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Factors influencing the selection of hydrocodone and oxycodone as primary opioids in substance abusers seeking treatment in the United States

Cicero, Theodore J.a,*; Ellis, Matthew S.a; Surratt, Hilary L.b; Kurtz, Steven P.b

doi: 10.1016/j.pain.2013.07.025
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Summary Selection of hydrocodone and oxycodone as primary opioids of misuse is complexly determined by gender, age, pain, accessibility, drug formulation, and quality of the high.

The purpose of the present study was to identify the factors that influence the selection of hydrocodone and oxycodone as primary drugs of abuse in opioid-dependent subjects (n = 3520) entering one of 160 drug treatment programs around the country. Anonymous, self-administered surveys and direct qualitative interviews were used to examine the influence of demographic characteristics, drug use patterns, and decision-related factors on primary opioid selection. Our results showed that oxycodone and hydrocodone were the drugs of choice in 75% of all patients. Oxycodone was the choice of significantly more users (44.7%) than hydrocodone (29.4%) because the quality of the high was viewed to be much better by 54% of the sample, compared to just 20% in hydrocodone users, who cited acetaminophen as a deterrent to dose escalation to get high and hence, its low euphoric rating. Hydrocodone users were generally risk-averse women, elderly people, noninjectors, and those who prefer safer modes of acquisition than dealers (ie, doctors, friends, or family members). In contrast, oxycodone was a much more attractive euphorigenic agent to risk-tolerant young, male users who prefer to inject or snort their drugs to get high and are willing to use more aggressive forms of diversion. Prevention and treatment approaches, and pain physicians, should benefit from these results because it is clear that not all drug abusers share the same characteristics, and the decision to use one drug over another is a complex one, which is largely attributable to individual differences (eg, personality, gender, age, and other factors).

aDepartment of Psychiatry, Washington University, St. Louis, MO 63110, USA

bCenter for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, Miami, FL 33137, USA

*Corresponding author. Address: Department of Psychiatry, Washington University, Campus Box 8134, 660 S. Euclid Avenue, St. Louis, MO 63110, USA. Tel.: +1 314 362 4516; fax: +1 314 362 5630.


Submitted May 23, 2013; revised July 11, 2013; accepted July 17, 2013.

© 2013 International Association for the Study of Pain
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