Question 6: Are the clinical benefits of oxycodone associated with its appeal to illicit users?

Raymond Sinatra, MD: Neil, I don't know about you, but in my practice one of the reasons I select an opioid is for its safety, but also for its efficacy. And one of the advantages I've noticed with oxycodone is a more rapid onset, more predictable onset to peak effect than morphine preparations. This is an important benefit for clinical efficacy in chronic pain. But I'm just thinking that maybe that high oral bioavailability ... again, oxycodone has among the highest oral bioavailability of any opioid ... correct me if I'm wrong ... might make it a drug that could be as Jean said, you know, it's like a lot of Percocet all at once. It might make it a drug that is going to be very desirable for its buzz and its euphoric effect. Have you found that to be the case both in using it clinically in pain and do you speculate that could be part of the reason why it's the drug of choice or one of the drugs of choice for diversion abuse?

Neil Jobalia, MD: I'm not sure ... again, as with the other panelists, I have a scientific answer for that. And in my experience however it seems that all the opioids are relatively equal except for the fact that maybe the side effect profile of OxyContin in my opinion and my experience being more favorable for patients. Maybe that's ... you know, would explain why people get more positive and less negative effects from the drug oxycodone. So I don't know if that's really the reason for it or not. I know in my practice it is better tolerated as far as side effects go or unpleasant ... even unpleasant effects, not necessarily side effects. So maybe there is some explanation for that. I still wonder if this is not something that because of the ... I guess the numbers, and I don't know what they are specifically, but the numbers of prescriptions written for OxyContin maybe versus MS-Contin or Kadian, Duragesic, this is the first introduction to the long acting opioid that the diversion population has come to. And if this is taken off the market, which I would like to also go on the record that I completely disagree with, once this is gone they will have that class of drugs as an option and I think they'll just start exploring other drugs in that class.