OxyContin (Oxycodone) Prescribing Knowledge
The correct answer is B: OxyContin is one of the most common drugs involved in prescription opioid overdose deaths. This is a critical safety fact that all prescribers must understand when considering opioid therapy.
Why Option B is Correct
Immediate-release oxycodone was involved in the greatest number of opioid-related deaths in population-based studies, with 61% of oxycodone overdose decedents having filled a prescription for oxycodone within 60 days prior to death 1. The drug has demonstrated exceptionally high abuse liability and "liking" scores compared to other opioids, contributing significantly to the prescription opioid epidemic 2. Between 1997 and 2007, retail sales of oxycodone increased by 866%, and the false marketing of OxyContin as "non-addictive" substantially contributed to widespread misuse 2.
- Methadone has been associated with disproportionate numbers of overdose deaths relative to prescribing frequency, but oxycodone products remain among the most commonly implicated in fatal overdoses 3.
- Higher dose strengths of immediate-release oxycodone products showed strong linear correlation with mortality (rho = 1.00, P < 0.01) 1.
Why the Other Options are Incorrect
Option A: Should NOT be prescribed with benzodiazepines
Concurrent prescribing of opioids and benzodiazepines is explicitly contraindicated due to profound sedation, respiratory depression, coma, and death risk 4. The FDA requires a boxed warning about this combination, and the 2022 CDC guidelines emphasize avoiding benzodiazepine co-prescription whenever possible 3. This combination does not enhance effectiveness—it dramatically increases mortality risk.
Option C: DOES place patients at risk for misuse/abuse
OxyContin contains oxycodone, a Schedule II controlled substance that exposes users to risks of addiction, abuse, and misuse even when appropriately prescribed 4. The FDA-mandated labeling explicitly states: "Addiction can occur at recommended dosages and if the drug is misused or abused" 4. The abuse potential of oxycodone is equivalent to morphine 5, and it demonstrates uniquely high "liking" and "wanting" scores that contribute to its abuse susceptibility 2.
- All patients receiving oxycodone must be monitored for development of addiction, abuse, or misuse behaviors 4.
- Risks increase with personal or family history of substance abuse or mental illness, but this should not prevent appropriate pain management—it necessitates intensive counseling and monitoring 4.
Option D: Dosage increases require careful justification
Dosage escalation is not appropriate simply because "pain and function are meaningfully improved"—this represents dangerous prescribing logic. The 2022 CDC guidelines recommend avoiding or carefully justifying decisions to titrate dosage to ≥90 MME/day, with implementation of additional precautions including increased follow-up frequency and naloxone provision 6.
- Clinicians should continually reevaluate patients to assess maintenance of pain control, relative incidence of adverse reactions, and development of addiction, abuse, or misuse 4.
- If pain increases after dosage stabilization, clinicians should attempt to identify the source of increased pain before increasing the dose 4.
- The goal is to obtain an appropriate balance between pain management and opioid-related adverse reactions, not unlimited dose escalation 4.
Critical Prescribing Principles
ER/LA opioids like OxyContin should not be used for acute pain, should not be the first choice when initiating opioid therapy, and should be reserved for severe, continuous pain in opioid-tolerant patients 3.
- Patients must be opioid-tolerant (receiving ≥60 mg daily oral morphine, ≥30 mg daily oral oxycodone, or equianalgesic doses for ≥1 week) before initiating ER/LA formulations 3.
- When starting opioid therapy for chronic pain, prescribe immediate-release opioids instead of ER/LA opioids due to higher overdose risk with ER/LA initiation 3.
Common Pitfall to Avoid
The most dangerous misconception is that OxyContin's controlled-release formulation makes it safer or less addictive than immediate-release opioids. This false marketing claim contributed directly to the opioid epidemic 2. The controlled-release mechanism can be defeated by crushing, and the high oxycodone content in each tablet creates severe overdose risk when the extended-release properties are bypassed 7, 2.