Oxycodone, also known by the brand name Endone, is a potent opioid medication commonly prescribed for pain in Australia. But new evidence from an Australian study shows it’s time to rethink its use for more effective pain management and greater patient safety. Ahead of National Pain Week from 24-30 July 2023, we answer your most common oxycodone questions and talk to Professor Christine Lin about the findings of a landmark Australian study into its use.
Why is oxycodone in the news?
New evidence from an Australian peer-reviewed study, published in prestigious medical journal The Lancet, has found oxycodone is less effective at managing pain than previously thought.
“For people with acute low back pain and neck pain, taking an opioid such as oxycodone will likely not improve your pain in the short term, and you may be worse off in the long term,”
says one of the authors, Professor Christine Lin, from the Institute for Musculoskeletal Health at University of Sydney.
What is oxycodone?
Oxycodone is a pharmaceutical opioid available in various forms including tablets, capsules, liquid and suppositories. Once oxycodone enters the bloodstream, it acts as a depressant on the central nervous system.1 As a prescription medicine, it should only be taken under the guidance of a healthcare professional. Non-medical use of oxycodone, which refers to using the drug without a prescription such as taking someone else’s medication, is illegal in Australia.1
What’s the difference between oxycodone and Endone?
Oxycodone is the generic name for the opioid medication, while Endone is a brand name for a specific formulation of oxycodone which comes as 5mg tablets.2 Both terms refer to the same opioid analgesic.
What is oxycodone used for?
Traditionally, oxycodone is used for the management of moderate to severe pain that is not effectively controlled by other pain medicines such as paracetamol or ibuprofen.1
“Opioids are the most commonly prescribed pain medicine for low back pain and neck pain in Australia, but OPAL trial results show that this high use for acute low back pain and neck pain needs to be reconsidered,” Professor Lin says. “We found that there were no differences in pain reduction in the short term between people who took oxycodone and people who took placebo.”
The triple-blinded, placebo-controlled randomised trial also found even a short course of oxycodone for acute pain may be doing more harm than good due to oxycodone having a high risk of misuse, addiction and common side effects including constipation.2
What does the latest research on oxycodone mean for patients?
The OPAL trial found “opioids should not be recommended for acute non-specific low back pain or neck pain given that we found no significant difference in pain severity compared with placebo” and “calls for a change in the frequent use of opioids for these conditions”.2
While the study examined the efficacy of oxycodone for acute musculoskeletal pain, its findings support other research about its use for pain management more generally.
“For acute non-cancer pain, we are starting to see research similar to the OPAL study, that is opioids are no more effective than placebo or non-opioid medicines for relieving pain,” Professor Lin says.
Regarding oxycodone use long-term for chronic conditions, the outlook isn’t favourable either.
“In terms of other types of non-cancer pain, most of the research (broader than the OPAL study) to date is in people with chronic pain and shows that there is a small improvement in pain in the short term, but there is also an increase in adverse events,” Professor Lin says.
“We also know there are long term serious consequences with opioids, such as addiction, poisoning and death. Therefore, generally, opioids are not recommended for long-term management of chronic pain.”
What does this new research show about the risks versus benefits of using oxycodone for other kinds of pain?
“Acute pain has many different presentations,” Professor Lin says. “There might still be an indication for opioids for some types of acute pain, for example to reduce pain during or immediately after a painful procedure.”
What are the risks of using oxycodone?
Risks for oxycodone use include potential for addiction and misuse along with frequent side effects such as dizziness, tiredness, confusion, constipation, dry mouth and nausea.3
Interactions with other medicines and alcohol are also possible. Mixing oxycodone with alcohol or other drugs can have dangerous effects on the central nervous system, leading to increased sedation, respiratory depression, and potential overdose which can be fatal.1
However the greatest concern with using opioids such as oxycodone is the risk of addiction and dependence. Even when taken as prescribed, oxycodone has a high potential for addiction and dependence. Before starting any treatment with oxycodone, it’s crucial to discuss with your doctor how long you will be using it for and how any signs of physical tolerance and psychological dependence will be managed.4-5
Abrupt discontinuation of oxycodone may result in unpleasant withdrawal symptoms such as anxiety, diarrhoea, stomach cramps, and sleeping difficulties so it’s important to seek medical guidance when discontinuing the medication if you’ve been using it longer than a few days.1
How does oxycodone work?
According to the traditional approach to pain management, oxycodone works by binding to opioid receptors in the brain and spinal cord, inhibiting the transmission of pain signals and altering the perception of pain.1
While the jury is now out on whether the kind of clinical benefit associated with that mechanism of action, there’s no dispute about another way oxycodone acts in the body. Because oxycodone also activates the brain’s reward system, leading to a sense of euphoria and relaxation, it has a high potential for misuse, physical dependence and addiction.1,3-5
What strategies are likely to be more useful for patients managing pain than oxycodone?
“For acute low back pain and neck pain, most people recover well with time,” Professor Lin says. “Guidelines recommend reassuring patients that prognosis is favourable, staying active and avoiding bed rest. Heat can be helpful for temporary pain relief to help with movement. Management should focus on non-pharmacological interventions, but if pain medicines are being considered, anti-inflammatories would be the first line choice.”
Since managing pain can be complex, a multi-disciplinary approach is increasingly used for people living with chronic conditions. Some people find applying heat or ice useful or using therapies such as, meditation, physiotherapy and, if required, psychological counselling.4-5
Other than addiction what are the issues with using oxycodone long-term?
A significant risk of ongoing opioid use for chronic pain rather than briefly for new, acute pain, is that it can change the way the body responds to pain. According to HealthDirect, “long-term use of opioids can also make a person more sensitive to pain — known as ‘opioid-induced hyperalgesia’”.5
What if I’ve already been taking oxycodone long-term?
If you’ve been using oxycodone long-term for a chronic condition, it’s important to talk to your GP or a pain specialist for advice before stopping.
“Results of the OPAL study should not be generalised to people with chronic pain who have been on opioids for some time,” Professor Lin cautions. “For people who have been on opioids for some time, if you are considering coming off opioids, please seek help from your health care professionals. Coming off opioids suddenly may have unwanted effects so is not recommended. You may also need other pain management strategies to support this process.”
How can I get help with oxycodone?
For free and confidential advice about alcohol and other drug treatment services, contact the National Alcohol and Other Drug Hotline on 1800 250 015 or https://www.health.gov.au/contacts/national-alcohol-and-other-drug-hotline
REFERENCES
1. National Drug & Alcohol Research Centre. Oxycodone fact sheet [Internet]. 2023. Available from https://ndarc.med.unsw.edu.au/resource/oxycodone-0
2. Jones C M P, Day R O, Koes B W, Latimer J, Maher C G, McLachlan A J, Billot L, Shan S, Lin C-W C. Opioid analgesia for acute low back pain and neck pain (the OPAL trial): a randomised placebo-controlled trial. The Lancet [Internet]. 2023. Available from https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(23)00404-X.pdf
3. NPS Medicinewise. Consumer medicine information: Endone Oxycodone hydrochloride [Internet]. 2022. Available from https://www.nps.org.au/medicine-finder/endone-tablets
4. Alcohol and Drug Foundation. Oxycodone. December 02, 2021. Accessed June 28, 2023. https://adf.org.au/drug-facts/oxycodone/
5. HealthDirect. Chronic pain. January 2021. Accessed July 7, 2023. https://www.healthdirect.gov.au/chronic-pain
