Warning on overuse of hillbilly heroin

BRONWYN TORRIE
Last updated 05:00 20/06/2013

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Alarming prescription rates for an addictive painkiller known as "hillbilly heroin" have prompted a nationwide call for doctors to curb its use.

The painkiller oxycodone became more popular than morphine last year.

Between 2007 and 2011, the number of patients dispensed oxycodone nationally increased 254 per cent, compared with a 37 per cent increase for morphine.

Concerns about addiction and misuse sparked a Capital & Coast District Health Board campaign last year to curb the use of the opioid.

It centred around educating GPs and hospital doctors about the dangers of oxycodone, and has led to a 50 per cent drop in prescription rates in its hospitals, creating savings of $51,000.

There was also a 22 per cent drop in GP prescriptions.

Capital & Coast now had the lowest prescribing rates of oxycodone in the country, Wellington GP and Pharmac medical director Peter Moodie said.

The success of the campaign, championed by Dr Moodie, prompted Pharmac to create a toolkit for all DHBs.

"It's really just heightened awareness of the use of the drug and the potential for misuse."

About 70 per cent of oxycodone users start taking it while in hospital, and 17 per cent of those patients have their prescriptions continued by a GP.

The skyrocketing use of the drug was never intended when it first arrived in New Zealand in 2005. It was supposed to be a substitute for those who could not tolerate morphine, but instead became the preferred drug, Capital & Coast chief medical officer Geoff Robinson said.

"The medical profession took up the prescribing of this with enthusiasm, supported by drug companies' marketing. Because of the name oxycodone, a number of practitioners thought this was a type of codeine and didn't realise it was in fact double the strength of morphine."

Unlike in Australia and the United States, oxycodone had not become the main street drug for junkies, which Dr Robinson said was "perhaps surprising given the number of prescriptions".

Addicts still prefer to inject morphine and methadone, according to the latest Illicit Drug Monitoring System figures.

However, the number of addicts who illicitly used oxycodone doubled to 18 per cent from 2008 to 2010.

It is prescribed by GPs as a tablet, but is also available in hospitals in an injectable form. People can chew or crush the tablets for rapid absorption.

Despite the dangers of misuse, Dr Robinson - also an addiction medicine specialist - said it still had a place as an alternative to morphine. Doctors just needed to be extra vigilant so they did not create addicts by accident, he said.

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The Royal New Zealand College of General Practitioners said all its fellows were "trained to understand the requirements for safe prescribing of medicines for managing pain".

WHAT IS OXYCODONE?

A strong opioid used to dull moderate to severe pain when morphine is not tolerated by a patient. It is highly addictive and twice as potent as morphine. It was first synthesised in 1916 in Germany, and became available for clinical use in the United States by 1939. Street names for it include hillbilly heroin, Oxy and O.C. Users can either go cold turkey or be weaned off the drug. The dosage, and how long a person is on it, determines withdrawal symptoms.

- The Dominion Post

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