JULY 2004

Oxycodone, Hydrocodone, and Polydrug Use, 2002

In Brief ■ The most frequent substances found in combination

with oxycodone and hydrocodone in drug abuse-
In recent years, the abuse of opioid pain relievers1 has related ED visits were alcohol, benzodiazepines, other
been recognized as a serious and growing public health opioid pain relievers, and cocaine.
problem.2,3 Recent estimates from the Drug Abuse
Warning Network (DAWN) showed that drug abuse- Introduction
related emergency department (ED) visits involving opioid
pain relievers have been increasing since 1994. Two of these In recent years, the abuse of opioid pain relievers has
pain relievers, oxycodone and hydrocodone,4 account for a been recognized as a serious and growing public health
substantial proportion of the increase (Figure 1). problem.5
■ In 2002, opioid pain relievers accounted for more than DAWN is a national public health surveillance system
119,000 ED mentions, or 10 percent of all the drug that monitors drug abuse-related ED visits. It collects
mentions in drug abuse-related ED visits. Oxycodone data on all drugs involved in such visits and is useful
and hydrocodone were the most frequently named for tracking trends in the consequences of drug abuse
pain relievers, accounting for 40 percent (47,594 involving drugs such as opioid pain relievers.
mentions) of the opioid pain relievers involved in This report focuses on drug abuse-related ED visits
these ED visits. involving 2 frequently reported opioid pain relievers—
■ Approximately three-quarters of ED visits involving oxycodone and hydrocodone. These drugs are marketed
oxycodone and hydrocodone involved additional under many brand names, including Vicodin®,
drugs (71% and 78%, respectively), while only 54 OxyContin®, and Percocet®. Some formulations
percent of all drug abuse-related visits involved contain a single active ingredient (e.g., OxyContin®
multiple drugs.

FIGURE 1
Trends in drug abuse-related ED visits involving hydrocodone and
oxycodone, coterminous U.S., 1994-2002

25,000

20,000
Hydrocodone/
Visits

combinations
15,000
Oxycodone/
10,000 combinations

5,000

0
1994 1995 1996 1997 1998 1999 2000 2001 2002

SOURCE: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2002 (03/2003 update).
2 OXYCODONE, HYDROCODONE, AND POLYDRUG USE, 2002 • JULY 2004

contains only oxycodone), while others contain the FIGURE 2

opioid in combination with acetaminophen, aspirin, or Mentions of opioid pain relievers,
ibuprofen (e.g., Vicodin® contains both hydrocodone by specific drug, 2002
and acetaminophen). ED visits involving both single-
ingredient and combination formulations are included
in this analysis.
42,214 25,197
Opioid Pain Relievers in ED Visits Unnamed Hydrocodone

Related to Drug Abuse

In 2002, opioid pain relievers accounted for more

than 119,000 ED mentions,6 or 10 percent of all drug 22,397
mentions in drug abuse-related ED visits. Opioid pain Oxycodone

relievers were as frequent as heroin or marijuana in 14,893

All others 2,775
ED visits related to drug abuse, but less frequent than 11,709 Morphine
cocaine or alcohol. Methadone

More than one-third (35%) of ED mentions of opioid SOURCE: Office of Applied Studies, SAMHSA, Drug
Abuse Warning Network, 2002 (03/2003 update).
pain relievers were not identified by name (Figure 2).
Of those that were named, oxycodone (19% of opioid
pain reliever mentions) and hydrocodone (21%) were FIGURE 3
the most frequent. Other opioid pain relievers, such as Number of drugs involved in
morphine, occurred much less frequently. oxycodone- and hydrocodone-
related ED visits: 2002
Trends in Oxycodone and
Hydrocodone in ED Visits: 1994-2002 Hydrocodone
Hydrocodone

Between 1994 and 2002, mentions of oxycodone and 1 drug

hydrocodone increased in ED visits related to drug
abuse (Figure 1). 2 drugs

3 drugs
In 1994, ED mentions of oxycodone numbered about
4,000 nationally. By 2002, ED mentions of oxycodone 4 drugs
had increased to more than 22,000 mentions—an
increase of 450 percent. 5 drugs

0 2,000 4,000 6,000 8,000 10,000

In 1994, ED mentions of hydrocodone were more Visits
than twice as frequent as oxycodone, but that gap has
narrowed. By 2002, ED mentions of hydrocodone had Oxycodone
Oxycodone
risen by 170 percent, from about 9,300 in 1994 to more
than 25,000 in 2002. 1 drug

2 drugs
Polydrug Use
3 drugs
In 2002, more than half (54%) of drug abuse-related
ED visits involved multiple drugs. Over a third (36%) 4 drugs
involved 2 drugs; 13 percent involved 3 drugs; and the
remaining 6 percent involved 4 or 5 drugs. Alcohol was 5 drugs
involved in nearly a third (31%) of drug abuse-related 0 2,000 4,000 6,000 8,000 10,000
ED visits. Visits

SOURCE: Office of Applied Studies, SAMHSA, Drug

Abuse Warning Network, 2002 (03/2003 update).
 OXYCODONE, HYDROCODONE, AND POLYDRUG USE, 2002 • JULY 2004 3

Polydrug use was even more involved another opioid pain Carisoprodol, which is used
prevalent among the ED visits reliever. About 3,000 of these visits therapeutically as a muscle relaxant,
involving oxycodone and involved both oxycodone and was present in 4 percent of ED
hydrocodone. In 2002, 71 percent of hydrocodone. Among the other visits involving oxycodone and in
oxycodone-related ED visits and 78 opioid pain relievers, methadone 8 percent of ED visits involving
percent of hydrocodone-related ED appeared in about 5 percent of visits hydrocodone.
visits involved multiple drugs. involving oxycodone.

