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Changing patterns in opioid addiction

Characterizing users of oxycodone and other opioids

Bruna Brands, PhD
Research Scientist at CAMH at the time of the study and is now Senior Scientist in the Office of Research and Surveillance at Health Canada and an Assistant Professor in the Department of Pharmacology at the University of Toronto

Selina Li, MSW
Research analyst at CAMH at the time of the study

Laura Catz-Biro, MD
Staff physician in Medical Withdrawal Management Services at CAMH at the time of the study and is now a family physician in Toronto

Correspondence: Dr Sproule, Centre for Addiction and Mental Health, 33 Russell St, Toronto, ON M5S 2S1; e-mailbeth_sproule{at}camh.net

OBJECTIVE To evaluate the clinical observation that the number of individuals seeking opioid detoxification from oxycodone was increasing at the Centre for Addiction and Mental Health (CAMH) in Toronto, Ont; and to identify the characteristics of individuals seeking opioid detoxification at CAMH.

DESIGN Retrospective analysis of patient health records.

SETTING Medical Withdrawal Management Service at CAMH.

PARTICIPANTS All patients admitted for opioid detoxification between January 2000 and December 2004.

MAIN OUTCOME MEASURES Number of opioid detoxification admissions each year; type, dose, and source of opioids; comorbid problems and symptoms.

RESULTS There were 571 opioid detoxification admissions during the 5-year study period. The number of admissions increased steadily over the 5 years; in particular, the number of admissions related to controlled-release oxycodone increased substantially (3.8%, 8.3%, 20.8%, 30.6%, and 55.4% of the total opioid admissions in 2000 to 2004, respectively; ₄²= 105.5, P < .001). The rates of admissions involving heroin remained low and stable. Use of controlled-release oxycodone was associated with considerably higher doses than use of other prescription opioids was. Physician prescriptions were the source of the prescription opioids for a large percentage of patients, particularly for older patients. Prescription opioid users reported considerable comorbid substance use problems, pain, and psychiatric symptoms.

CONCLUSION This study has demonstrated a significant rise in the number of individuals seeking treatment at CAMH for controlled-release oxycodone addiction. The substantial comorbid pain, psychiatric symptoms, and other psychoactive substance use problems in these patients, coupled with the finding that prescriptions were an important source of opioids, highlight the clinical complexities encountered in the treatment of these individuals. Further research examining these complexities and the many possible pathways leading to prescription opioid addiction is required in order to develop effective prevention and treatment strategies.

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