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The relative abuse liability of oral oxycodone, hydrocodone and hydromorphone

Holy_cow

Holy_cow

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Joined
Nov 29, 2007
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171
Thought this was interesting:

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 and 40 mg), hydrocodone (15, 30 and 45 mg), hydromorphone (10, 17.5 and 25 mg) and placebo. Healthy adult volunteers (n = 9) with sporadic prescription opioid abuse participated in 11 experimental sessions (6.5 h 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.
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http://www.sciencedirect.com/scienc...d=994540&md5=125b3b9da7e4ce9f23d3ad7189af04ba
 
I think there is some truth to this, as from what I've observed, the oral abuse liability does go something like:

Oxycodone, hydrocodone and then hydromorphone (highest to lowest).

This is of course, all very subjective, and I am not so sure about the nine "healthy adult volunteers with sporadic prescription opioid abuse"...
 
Sort of a silly study, sample size is tiny and overly selective sample.
 
I am not surprised by this at all. To me oxycodone is the least recreational of all the strong opiates and mostly apeals to poly drug abusers. Its widespread abuse among opiate fans seems to stem more from its method of distribution in large dosage pills lacking in APAP (oxycontin) rather than its qualatative high. To me hydrocodone seems far superiour in the quality department but is hampered by the widely available forms all containing APAP. I think this has been rather obvious for quite some time and is the reason that only recently have we been hearing talk of hydrocontins and other large dose APAP free forms of this powerfull painkiller. And although its analgesic potency is clearly lower than oxycodone it seems unquestionable that mg for mg it is at least equal if not surpassing oxy in recreational effects such as sedation, body load, and euphoria.

As for morphine thats a no brainer, it has an almost psychedelic quality that all the other prescription painkillers lack.
 
^ exactly.
I also find hydrocodone to be more euphoric and sedating than oxycodone.

I think oxycodone's availability is what makes it attractive, and as you said, the fact that oxycontins come with large doses of oxycodone with no apap makes it even more appealing.

anyone who has IV'd heroin or morphine know that oxycodone (or any other opiate) pales in comparison.

When talking about IV....Heroin/Morphine are #1!
then i'd say hydromorphone, followed by oxymorphone (never tried it, but I assume its fantastic), then demerol (IV demerol is incredible), and then all the rest dont matter!
 
Oral sex (just kidding)

I agree with the poster who called that a poor study. It's even BAD SCIENCE. Double blind is the only way to get results, and you need a much larger sample group.

BTW, Hydromorphone only has a 10% bioavailability taken orally. That jumps to nearly 47% when insulfated. However, the only way you can get it is Opana (at least as far as I know) which has micronized silicates added to prevent abuse. Think powdered glass. Not good for nose, lungs and especially veins..

That being said, anyone got some Opana? :)
 
Painiac512 said:
Double blind is the only way to get results, and you need a much larger sample group.
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Well, it was double blind, there was just no control sample.
 
nuke said:
Well, it was double blind, there was just no control sample.
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This outpatient study employed a double-blind, randomized, within-subject, placebo-controlled design to examine...
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Maybe the control sample was just not mentioned due to the findings?
 
I call BS (Bad Science) on that! Having been married to a well published scientist for what seems like forever (just kidding, honey), I've learned that you include all your data to be considered a valid experiment. "Cooking" the data is unethical and just plain wrong. You learn nothing then unless you're wise enough to feel guilt from your obvious 'mistake.'

But then that's more a philosophical issue.

Sorry to any I offend this morning. Very tough night with this damned leg of mine keeping me from ever dropping into dreamyland. And that's with 4mg alprazolam, 25mg AmbienCR, and 30mg Restoril (tamazepam). Usually that much of all them knocks me cold out for at least 6 hours. Today all it's done is to make me too impaired to drive out for breakfast tacos. Damn benzos/hypnotics!

Paxum vobiscum
 
^ eh????

given that the stated purpose of the study was to look at the preferences of ex abusers what would a control sample consist of? non ex abusers. FFS various randoms? and what would that tell you.

the trial participants didn't know what substance they were taking, and the study was properly double blinded. and whilst I am wary about believing something that relies on evaluating something subjective like euphoria, they used multiple structured questionaires which are less prone to leading.

