How is oxycodone synthesized

Though a few opioid molecules — hydrocodone e. The phrase "synthetic opioid" is considered redundant; nearly all opioids are synthesized. The pharmaceutical industry has created more than different opioid molecules. Some are widely used medically, some are not. Examples of well-known opioids used medically in the U. Both groups of drugs are "narcotics. It's most precise to refer to both groups of narcotic drugs as "opiates and opioids," the naturally derived and the synthetic.

But currently, when people wish to refer to all of these drugs, they often use the term "opioid. If a person is dependent on "addicted to" one particular opiate or opioid drug, whether it's medically prescribed or illicitly obtained, they may find that switching to a different opiate or opioid can help maintain their dependency or addiction. That is, substituting one opiate or opioid for another may help prevent withdrawal symptoms. The type of prescribers initiating oxycodone remained similar in , compared with when first reported in Figure 1: Number of oxycodone and morphine prescriptions dispensed excluding injected preparations.

There are few head-to-head trials comparing oxycodone with morphine or other opioids, yet several claims have been made about its alleged superiority, many of which are not entirely accurate.

There is no debating that oxycodone is an effective analgesic, however, there is no compelling clinical reason to choose it over morphine, and the associated risks and problems with its use, clearly place oxycodone as a second-line option.

Oxycodone is approximately 7. The stigma associated with morphine is a reason that some patients are reluctant to use it, however, the same patients are comfortable using oxycodone. When discussing appropriate analgesic treatments with patients, clinicians need to ensure that patients understand that oxycodone is used for the same purpose as morphine and is actually more potent.

All opioid analgesics including weak opioids are potentially addictive, but the marketing campaign for oxycodone promoted the belief that it had a lower addictive potential than other strong opioids.

However, the literature suggests that oxycodone actually has a higher addictive potential than morphine. A systematic review of nine randomised trials compared the likeability and likelihood of misuse of oral oxycodone, morphine and other selected opioids in recreational drug users and people with a history of opioid misuse. It was found that oxycodone was more favoured and more likely to be misused than either morphine or hydrocodone not available in New Zealand.

The addictive potential of strong opioids needs to be discussed with and understood by patients before they are prescribed. A psychological assessment of the likelihood of addiction forms part of the risk-benefit analysis for the decision to prescribe an opioid. Many clinicians have prescribed oxycodone in preference to morphine due to the belief that oxycodone is safer in patients with renal impairment.

In many cases, morphine can still be safely used in patients with renal impairment, if it is dosed carefully; use the lowest effective dose and consider the cumulative effect. Patients will have an individual response to morphine in terms of its effect on their renal function. Fentanyl is regarded as the safest strong opioid for patients with renal impairment although does have other adverse effects.

The two main metabolites of oxycodone are oxymorphone a very potent analgesic and noroxycodone a weak analgesic , which are both renally excreted. Overall, oxycodone and morphine have similar adverse event profiles that are consistent with other opioid analgesics. CYP2D6 is a highly polymorphic enzyme; gene mutations and deletions cause the enzyme to be non-functional or over-expressed.

This results in people having phenotypes for poor, intermediate, extensive or ultra-rapid metabolisers of drugs which are dependent on this enzyme. Most evidence has found that the CYP2D6 genotype does not have a significant influence on the analgesic effect of oxycodone or risk of adverse effects, but this is an ongoing area of research. It has been suggested that the high use of oxycodone is partly related to the marketing campaign for OxyContin. When Perdue Pharma introduced OxyContin to the United States in it embarked on an expensive marketing and promotion campaign.

A consistent feature of the promotion and marketing campaign for OxyContin was the minimisation of the risk of addiction, which Perdue claimed was very small, in patients with chronic non-malignant pain.

Dispensing data shows that in New Zealand, the majority of prescriptions for oxycodone are not being written by General Practitioners. Some General Practitioners feel compelled to continue this prescribing, therefore adding to the problem. Slow-release opioids should only be prescribed on discharge if the patient was already taking long-term opioids prior to their hospital admission, and their dose requirements have changed.

Patients commenced on long-term opioids in hospital for chronic pain, e. The SA Health guidelines suggest that the following points are considered when determining whether to prescribe an opioid on discharge: An additional point to consider not included in the guidelines is whether a strong opioid is still required or whether it may be more appropriate to prescribe a weaker opioid on discharge, such as codeine.

The patient should be given clear instructions on the use of analgesics they are prescribed, the adverse effects they may expect and a pain management plan. The patient should be reviewed by their General Practitioner within three to five days. The New Zealand statistics show that although the growth in oxycodone prescriptions may have slowed in recent years, prescribing rates are still very high.

The data from Canada, the USA and Australia regarding illicit use, hospitalisations and deaths as a result of oxycodone should be of great concern to New Zealand as these countries have a longer experience with oxycodone use. The overriding message is that continued high prescribing rates will eventually result in more illicit use of oxycodone, more people addicted to oxycodone, and associated downstream effects, which New Zealand is already starting to see this will be examined in further detail in the next article in this series.

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