Product No. 2001-L0424-001
`
`I N F O R M A T I O N
`
`BULLETIN
`
`JANUARY 2001
` D E P A R T M E N T O F J U S T I C E
`
`U. S.
`
`OxyContin Diversion and Abuse
`
`Photo courtesy of Roger Kerekes, Johnstown Tribune-Democrat
`
`Bottles of OxyContin
`
`reporting. OxyContin Tablet, commonly referred to as
`OxyContin, has become the oxycodone product of
`choice in Maine, Ohio, and West Virginia, and in por-
`tions of eastern Kentucky, Maryland, western Pennsylva-
`nia, and rural southwestern Virginia.
`Kentucky-The Kentucky State Police reports that
`OxyContin is the drug of choice in eastern Ken-
`tucky. The Kentucky State Police in Hazard report
`a significant shift from cocaine and methamphet-
`amine abuse to OxyContin and Tylox abuse. Tylox
`is another trade name oxycodone product.
`
`Overview
`
`Diversion and abuse of the prescription pain re-
`liever OxyContin is a major problem, particularly in
`the eastern United States. The Drug Enforcement Ad-
`ministration (DEA) reports that, in the United States,
`oxycodone products, including OxyContin, are fre-
`quently abused pharmaceuticals. The pharmacologi-
`cal effects of OxyContin make it a suitable substitute
`for heroin; therefore, it is attractive to the same abuser
`population. Law enforcement reports indicate heroin
`abusers are obtaining OxyContin because the pharma-
`ceutical drug offers reliable strength and dosage levels.
`In addition, if the abusers’ health insurance covers an
`illness that the drug treats, the insurance provider may
`cover the cost of the drug. Conversely, OxyContin
`abusers who have never used heroin may be attracted
`to the lower priced heroin when their health insur-
`ance no longer pays for OxyContin prescriptions or
`when they cannot afford the high street-level price
`of OxyContin. For example the West Virginia,
`Hancock-Brooke-Weirton Drug Task Force reports that
`a local couple, recently sentenced for conspiracy to sell
`heroin, turned to heroin after their doctor refused to
`continue prescribing OxyContin and they could not af-
`ford the street price of the pharmaceutical. OxyContin
`abusers sometimes commit theft, armed robbery, and
`fraud to sustain their habits.
`
`The illegal diversion, distribution, and abuse of
`oxycodone products, particularly OxyContin, appear to
`be concentrated most heavily in the East, according to re-
`spondents to the National Drug Intelligence Center
`(NDIC) National Drug Threat Survey 2000 and DEA
`
`ARCHIVED
`
`This document may contain dated information.
`It has been made available to provide access to historical materials.
`
`Purdue - IPR2018-00625; IPR2018-00717, Ex. 2020
`
`

`

`OxyContin Diversion and Abuse
`
` Maine-The U.S. Attorney, District of Maine,
`identifies OxyContin as the most significant drug
`threat in the state.
` Maryland-The Maryland Drug Early Warning
`System, a real-time substance abuse monitoring
`program, identifies oxycodone as a leading
`emerging drug of abuse in 2000. The DEA
`reports nearly 85 percent of 1999 arrests for writing
`false prescriptions in Maryland involved
`oxycodone products, including OxyContin.
` Ohio-The Cincinnati Police Department’s Phar-
`maceutical Diversion Squad reports a growing
`OxyContin threat. From January to October 2000,
`illicit drug dealers in Cincinnati diverted over
`9,000 doses of OxyContin (31 percent of all di-
`verted oxycodone products). During the same time
`period, 49 of the squad’s 341 diversion investiga-
`tions targeted OxyContin, resulting in 22 arrests.
` Pennsylvania-The Cambria County Drug Task
`Force reports that, as of September 2000, almost
`30 percent of its undercover drug purchases in-
`volved OxyContin, and 31 suspects were accused
`of distributing tens of thousands of dollars’ worth
`of OxyContin.
` West Virginia-The Gilbert Police Department
`reports OxyContin is the “worst” drug the
`department has ever encountered, with OxyContin
`abuse even surpassing marijuana abuse.
`Background
`
`OxyContin is a trade name product for the generic
`narcotic oxycodone hydrochloride, an opiate agonist.
`Opiate agonists provide pain relief by acting on opioid
`receptors in the spinal cord, brain, and possibly in the tis-
`sues directly. Opioids, natural or synthetic classes of
`drugs that act like morphine, are the most effective pain
`relievers available. Oxycodone is manufactured by
`modifying thebaine, an alkaloid found in opium.
`Oxycodone has a high abuse potential and is prescribed
`for moderate to high pain relief associated with injuries,
`bursitis, dislocation, fractures, neuralgia, arthritis, and
`
`2
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`lower back and cancer pain. It is also used post-
`operatively and for pain relief after childbirth.
`Percocet, Percodan, and Tylox are other trade name
`oxycodone products.
`
`Oxycodone is a central nervous system depres-
`sant. Oxycodone’s action appears to work through
`stimulating the opioid receptors found in the central
`nervous system that activate responses ranging from
`analgesia to respiratory depression to euphoria. People
`who take the drug repeatedly can develop a tolerance
`or resistance to the drug’s effects. Thus, a cancer patient
`can take a dose of oxycodone on a regular basis that
`would be fatal in a person never exposed to oxycodone
`or another opioid. Most individuals who abuse
`oxycodone seek to gain the euphoric effects, mitigate
`pain, and avoid withdrawal symptoms associated with
`oxycodone or heroin abstinence.
`
`OxyContin is an oral, controlled-release
`oxycodone that acts for 12 hours, making it the longest
`lasting oxycodone on the market. Patients taking
`shorter acting oxycodone products, such as Percocet,
`may need to take the product every 4 to 6 hours. While
`drug doses vary by individual, the typical OxyContin
`dose prescribed by physicians ranges from two to
`four tablets per day. OxyContin was developed and
`patented in 1996 by Purdue Pharma L.P. and was
`originally available in 10 milligram (mg), 20 mg, 40 mg,
`and 80 mg tablets. A 160 mg tablet became available
`in July 2000. By comparison, Percocet and Tylox
`contain 5 mg of oxycodone and Percodan-Demi con-
`tains just 2.25 mg. The strength, duration, and known
`dosage of OxyContin are the primary reasons the drug
`is attractive to both abusers and legitimate users.
`Abuse
`
`The abuse of oxycodone products in general has
`increased in recent years. In April 2000, The Journal of
`the American Medical Association (JAMA) published a
`study, which examined two data collection sources. The
`DEA Automation of Reports and Consolidated Orders
`System (ARCOS) data tracks the distribution of
`oxycodone and other opioid analgesics and the Drug
`
`ARCHIVED
`
`This document may contain dated information.
`It has been made available to provide access to historical materials.
`
`Purdue - IPR2018-00625; IPR2018-00717, Ex. 2020
`
`

`

`Abuse Warning Network (DAWN) Medical Exam-
`iner (ME) and Emergency Department (ED) data as-
`certained the health consequences associated with
`its abuse from 1990 to 1996. The JAMA study found
`a 23 percent increase in the medical use of oxycodone
`with no corresponding increase in the illicit abuse of
`the drug. However, 1998 DAWN ME data reported a
`93 percent increase in oxycodone mentions between
`1997 and 1998 and the number of oxycodone-related
`DAWN ED mentions increased 32.4 percent from
`1997 (4,857) to 1999 (6,429).
`
`Opioids, Pain, and Addiction
`Addiction to opioids used for legitimate medical
`purposes under a qualified physician’s care is
`rare. According to the National Institute on
`Drug Abuse, however, many physicians limit
`prescribing powerful opioid pain medications
`because they believe patients may become ad-
`dicted to the drugs. Recent evidence suggests
`that, unlike opioid abusers, most healthy,
`nondrug–abusing patients do not report eupho-
`ria after being administered opioids, possibly be-
`cause their level of pain may reduce some of the
`opioid’s euphoric effects making patients less
`likely to become abusers. (Source: NIDA
`INFOFAX Pain Medications)
`
`Several deaths have resulted specifically from the
`abuse of OxyContin in Kentucky, Ohio, Virginia, and
`West Virginia. The Pike County, Kentucky, Coroner
`reported 19 OxyContin-related deaths during calendar
`year 2000. In December 2000, seven OxyContin over-
`dose deaths were reported in Southeastern Kentucky
`by two Kentucky State Police posts. The Logan Daily
`News reported in October 2000 that four Hocking
`County, Ohio, residents overdosed on OxyContin over
`an 18-day period. Two of the four died. There have been
`at least four OxyContin overdose deaths in Pulaski,
`Virginia, since 1998. In July 2000, The Williamson Daily
`reported five OxyContin-related overdose deaths in
`southwestern West Virginia since May 2000.
`OxyContin is designed to be swallowed whole;
`however, abusers ingest the drug in a variety of ways.
`
`National Drug Intelligence Center
`
`OxyContin abusers often chew the tablets or crush the
`tablets and snort the powder. Because oxycodone is
`water soluble, crushed tablets can be dissolved in wa-
`ter and the solution injected. The latter two methods
`lead to the rapid release and absorption of oxycodone.
`The alcohol and drug treatment staff at the Mountain
`Comprehensive Care Center, Prestonsburg, Kentucky,
`reports individuals who have never injected drugs are
`using OxyContin intravenously and they have never seen
`a drug “proliferate like OxyContin has since May 2000.”
`The staff at this center has over 90 cumulative years’
`experience conducting drug evaluations.
`
`OxyContin and heroin have similar effects;
`therefore, both drugs are attractive to the same
`abuser population. OxyContin is sometimes referred
`to as “poor man’s heroin,” despite the high price it
`commands at the street level. A 40 mg tablet of
`OxyContin by prescription costs approximately $4
`or $400 for a 100-tablet bottle in a retail pharmacy.
`Street prices vary depending on geographic location,
`but generally OxyContin sells for between 50 cents
`and $1 per milligram. Thus, the same 100-tablet
`bottle purchased for $400 at a retail pharmacy can
`sell for $2,000 to $4,000 illegally.
`
`Strength
`
`Illicit Retail
`Licit Retail
`Price per tablet
`Price per tablet
`$5 to $10
`$1.25
`10 mg
`$10 to $20
`$2.30
`20 mg
`$25 to $40
`$4.00
`40 mg
`$65 to $80
`$6.00
`80 mg
`unknown
`$14.00
`160 mg
`Source: Cincinnati Police Department Pharmaceutical Diversion
`Squad, November 2000
`
`OxyContin is, however, relatively inexpensive for
`those covered by health insurance, since the insurance pro-
`vider covers most costs associated with doctor visits
`and the prescription. Unfortunately, many OxyContin
`abusers whose health insurance will no longer pay for
`prescriptions and who cannot afford the high street-level
`prices are attracted to heroin. For example, in West Vir-
`ginia the availability of lower cost heroin is attracting
`many OxyContin abusers who have never used heroin.
`
`3
`
`ARCHIVED
`
`This document may contain dated information.
`It has been made available to provide access to historical materials.
`
`Purdue - IPR2018-00625; IPR2018-00717, Ex. 2020
`
`