50 were screened 12 were lost and didn't come back 13 were excluded for medical reasons, 7 did not meet the drug use criteria, 5 decided not to join the study 13 were enrolled, 4 left before completing the study leaving only 9 having completed the study. the maths though here doesn't add up... unless some failed or were lost for more than 1 reason.

there is no reason to suggest any cooking of data, and I'm sure if you asked the authors they would supply the raw data for analysis.

The take home message is don't do studies on supposed ex-opiate abusers because they are rather unreliable, unhealthy and tend, suprise suprise to abuse opiates when they to claim not to.

the only thing I find interesting about this, is the further confirmation that abuse potential is not necessarily related to analgesia. hopefully that the two will be fully teased apart, giving opioid analgesia without abuse.
 
You are absolutely right about the maths not adding up.

I suppose I'm used to having control groups and study groups of much larger volume. To me, 50 total individuals doesn't create a very good sample size.

I do wonder what the results would be like with, say, 500 individuals.

Damn I am grumpy today. I apologize in advance for being an ass.

Pax
 
Painiac512 said:
I agree with the poster who called that a poor study. It's even BAD SCIENCE. Double blind is the only way to get results, and you need a much larger sample group.

BTW, Hydromorphone only has a 10% bioavailability taken orally. That jumps to nearly 47% when insulfated. However, the only way you can get it is Opana (at least as far as I know) which has micronized silicates added to prevent abuse. Think powdered glass. Not good for nose, lungs and especially veins..

That being said, anyone got some Opana? :)
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Opana is Oxymorphone. Dilaudid is Hydromorphone.
 
The day that 9 observations is an appropriate sample size is the day that this study will contain some validity.
 
I think it can have some validity in suggesting trends, although it is not ultimate proof in any sense. Think about the questions this study was asking: Does the analgesic potency of the drug have a direct correlation with recreational potential? Even very few volunteers can offer valid insight on such a basic question, particularly when we have such stark differences in potency but relatively equal ratings for enjoyment. It may not be full proof science but it makes its point and suggests that there is potential in funding a larger more robust study of the same nature. I see this more as a study in the feasibility of answering the question more than an answer in and of itself.
 
I am not surprised by this at all. To me oxycodone is the least recreational of all the strong opiates and mostly apeals to poly drug abusers. Its widespread abuse among opiate fans seems to stem more from its method of distribution in large dosage pills lacking in APAP (oxycontin) rather than its qualatative high. To me hydrocodone seems far superiour in the quality department but is hampered by the widely available forms all containing APAP. I think this has been rather obvious for quite some time and is the reason that only recently have we been hearing talk of hydrocontins and other large dose APAP free forms of this powerfull painkiller. And although its analgesic potency is clearly lower than oxycodone it seems unquestionable that mg for mg it is at least equal if not surpassing oxy in recreational effects such as sedation, body load, and euphoria.

As for morphine thats a no brainer, it has an almost psychedelic quality that all the other prescription painkillers lack.
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^ exactly.
I also find hydrocodone to be more euphoric and sedating than oxycodone.

I think oxycodone's availability is what makes it attractive, and as you said, the fact that oxycontins come with large doses of oxycodone with no apap makes it even more appealing.
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On this note, I'll chime in -- not that it means much, but in my small locality the opioid fans/dilettantes/hobbyists/careerists I know well are all in love with the recent appearance in some quantity of the Vicoprofen preparation of hydrocodone, which is ibuprofen/hydrocodone ... maybe not as much the careerists, as they like heroin, it is certain.

It may not be full proof science but it makes its point and suggests that there is potential in funding a larger more robust study of the same nature.
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For sure. I see no reason (besides the same limitations one always faces) that less shallow research on precisely this matter couldn't be carried out.
 
more funding? doubtful.

Anyway, the suggestions of "cooking" data and other nonsense are simply ridiculous. Do you bother to read the whole thing before you make outlandish statements or just skip it because what's the point of putting any effort into stupidity?
 
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