Challenges of the Oxycodone Hydrochloride Shortage

Objectives: To evaluate the clinical impact and treatment adaptations during the immediate-release oxycodone hydrochloride shortage. Methods: This retrospective, observational study was conducted during the oxycodone shortage period (May 2024-March 2025) in patients with cancer pain. Pain intensity was assessed using the Numerical Rating Scale (NRS) at baseline (prior to switching, while receiving oxycodone) and at follow-up (after switching to alternative analgesics). Changes in pain intensity were evaluated using within-patient differences (ΔNRS), with clinically meaningful worsening defined as an increase of ≥2 points. Descriptive and inferential statistics were used to summarize patient characteristics and outcomes. Results: Of 300 patients screened, 55 met inclusion criteria (mean age 65.2 ± 11.0 years; 63.6% male). Pain intensity increased significantly following treatment modification during the period of oxycodone unavailability, with mean NRS scores rising from 4.3 ± 1.7 to 5.9 ± 2.5 (p < 0.001). The mean ΔNRS was +1.56 (95% CI 0.79-2.34), with clinically meaningful worsening observed in 36 patients (65.5%). No statistically significant association was observed between substitute analgesic type and clinically meaningful worsening (p = 0.11). Conclusions: The oxycodone shortage was associated with worsened pain control and increased need for treatment modifications in cancer patients, highlighting the importance of uninterrupted access to essential opioids.