`

`OxyContin Diversion and Abuse
`
`Related Criminal Activity
`and Diversion
`
`OxyContin abuse has led to an increased
`number of pharmacy robberies, thefts, shoplifting
`incidents, and health care fraud incidents, as
`illustrated by the following:
` Maine-In June 2000, the Bangor Daily News
`reported the arrest of an individual charged with
`selling approximately $8,000 worth of OxyContin
`weekly. The OxyContin was prescribed to the
`individual’s wife to control cancer-related pain.
`The husband illegally diverted some of the pills,
`which allegedly were paid for by Medicaid, for a
`substantial profit.
` Maine-In August 2000, the Portland Press Herald
`reported that law enforcement authorities dis-
`mantled a drug ring accused of obtaining
`OxyContin by forging prescriptions, having them
`filled at pharmacies in southern Maine and New
`Hampshire, and covering the costs with their
`Medicaid cards.
` Ohio-A heroin addict who learned about
`OxyContin at a methadone clinic committed at
`least seven aggravated robberies in early 2000
`attempting to finance his 800-mg-a-day
`OxyContin habit.
` Pennsylvania-The Cambria County Drug Task
`Force views prescription fraud as the fastest
`growing crime in Cambria County; an increase
`in the number of pharmacy burglaries in the
`county is directly related to OxyContin abuse.
`For example, on January 1, 2001, a robber stole
`more than $1,000 worth of OxyContin from a
`local pharmacy.
` Pennsylvania-In December 2000, the Penn-
`sylvania State Police reported an attempted
`armed robbery at a pharmacy in Clearfield
`County, where the suspect sought OxyContin.
`
`4
`
` Virginia-The Police Chief in Pulaski reported
`in October 2000 that approximately 90 percent
`of all thefts, burglaries, and shoplifting incidents
`in the area were linked to the OxyContin trade.
` Virginia-Prosecutors in Tazewell County reported
`in October 2000 that more than 150 people have
`been charged with felonies associated with
`OxyContin abuse. Since February 1999, thieves
`reportedly demanded only OxyContin in at least
`10 pharmacy robberies. The high number of
`robberies prompted some pharmacies in
`Tazewell County to discontinue selling
`OxyContin and post signs stating they no longer
`would carry the drug.
`
`Drugs such as OxyContin are diverted in a vari-
`ety of ways including pharmacy diversion, “doctor shop-
`ping,” and improper prescribing practices by physicians.
`Pharmacy diversion occurs when individuals working
`in pharmacies take products directly from the shelves,
`or when people make fraudulent prescriptions. Two
`pharmacists in Mercer County, West Virginia, were
`charged in September 2000 with illegally obtaining pain
`relieving hydrocodone pills. They allegedly took the
`pills directly off the pharmacy shelves and created
`fraudulent prescriptions. They then traded the drugs for
`sexual favors.
`
`The most widely used diversion technique at
`the street level is doctor shopping. Individuals, who
`may or may not have a legitimate ailment requiring
`a doctor’s prescription for controlled substances, visit
`numerous doctors, sometimes in several states, to
`acquire large amounts of controlled substances they
`abuse or sell to others. This problem is pronounced
`in southwestern Virginia and southern West Virginia.
`
`Improper prescribing practices by unscrupulous
`physicians are another way of diverting pharmaceu-
`ticals, according to law enforcement sources sur-
`veyed by the NDIC. For example, a White Sulphur
`Springs, West Virginia, physician was sentenced on
`October 24, 2000, and will spend more than 2 years in
`federal prison for Medicaid fraud and for dispensing
`prescription sedatives and painkillers in exchange for
`
`ARCHIVED
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`It has been made available to provide access to historical materials.
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`