However, oxycodone and

TABLE 1
hydrocodone appeared to have
different polydrug patterns Drugs in combination with oxycodone and
(Figure 3). For oxycodone, single- hydrocodone, drug abuse-related ED visits, 2002
drug visits were the most frequent
(29% of 20,748 visits), with 2- or Oxycodone Hydrocodone
3-drug visits occurring in similar Total visits 20,748 (100%) 25,109 (100%)
numbers (between 5,000 and 6,000
visits). For hydrocodone, 2-drug Number of drugs in visit
visits were most frequent (33% Single-drug visits 5,918 (29%) 5,438 (22%)
of 25,109 visits), with fewer visits Multiple-drug visits 14,830 (71%) 19,671 (78%)
involving 3 or 4 drugs. The numbers 2 drugs 5,462 (26%) 8,191 (33%)
of 5-drug visits were similar for
3 drugs 4,980 (24%) 6,147 (24%)
oxycodone and hydrocodone (6%
4 drugs 3,229 (16%) 4,432 (18%)
and 4%, respectively).
5 drugs 1,158 (6%) 901 (4%)

Drugs Used in
Drugs in combinations
Combination With
Other opioid analgesic 3,785 (18%) 3,562 (14%)
Oxycodone and
Hydrocodone oxycodone 3,049 (12%)
hydrocodone 3,049 (15%)
More than 200 different drugs were
reported to DAWN in combination Major substances of abuse 9,128 (44%) 10,735 (43%)
with oxycodone and hydrocodone.
alcohol 6,893 (33%) 7,864 (31%)
Major substances of abuse,
cocaine 2,393 (12%) 2,269 (9%)
benzodiazepines,7 other opioid pain
relievers, and a muscle relaxant were heroin 1,614 (8%) 961 (4%)

the most frequent co-occurring drugs marijuana 1,545 (7%) 1,290 (5%)
in oxycodone- and hydrocodone-
related ED visits (Table 1). Benzodiazepines 4,296 (21%) 6,424 (26%)
alprazolam 1,516 (7%) 3,041 (12%)
More than 40 percent of oxycodone- diazepem 1,277 (6%) 1,628 (7%)
and hydrocodone-related ED visits
clonazepam 880 (4%) 941 (4%)
also involved a major substance of
unnamed benzodiazepine 486 (2%) 559 (2%)
abuse. Alcohol was the most frequent
of these, followed by cocaine, heroin, lorazepam 450 (2%) 605 (2%)
and marijuana. About one-fifth of
oxycodone visits and a quarter of SOURCE: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2002 (03/2003 update).
hydrocodone visits also involved a
benzodiazepine. The most frequent
benzodiazepines were alprazolam, The DAWN Report is published periodically by the Office of Applied Studies, Substance Abuse
and Mental Health Services Administration (SAMHSA). This issue was written by Dr. Judy Ball
diazepam, and clonazepam.
and Dana Lehder Roberts (OAS/SAMHSA). All material appearing in this report is in the public
domain and may be reproduced or copied without permission from SAMHSA. Citation of the
More than 3,500 ED visits involving
source is appreciated.
oxycodone or hydrocodone also
4 OX YCODONE, H YDROCODONE, AND POLYDRUG USE, 2002 • JULY 2004

End Notes
1 Opioid pain relievers are synthetic medications with effects
About DAWN
similar to substances derived from opium. This publication
The Drug Abuse Warning Network (DAWN) is a national
focuses on 2: oxycodone and hydrocodone.
2 The Substance Abuse and Mental Health Services surveillance system that collects data on drug abuse-
Administration (SAMHSA) has launched an educational related visits to emergency departments (EDs) and drug
campaign to combat prescription drug misuse and abuse. abuse-related deaths reviewed by medical examiners and
For more information, go to [Link] coroners. Data on ED visits are collected from a national
3 For information on the prevalence of prescription drug
misuse nationally, see Substance Abuse and Mental Health probability sample of non-Federal, short-stay hospitals, with
Services Administration, Office of Applied Studies. The oversampling in 21 major metropolitan areas. Data from the
NHSDA Report: Nonmedical Use of Prescription-Type Drugs sample are used to generate estimates for the coterminous
among Youths and Young Adults. Rockville, MD. January U.S. and the 21 metropolitan areas.
16, 2003. [Link]
[Link].
4 DAWN refers to each drug in terms of its generic name, as ED visits are reportable to DAWN if a patient between the
drugs are available under many different brand names. ages of 6 and 97 was treated for a condition associated
5 On August 6, 2003, the 108th Congress convened a hearing
with intentional drug abuse, including recreational use,
before the Senate Committee on Governmental Affairs on
dependence, or suicide attempt. Visits involving chronic
the subject of “Legal Drugs, Illegal Purposes: The Escalating
Abuse of Prescription Medications.” For a transcript of the health conditions resulting from drug abuse are reportable.
hearing see [Link] Abuse of prescription and over-the-counter medications is
6 A “mention” is the unit of measurement for individual drug
reportable. Adverse reactions associated with appropriate
reports. For example, an ED visit that involved the use
use of these drugs and accidental ingestion or inhalation of
of both hydrocodone and oxycodone would have 2 “drug
mentions.” In DAWN, up to 4 drugs plus alcohol can be any drug are not reportable.
reported for a single ED visit.
7 Benzodiazepines are prescription drugs used to treat anxiety,
insomnia, and seizures.

U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES