The relative abuse liability of oral oxycodone, hydrocodone and hydromorphone assessed in prescription opioid abusers

Abstract

Abuse of prescription opioids has risen precipitously in the United States. Few controlled comparisons of the abuse liability of the most commonly abused opioids have been conducted. This outpatient study employed a double-blind, randomized, within-subject, placebo-controlled design to examine the relative abuse potential and potency of oral oxycodone (10, 20 & 40 mg), hydrocodone (15, 30 & 45 mg), hydromorphone (10, 17.5 & 25 mg) and placebo. Healthy adult volunteers (n=9) with sporadic prescription opioid abuse participated in 11 experimental sessions (6.5 hr in duration) conducted in a hospital setting. All three opioids produced a typical mu opioid agonist profile of subjective (increased ratings of liking, good effects, high and opiate symptoms), observer-rated, and physiological effects (miosis, modest respiratory depression, exophoria and decrements in visual threshold discrimination) that were generally dose-related. Valid relative potency assays revealed that oxycodone was roughly equipotent to or slightly more potent than hydrocodone. Hydromorphone was only modestly more potent (less than two-fold) than either hydrocodone or oxycodone, which is inconsistent with prior estimates arising from analgesic studies. These data suggest that the abuse liability profile and relative potency of these three commonly used opioids do not differ substantially from one another and suggest that analgesic potencies may not accurately reflect relative differences in abuse liability of prescription opioids.

The Subjective, Reinforcing, and Analgesic Effects of Oxycodone in Patients with Chronic, Non-Malignant Pain who are Maintained on Sublingual Buprenorphine/Naloxone

“…When compared with Bup/Nx, oxycodone had similar effects on experimentally induced pain and clinical pain assessments, yet with minimal aversive effects and a number of positive subjective effects. This observation is consistent with recent reports of an overall positive subjective profile of oxycodone among opioid abusers and non-abusers (Comer et al, 2008;Walsh et al, 2008;Zacny and Lichtor, 2008). Yet, in comparison to other investigations noting the positive subjective effects of similar oxycodone doses, those reported in this study were relatively small.…”

“…The use of opioids for the treatment of chronic, non-cancer pain has escalated in recent years, and it is estimated that opioids are used to manage a significant percentage of cases involving moderate to severe persistent pain (Ballantyne and Mao, 2003;Trescot et al, 2006). Despite their medical utility, many opioid analgesics including morphine, hydrocodone, hydromorphone, fentanyl, and oxycodone have significant abuse liability (Comer et al, 2008;Walsh et al, 2008;Zacny and Lichtor, 2008). Aberrant opioid use behaviors among patients with pain include: obtaining prescriptions from multiple prescribers, forging prescriptions, 'borrowing' or stealing opioids, aggressively seeking more medication from physicians, and escalating doses without the physician's knowledge (Cowan et al, 2001;Martell et al, 2007;Passik et al, 2006).…”

“…Multiple laboratories have consistently shown that oxycodone produces dose-related increases in positive subjective effects among heroin abusers, prescription opioid abusers, and non-drug abusers (Comer et al, 2008(Comer et al, , 2009(Comer et al, , 2010bWalsh et al, 2008;Zacny and Gutierrez, 2009;Zacny and Lichtor, 2008). Oxycodone serves as a robust reinforcer among participants who abuse heroin or prescription opioids (Comer et al, 2008;Comer et al, 2009), yet non-drug-abusing volunteers only selfadminister oxycodone when they are exposed to experimentally induced pain (Comer et al, 2010).…”

Likeability and Abuse Liability of Commonly Prescribed Opioids

“…"Take again" ratings were consistently higher for oxycodone than morphine [6,10]. One study found no substantial difference in subjective effects related to likability of oxycodone, hydrocodone, and hydromorphone, but did demonstrate increased risk of abuse over placebo for all three opioid products assessed [13]. A similar study comparing oxycodone and hydrocodone to placebo found that peak liking ratings were significantly greater with oxycodone compared to placebo, and those of hydrocodone were not [14].…”

Strategies to Reduce the Tampering and Subsequent Abuse of Long-acting Opioids: Potential Risks and Benefits of Formulations With Physical or Pharmacologic Deterrents to Tampering

“…52 Oxycodone, hydrocodone, and hydromorphone (2 other 6-keto opioids) are similar to one another in subjective effects, so it is puzzling that the 6-keto opioid, oxymorphone, would be dissimilar. 53 It is possible that differences in subjective effects were more substantial than differences in formulation for oxymorphone ER-PSH vs CR oxycodone. The formulation of CR oxycodone used in this study had a biphasic release pattern, characterized by an initial bolus release of 30% to 40% of the dose within 1 hour, followed by a slow-release phase of 8 to 12 hours.…”