Prescription opioid painkillers are behind one of the biggest epidemics of drug abuse in recent years, but their potential for addiction has a long history. One of the most widely abused opioids, oxycodone, was first derived from chemicals found in the opium poppy – also a source of heroin – in 1916. Over the decades, the risk of improper use of oxycodone became clear: In the 1960s, California reported that oxycodone was linked to a quarter of the state’s cases of drug addiction.

Despite stricter scheduling in the 1970s, more formulations of prescription painkillers were brought to market, such as hydrocodone (Vicodin), opioid patches, and time-release oxycodone pills branded as OxyContin. Throughout the late 1990s and 2000s, opioid painkillers were linked to a growing number of poisonings and overdoses, as part of an outbreak of drug addiction that was seen even among high school students. In the face of crackdowns on overprescribing, the number of deaths due to these powerful drugs tragically continues to grow.


Narcotics License Needed

In 1914, The Harrison Narcotic Act is the first federal attempt on controlling opioids and other narcotics. Under the act, manufacturers, pharmacists, and physicians must have a license, keep records for inspection, and pay the U.S. Department of the Treasury for related drug transactions.

Source: http://www.cfr.org/drug-trafficking-and-control/harrison-narcotics-tax-act-1914/p27928


From Stem to Synthesis

Oxycodone is derived from thebaine, a naturally occurring alkaloid found in the opium poppy.

Source: http://www.britannica.com/science/oxycodone


German Painkillers

A year after its first synthesis, oxycodone becomes clinically used for the first time in Germany.

Source: http://thblack.com/links/RSD/JPainSympMgmt2005_29_S47_Oxycodone.pdf


Hydrocodone Created

German scientists created hydrocodone by adding a hydrogen atom to codeine molecules. Scientists believed the new drug would help make the drug easier on the stomach. They also wanted to provide a less-addictive alternative to other painkillers, which were increasingly becoming abused nationwide.

Source: http://nymag.com/news/intelligencer/topic/57770/


Percodan Problems


The New York Times reports that the Federal Narcotics Bureau will be requiring Percodan, the only drug on the market containing oxycodone, to be prescribed via a written prescription. Previously, physicians were able to call in prescriptions for the drug to pharmacies. The change in procedure is largely due in part to a California complaint citing Percodan as the cause of at least 25% of drug addictions in California alone.

Source: Robertson, Nan. (1963, December 29th). U.S. Tightens Rule on Sale of A Drug. New York Times, p 20.


Vicodin Appears


FDA approval of painkiller brand Vicodin, which is hydrocodone combined with acetaminophen, goes into effect.

Source: http://www.drugs.com/pro/vicodin.html


Opioid Patch

In August 1990, the first opioid pain medication via a skin patch is approved. The patch can be changed every three days.

Source: http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm338566.htm


Popularity Surges for OxyContin

The FDA approves OxyContin, a time-release form of oxycodone. The painkiller quickly becomes the preferred drug of abuse for addicts across the U.S.

Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622774/, http://www.ncbi.nlm.nih.gov/pubmed/16202959


Label Change

OxyContin's label is updated to emphasize warnings for misuse and abuse after a rise in overdoses and deaths from prescription painkillers, including OxyContin. The label change includes a warning that the pain medication is not suitable for "as needed" pain nor for postoperative pain not expected to be long-lasting.

Source: http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm338566.htm


Rush Limbaugh's Addiction

Controversial talk show host Rush Limbaugh admits he is addicted to painkillers. It is reported he may be addicted to OxyContin, but this is never confirmed. The revelation caused all sides of the political spectrum to discuss the growing problem of prescription drug abuse.

Source: http://www.cnn.com/2003/SHOWBIZ/10/10/rush.limbaugh/


Rise in Overdoses

Opioid pain relievers are cited as being responsible for 73.8% of prescription drug overdose deaths.

Source: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6043a4.htm?s_cid=mm6043a4_w

Heath Ledger Dies


Australian Actor Heath Ledger dies from a combination prescription drug overdose at the age of 28. The New York CIty medical examiner's office reports Ledger had oxycodone and hydrocodone in his system along with other prescriptions.

The CDC reports that opioid pain relievers
account for more overdose deaths than
heroin and cocaine combined.

Sources: http://www.cnn.com/2008/SHOWBIZ/Movies/02/06/heath.ledger/, http://www.drugs.com/celebrity_deaths.html


Ryan Haight Act


The Ryan Haight Act goes into effect, making it illegal to deliver, distribute, or dispense a controlled substance over the Internet. The legislation marks, among other things, a reaction to the rapid increase of opioid use in America.

After marijuana, Vicodin was the second-most abused substance by 12th-graders in the last year.

Source: http://www.dea.gov/pr/multimedia-library/publications/drug_of_abuse.pdf#page=43, https://www.whitehouse.gov/sites/default/files/ondcp/policy-and-research/ndcs2010.pdf


"Pill Mill"

After physicians in Florida bought 89% of oxycodone sold in the U.S. during the first six months of 2010, out-of-staters flood to Florida to obtain an oxycodone prescription from one of the many clinics prescribing the narcotic. This led to tougher drug legislation in 2011 that barred the number of prescriptions Floridian physicians could write.

Source: Alvarez, Lizette. (2011, September 1). Florida Shutting 'Pill Mill' Clinics: New Laws Curb Illegal Sales of Medicines. New York Times, p A1.


New Drug


Drug companies begin patient testing for a drug 10 times stronger than Vicodin, made from pure hydrocodone. Addiction experts are concerned.

Source: http://www.dailymail.co.uk/news/article-2079029/New-painkiller-Zohydro-10-times-stronger-Vicodin-developed.html


Hydrocodone Becomes Schedule II


In order to combat growing prescription drug abuse, the DEA reschedules hydrocodone combination products to Schedule II to help tighten restrictions.

Source: https://www.ascp.com/articles/proposal-reschedule-hydrocodone-combination-products


Addiction on "House of Cards"

Season 3 of drama series "House of Cards" illustrates the importance of prescriber education when character Doug Stamper relapses into alcohol addiction after taking Percocet, which was prescribed by an Emergency Room physician.

Source: https://www.whitehouse.gov/blog/2015/03/27/reality-tv-house-cards-highlights-importance-prescriber-education

Opioid Deaths

Opioid overdose deaths have been rapidly climbing in the last decade. The number of unintentional overdose deaths from prescription pain relievers has soared in the United States, more than quadrupling since 1999.

Source: http://www.reuters.com/article/2015/10/13/us-health-opioids-misuse-idUSKCN0S727320151013#Y2SltS3o9OjucBIe.97, http://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2015/americas-addiction-to-opioids-heroin-prescription-drug-abuse