It has been interesting moon-lighting at another hospital to see how much oxycodone (common brands names: oxynorm and oxycontin) was being used professionally and recreationally.
I was out with a friend who told me he had been given 1 1/2 oxycontin tabs by an acquaintance a while ago and had been high as a kite for a couple of days. Interestingly he said there was no “come down”. Sounds like a very desirable drug of abuse.
In the ED everyone was prescribing oxycodone to everybody, from the ED reg to the ENT reg to the ortho house officer.
“… we are looking at a disaster in the making. We have been complacent about the warnings from the rest of the western world, with harms arising from pharmaceutical opioids overtaking those from heroin. This has reached epic proportions in the United States, with oxycodone particularly over-represented. Pharmaceutical opioids in the United States now kill more people than firearms or road traffic accidents, and more than the combined death rates from heroin and cocaine overdoses. This is shocking and shameful …” Dr Jeremy McMinn*
Oxycodone is more addictive and more expensive than morphine.
Oxycodone is no safer in renal failure than morphine.
Most people with morphine “allergy” were just given too much and developed nausea, vomiting, dysphoria or an itchy rash from the histamine release caused by morphine. It may be worth try a test dose of IV morphine to see if they can tolerate it, check with a senior first.
Generally in ED for analgesia we use paracetamol/acetaminophen and a NSAID such as ibuprofen. For severe pain we will use a fast acting IV or IN opioid such as fentanyl to control the pain. Once the pain is controlled if ongoing strong pain relief is required we will move to oral morphine (or IV if unable to take oral). Oral morphine is available in fast acting and slow release forms.
In our hospital we have made oxycodone only able to be prescribed by order of a consultant, and I’m trying to have oxcodone removed from our ED.
As an aside, at the other hospital, as always, there was a granny who had bounced back into hospital because she had been discharged from the ortho ward on oxycodone, prescribed a bulk forming laxative but no stimulant laxative, and hadn’t crapped for a week and felt rotten.
It’s a shame that the resident who discharged her wasn’t working that weekend. It would have been a good educational experience for him/her to come down, give the enema and readmit the patient.
This is a problem with all opioids, not just oxycodone. Always prescribe a stimulant laxative when prescribing more than a few doses of opioids eg something with sennosides in it. By the way sennosides are Category A (considered safe) in pregnancy. Shame the resident wasn’t on that weekend.