Opioid abusers who prefer oxycodone cited the quality of the high as the primary reason behind their choice, while those who prefer hydrocodone were more likely to cite its accessibility, a new study finds.

Oxycodone and hydrocodone are the drugs of choice for a majority of opioid-dependent individuals, and a new study finds that users of the 2 drugs prefer them for different reasons. The results, published in the December 2013 issue of PAIN, suggest that a user’s gender, age, and level of pain, as well as a drug’s accessibility, formulation, and the quality of its high can all influence an opioid abuser’s decision to use 1 of the drugs over the other.
Given that oxycodone and hydrocodone are the most commonly prescribed and abused opioids, the study investigated the factors that influence opioid abusers’ choice of a primary drug of abuse and the differences between hydrocodone and oxycodone users. The researchers anonymously surveyed 3520 opioid-dependent patients aged 18 years and older entering 160 different drug treatment programs around the country as part of an ongoing national survey. Patients were asked to identify the opioid they abused most and the opioid they would prefer to use if availability and cost were not issues. Respondents were also asked why they chose these drugs over others and why they did not choose other opioids they had taken before. To supplement these answers, the study also enrolled 200 survey respondents who agreed to give up their anonymity to participate in a follow-up survey.
Of the opioid-dependent patients surveyed, almost three-fourths identified hydrocodone or oxycodone as their primary drug of abuse. Oxycodone was the most popular choice, selected by 44.7% of respondents, followed by hydrocodone, preferred by 29.4%. When patients were asked to consider an ideal world in which money and accessibility did not matter, 55.5% preferred oxycodone and 19.4% preferred hydrocodone.
Overall, 90% of respondents said that mood alteration was a motivation for their drug use. Between 50% and 60% of respondents also mentioned treatment of pain as a factor. Accessibility and quality of the high were the 2 most common reasons patients gave for using their opioid of choice, but the importance of each reason varied between hydrocodone and oxycodone users. About half of oxycodone users indicated that the quality of the high was the major reason for choosing the drug, compared with just a fifth of hydrocodone users. Hydrocodone users were more likely than oxycodone users to cite availability as the main reason for choosing the drug.
Patient characteristics also varied between hydrocodone and oxycodone abusers. Hydrocodone users were more likely to be female and to be older than 45 than were oxycodone users. Patients who used hydrocodone were also more likely to take the drug orally and less likely to inject or snort the opioid than were oxycodone users. In addition, hydrocodone users were less likely to obtain their drugs from a dealer and more likely to use or forge a doctor’s prescription to get them.
In the follow-up survey, oxycodone users said that hydrocodone produced an inferior high and that they were concerned with the safety of hydrocodone. Given that the opioid is frequently combined with acetaminophen, oxycodone users were worried about side effects and acetaminophen poisoning.
Although the results of the study indicate that the reasons for drug preference among opioid-dependent patients can be complex, the authors note that research can help guide efforts to prevent and treat opioid abuse. “Prescribing physicians should not only be aware of the potential for abuse, as many are, but that the selection of a primary drug is not a trivial concern and may determine which drug to prescribe and monitor for abuse,” they write.