RESPONSIBLE USE OF OPIOID

IN INDONESIA
HIGHLIGHT ON OXYCODONE
Dedi Susila
Mean Availability of Opioid For
Pain Management in 2001 -2003

International Narcotics Control Board (INCB)

 Mean Availability of Opioid For
Pain Management in 2011 - 2013

International Narcotics Control Board (INCB)

Mean per-Annum S-DDD and DDD use in Indonesia

International Narcotics Control Board (INCB)

INADEQUATE PAIN TREATMENT IN INDONESIA

74% of Patient suffer moderate-severe pain

but only 17% patient
Sourceget ladder
: UTOPIA 2 &Pain
Initiative, 3 painkiller
Survey, 2011-2012
Pelatihan terakhir
Yang diikuti
Impediments to the Availability of Opioid Analgesic
 The Facts
• Drug overdose death has become the leading
cause of injury death in the US
• 55,403 lethal drug overdoses reported in
2015, of which 20,101 were related to
overdose due to prescription pain
medications, and 12,990 were related to
heroin overdose
• 4 in 5 new heroin users started by abusing
prescription pain medications
1. Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 1999-2015 on CDC WONDER Online Database, released December, 2016. Available at:
http://wonder.cdc.gov/ucdicd10.html
2. Substance Abuse and Mental Health Services Administration. Key Substance Use and Mental Health Indicators in the United States: Results from the 2015 National Survey on Drug Use and Health. Online Database, released
September, 2016. Available at: https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2015/NSDUH-FFR1-2015/NSDUH-FFR1-2015.htm
3. Jones CM. Heroin use and heroin use risk behaviors among nonmedical users of prescription opioid pain relievers - United States, 2002-2004 and 2008-2010. Drug Alcohol Depend. 2013 Sep 1;132(1-2):95-100. doi:
10.1016/j.drugalcdep.2013.01.007. Epub 2013 Feb 12.
Overdose Deaths Involving Opioids
by Type of opioid
Drug Overdose Deaths in the United States
2010 - 2015
An Even Higher Opioid Overdose
Death Count, 2017
NIDA (2015). Nationwide Trends. Retrieved January 26, 2017, from https://www.drugabuse.gov/publications/drugfacts/nationwide-trends
 Prescription drug abuse
• Current trend
– Increased number of pain medications
being prescribed
– Greater social acceptance of using
medications for different purposes

• Risks include misuse, abuse, addiction, and

overdose

"Prescription Opioid Overdose Data." Centers for Disease Control and Prevention. Centers for Disease Control
and Prevention, 16 Dec. 2016. Web. 26 Jan. 2017.
• One in every four chronic users of prescription
opioids for non-cancer pain in primary care
settings are affected by addiction
• Over 1,000 people are treated in the
emergency department everyday for misusing
prescription opioids
 HEROIN ABUSE

• Heroin is a semi-synthetic
opioid with no accepted
medical use in the US
• Heroin is injected or snorted,
which enters the body and
brain very quickly to produce an
extreme high that is highly
addictive and dangerous
• In 2015, approximately 0.3
million (0.1%) people 12 years
or older were currently using
heroin

"Heroin Overdose Data." Centers for Disease Control and Prevention. Centers for Disease Control and
Prevention, 16 Dec. 2016. Web. 26 Jan. 2017.
"Today’s Heroin Epidemic Infographics." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 07 July 2015. Web. 26 Jan. 2017.
 Example: Melissa’s Story

 Melissa was prescribed Percocet following a

cesarean section
 The pills helped the pain and she began going to
urgent care doctors who prescribed opioids
leniently
 The pills became too expensive but she felt
hooked, so she began using heroin and selling
drugs to support her habit
 She then entered treatment, but the only facility is
2 hours from her home and has a 6 month waitlist
for MAT
25
 Basic Considerations For Patients
With Acute Pain

Risk of Long-Term Opioid Use

Excessive Prescription
Level of Pain
Choice of Opioid
Strategy For Pain Control
Original and reformulated
OXYNEO® tablets

37
OXYNEO® : Formulated and
Processed with Abuse
Deterrent properties
• API is dispersed within a
polyethylene oxide
(PEO) polymer matrix
• This matrix is composed
of long molecular chains
that do not readily
dissolve in water
• PEO undergoes a
manufacturing process
(pressure, heat and • Resists crushing
time) • Forms a thick gel in
• This transforms the water
molecular chains into a • This makes it difficult
firm, interlocked matrix to draw the solution
making the tablets very into a syringe for
hard injection 38
THANK YOU