelines for the Use of 

Buprenorphine in the Treatment of Opioid 

Addiction (SMA) 07-3939 

Quick Guide for Physicians Based on 

TIP 40 QGPT40 

KAP Keys for Physicians Based on 

TIP 40 KAPT40 

TIP 43 Medication-Assisted Treatment for Opioid 

Addiction in Opioid Treatment Programs BKD524 

Quick Guide for Clinicians Based on 

TIP 43 QGCT43 

KAP Keys for Clinicians Based on 

TIP 43 (SMA) 07-4108 

TIP 45 Detoxification and Substance Abuse 

Treatment BKD541 

Quick Guide for Clinicians Based on 

TIP 45 (SMA) 06-4225 

Quick Guide for Administrators Based 

on TIP 45 (SMA) 06-4226 

KAP Keys for Clinicians Based on 

TIP 45 (SMA) 06-4224 

6 
ADVISORY

Summer 2008, OxyContin

..............................................................................

Substance Abuse Treatment

7

Notes

1. Center for Substance Abuse Treatment. (2005). 

Initial screening, admission procedures, and assessment 

techniques. In Medication-assisted treatment for opioid 

addiction in opioid treatment programs (pp. 43–61). 

Treatment Improvement Protocol 43, DHHS Publication 

No. (SMA) 05-4048. Rockville, MD: Substance Abuse and 

Mental Health Services Administration.

2. Center for Substance Abuse Treatment. (2006). 

Detoxification and substance abuse treatment. Treatment 

Improvement Protocol 45, DHHS Publication No. (SMA) 

06-4131. Rockville, MD: Substance Abuse and Mental 

Health Services Administration. 

3. Fisher, F. B. (2004). Interpretation of “aberrant” 

drug-related behaviors. Journal of American Physicians 

and Surgeons, 9(1), 25–28.

4. National Drug Intelligence Center. (2004, April). 

Pharmaceuticals. In National drug threat assessment 2004. 

Johnstown, PA: Author. Retrieved October 2, 

2007, from http://usdoj.gov/ndic/pubs8/8731/ 

8731p.pdf

5. National Drug Intelligence Center. (2004, August). 

Intelligence bulletin: OxyContin diversion, availability, 

and abuse. Johnstown, PA: Author. Retrieved February 

20, 2008, from http://usdoj.gov/ndic/

pubs10/10550/10550p.pdf

6. National Institute on Drug Abuse (NIDA). (2006, 

June). Prescription pain and other medications 

[Electronic Version]. NIDA InfoFacts. Retrieved 

October 2, 2007, from http://drugabuse.gov/ 

infofacts/PainMed.html

7. Riley, J., Eisenberg, E., Muller-Schwefe, G., 

Drewes, A. M., & Arendt-Nielsen, L. (2008). Oxycodone: 

A review of its use in the management of pain. Current 

Medical Research and Opinion, 24(1), 175–192.

8. Rosenblum, A., Parrino, M., Schnoll, S. H., 

Fong, C., Maxwell, C., Cleland, C. M., et al. (2007). 

Prescription opioid abuse among enrollees into 

methadone maintenance treatment. Drug and Alcohol 

Dependence, 90(1), 64–71.

9. Substance Abuse and Mental Health Services 

Administration, Office of Applied Studies. (2007). 

Results from the 2006 National Survey on Drug Use 

and Health: National findings. NSDUH Series H-32, 

DHHS Publication No. (SMA) 07-4293. Rockville, 

MD: Author.

10. Substance Abuse and Mental Health Services 

Administration, Office of Applied Studies. (2007). 

Drug Abuse Warning Network, 2005: National 

estimates of drug-related emergency department 

visits. Rockville, MD: Author. Retrieved August 16, 

2007, from http://dawninfo.samhsa.gov/files/

DAWN-ED-2005-Web.pdf
Summer 2008, Volume 7, Issue 1
 

Substance Abuse Treatment 

ADVISORY .............................................................................. 
 

Substance Abuse Treatment Advisory 

Substance Abuse Treatment Advisory—published on an as-needed basis for treatment providers—was written 

and produced under contract number 270-04-7049 by the Knowledge Application Program (KAP), a Joint 

Venture of JBS International, Inc., and The CDM Group, Inc., for the Center for Substance Abuse Treatment 

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

and Human Services (DHHS). 

Disclaimer: The views, opinions, and content expressed herein do not necessarily reflect the views, opinions, 

or policies of CSAT, SAMHSA, or DHHS. No official support of or endorsement by CSAT, SAMHSA, or 

DHHS for these opinions or for particular instruments, software, or resources is intended or should be inferred.

Public Domain Notice: All materials appearing in this volume except those taken directly from copyrighted 

sources are in the public domain and may be reproduced or copied without permission from SAMHSA/CSAT 

or the authors. Citation of the source is appreciated. However, this publication may not be reproduced or 

distributed for a fee without the specific, written authorization of the Office of Communications, SAMHSA, 

DHHS. 

Electronic Access and Copies of Publication: This publication may be downloaded or ordered at 

http://www.samhsa.gov/shin. Or, please call SAMHSA’s Health Information Network at 1-877-SAMHSA-7 

(1-877-726-4727) (English and Español). 

Recommended Citation: Center for Substance Abuse Treatment. (2008). OxyContin®: Prescription Drug 

Abuse—2008 Revision. Substance Abuse Treatment Advisory, Volume 7, Issue 1. Rockville, MD: Substance 

Abuse and Mental Health Services Administration. 

DHHS Publication No. (SMA) 08-4138 

Printed 2008 

Sign up for SAMHSA’s eNetwork Today! 

The Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) eNetwork is your personal 

link to SAMHSA for the latest news about grants, publications, campaigns, programs, statistics, and data 

reports. Join the eNetwork and indicate your areas of interest. You’ll receive up-to-the-minute information 

that’s important to you—right in your inbox. Visit http://www.samhsa.gov/enetwork and click Join the 

eNetwork. 

Substance Abuse Treatment Advisory 

OxyContin®: Prescription Drug Abuse—2008 Revision 

DHHS Publication No. (SMA) 08-4138 

Printed 2008