`

`sex. Also in October 2000, a Grundy, Virginia, physi-
`cian was arrested and charged with 79 counts of ille-
`gally dispensing prescription drugs, including
`OxyContin.
`
`The abuse of OxyContin, as with the abuse of
`most prescription drugs, creates a cycle of health care
`fraud. For example, a corrupt physician writes a
`patient a prescription for a pain reliever for a nonex-
`istent injury. The physician bills the insurance company
`for that, and subsequent, visits. The patient uses a
`portion of the prescribed pills and sells the rest for a
`substantial profit. This type of health care fraud is quite
`prominent in West Virginia, where the Huntington
`Drug and Violent Crime Task Force reports “there are
`too many doctors (in West Virginia) supplementing
`their income by writing improper prescriptions.”
`Sentencing and Legislation
`
`Oxycodone, including OxyContin, are Schedule
`II drugs under the Federal Comprehensive Drug Abuse
`Prevention and Control Act. Federal sentencing guide-
`lines for diverted Schedule II pharmaceuticals are de-
`termined by the total weight of the tablets, not
`strength. Similar drugs of lower strength like Percocet
`and Tylox may weigh more than OxyContin, thus
`distributing the same quantities may result in stiffer
`penalties than for distributing OxyContin.
`
`Authorities in Maine, in conjunction with the U.S.
`Government, launched a new initiative in 2000 regard-
`ing OxyContin abuse. The Maine Attorney General’s
`Office has proposed legislation seeking to make pos-
`session of a large number of OxyContin tablets a felony;
`such possession is currently a misdemeanor.
`Outlook
`
`Continued increases in the diversion and abuse
`of OxyContin are likely. Reliable strength, potential
`prescription cost coverage, and significant profit
`potential make OxyContin attractive to both illicit
`distributors and abusers. Authorities have recognized
`the increasing problems associated with diversion
`of the drug. Law enforcement officials, physicians,
`
`National Drug Intelligence Center
`
`pharmacists, and representatives of Purdue Pharma
`L.P. are working together to find methods to limit
`diversion and abuse. Legislative initiatives are also
`being drafted to make OxyContin distribution less
`appealing by creating more stringent penalties.
`Sources
`
`Cambria County Drug Task Force, Pennsylvania
`Community Epidemiology Work Group,
`National Institutes of Health, National Institute
`on Drug Abuse
`Darryl S. Inaba, Pharm. D. and William E.
`Cohen, Uppers, Downers, All Arounders,
`CNS Productions, Inc., 1993
`Department of Health and Human Services,
`Substance Abuse and Mental Health Services
`Administration, Drug Abuse Warning Network,
`Emergency Department Data
`Department of Health and Human Services,
`Substance Abuse and Mental Health Services
`Administration, Drug Abuse Warning Network,
`Medical Examiner Data
`Drug Enforcement Administration Boston
`Field Division
`Drug Enforcement Administration Washington
`Field Division
`Gilbert Police Department, West Virginia
`Grant, Dominick, Diversion Investigator, Drug
`Enforcement Administration
`Haddox, J. David, MD, DDS, Senior Medical
`Director, Health Policy, Purdue Pharma, L.P.
`Hancock-Brooke-Weirton Drug Task Force,
`West Virginia
`Huntington Drug and Violent Crime Task
`Force, West Virginia
`Kentucky State Police
`Luken, Dennis, Detective,
`Cincinnati Police Department,
`Pharmaceutical Diversion Squad, Ohio
`
`5
`
`ARCHIVED
`
`This document may contain dated information.
`It has been made available to provide access to historical materials.
`
`Purdue - IPR2018-00625; IPR2018-00717, Ex. 2020
`
`

`

`OxyContin Diversion and Abuse
`
`Maine Attorney General’s Office
`McCloskey, Jay, U.S. Attorney,
`District of Maine
`Mountain Comprehensive Care Center,
`Prestonburg, Kentucky
`Pennsylvania State Police
`Physician’s Desk Reference 54 Edition 2000
`Pulaski Police Department, Virginia
`Ramseyer, Randy, Assistant U.S. Attorney,
`Western District of Virginia
`The Bangor Daily News, Bangor, Maine
`
`The Journal of American Medical Association
`The Logan Daily News, Hocking County, Ohio
`The Maryland Drug Early Warning System
`The Portland Press Herald, Portland, Maine
`The Roanoke Times, Roanoke, Virginia
`The Tribune-Democrat, Johnstown, Pennsylvania
`The Williamson Daily, Williamson,
`West Virginia
`Times-Dispatch, Richmond, Virginia
`
`319 Washington Street 5th Floor, Johnstown, PA 15901-1622 • (814) 532-4601
`
`ARCHIVED
`
`This document may contain dated information.
`It has been made available to provide access to historical materials.
`
`Purdue - IPR2018-00625; IPR2018-00717, Ex. 2020
`
`