'Hillbilly heroin' use grows

Prescriptions for an addictive painkiller known as "hillbilly heroin" are growing at an alarming rate despite nationwide calls for doctors to curb its use.

The opioid oxycodone is now the No 1 prescribed medication for chronic severe pain in New Zealand.

Introduced in New Zealand in 2005, it was intended for moderate-to-severe pain relief when a patient could not tolerate morphine.

Oxycodone is twice as potent as morphine, twice as expensive, and has a greater abuse potential with recreational drug users, according to The Best Practice Advocacy Centre New Zealand.

It is highly addictive - it is estimated that between 3 per cent and 11 per cent of Kiwi users are addicted to the drug - and should be used at the lowest effective dose, for the shortest time possible.

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

Associate Professor at the National Addiction Centre Simon Adamson said the name oxycodone sounds similar to the less-powerful painkiller codeine which could lead patients and practitioners underestimating its strength.

"If your doctor told you, I'm going to give you a drug that is two times the strength of morphine, you'd probably baulk more than if you were given a prescription for something called oxycodone," he said.

Unlike in Australia and the United States, oxycodone had not become the main street drug for junkies in New Zealand, he said.

But for many people who got hooked on the drug, their unintentional dependency was "a real culture shock".

"We shouldn't stop prescribing these medications, they are useful and important and doctors want to relive pain, but we need to identify the risk potential, that taking a medication long term is a really risky thing," Adamson said.

"Physicians need to educate their patients, too.

"It's a very serious problem [overseas], and we would be foolish to not learn from that."

Extensive marketing of oxycontin (now oxycodone) in the mid-1990s has led to over-representation of opioid addiction in the Western world - particularly in the United States, Canada, and Australia.

Because the drug wasn't introduced to the New Zealand market until eight years ago, addiction and overdose levels are slightly better in New Zealand.

National Association of Opioid Treatment Providers Co-chair Dr Jeremy McMinn said there had been a "push" around the world to be far more generous in treating pain with opioids.

It was important for physicians to consider whether whether the benefits of opioids in relieving pain was likely to outweigh the risks of the drugs, he said.

"Chronic pain is complex, often without obvious injury," McMinn said.

"It's about managing a persisting condition as best you can."


Oxycodone addicts were still a minority, but the widespread availability of the drug meant it had the potential to hook "everyone who has even got a low level of vulnerability to addiction".

Addiction medicine specialist at Northland District Health Board Alistair Dunn said that in 2009, Australasia "was starting to see a problem" with prescription opioids.

"In the Northland region we did an educational campaign," he said.

"[In recent years] we were able to document a drop in prescription rates. I would assume the same is now happening nationally."

In 2011 The New Zealand Medical Journal reported a need for better information and support for doctors on prescribing painkillers, and specifically guidelines for opioid treatment of chronic non-cancerous pain.

But public awareness of the dangers of oxycodone was still lacking, Dunn said.

"All doctors need to explain how strong it is," he said.

"If patients knew that, they would be less likely to take it.

"Anecdotal reports suggest [oxycodone] is more akin to heroin than morphine, and that contributes to its addictive potential."

Addiction to prescription drugs is not just confined to opioids - there are also pitfalls with benzodiazepines, often in the form of sleeping tablets, he said.

"There are two categories of addicts," Dunn said.

"[One is] white middle-class elderly people who get it from their doctor and end up taking a [sleeping tablet] every night for the rest of their lives. Then there are younger groups who take it in binge patterns, and mix it with other drugs."

In January this year drug-buying agency Pharmac distributed "education toolkits" containing material regarding appropriate use of oxycodone to every district health board.

Pharmac media spokesman Simon England said: "We won't see any trend emerging for a few years, but it is something we will monitor."

What is oxycodone?

Oxycodone was first synthesised in Germany in 1916 and became available for clinical use in the US by 1939. Its street names include: hillbilly heroin, Oxy, and O.C.

Stats at a glance:

- More Americans now die from opioid overdose than from motor vehicle accidents

- Opioids are more abused than any other illicit drug, including marijuana

- In Australia and the US between 1997 and 2006, the supply of oxycodone overtook methadone, morphine, hydrocodone, and codeine.

- About 3 per cent of New Zealanders who take opioids for chronic non-cancer pain develop misuse or addiction problems and 11 per cent develop "aberrant drug-related behaviours", such as aggressively requesting medicines, self-directed dose escalation or inappropriate use of the medicine such as injecting.

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