Oxycodone’s Unparalleled Addictive Potential: Is it Time for a Moratorium?

  • Daniel Remillard
  • Alan David Kaye
  • Heath McAnallyEmail author
Other Pain (A. Kaye and N. Vadivelu, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Other Pain


Purpose of Review

This study and literature review were carried out to investigate whether oxycodone is the most addictive prescription opioid.

Recent Findings

This was a cross-sectional survey from a pain management practice in south-central Alaska and review of the literature involving 86 patients diagnosed with opioid dependence/opioid use disorder from 2013 to 2018. Patients were given a list of prescription opioids and asked to identify the one (1) most desirable to themselves, (2) most desirable among drug-using associates or community, and (3) they deemed most addictive. Patients with a history of heroin use were asked which, if any, served as their gateway drug to heroin. The literature was reviewed using a PubMed search for articles containing the words “oxycodone” and “abuse,” “addiction,” “dependence,” “disorder,” and “euphoria.” Oxycodone was ranked most highly in all four questions (n = 50, 60.2%; n = 46, 75.4%; n = 38, 60.2%; n = 14, 77.8%, respectively) by a wide margin.


Numerous observational studies performed over the past few decades have demonstrated the supreme “likability” and abuse and dependence liability/addictiveness of oxycodone, with more recent mechanistic studies illuminating biological underpinnings including markedly increased active transport across the blood-brain barrier, increased phasic dopaminergism in the ventral tegmental area, nucleus accumbens and related striatal reward centers, and possibly increased kappa opioid receptor-mediated withdrawal dysphoria. Oxycodone possesses pharmacologic qualities that render it disproportionately liable to abuse and addiction and the risks of any long-term prescription outweigh the benefits.


Oxycodone Heroin Addiction Dependence Active transport Phasic dopamine 


Compliance with Ethical Standards

Conflict of Interest

Heath McAnally and Daniel Remillard declare no conflict of interest. Alan Kaye is on the speaker bureau for Merck and Depomed, Inc.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Daniel Remillard
    • 1
  • Alan David Kaye
    • 2
  • Heath McAnally
    • 1
    • 3
    Email author
  1. 1.Northern Anesthesia and Pain Medicine, LLCEagle RiverUSA
  2. 2.Department of AnesthesiologyLouisiana State University Health Sciences CenterNew OrleansUSA
  3. 3.Department of Anesthesia and Pain MedicineUniversity of Washington School of MedicineSeattleUSA

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