OxyContin Addiction and Abuse

How to Protect Your Loved Ones

OxyContin Addiction and Abuse

How to Protect Your Loved Ones?

Introduction

Do you know the US is the world’s biggest consumer of prescription opioids? Prescriptions for opioids, including OxyContin, soared from 76 million in 1991 to almost 207 million in 2013.1 According to the Centers for Disease Control and Prevention (CDC), there were over 191 million opioid prescriptions in 2017.2

Oxycodone, the active ingredient in OxyContin, ranks among the top 4 most frequently prescribed opioids. The others are hydrocodone (Vicodin), codeine, and morphine. In 2013, Americans consumed 81% of the world’s total oxycodone.1 There were 7.2 million prescriptions for oxycodone-only products in 2000. Among them, about 6 million were for OxyContin.3

In 2016, the number of oxycodone prescriptions reached 60.1 million. However, the number dropped to 55.2 million in 2017. During the first six months of 2018, the number of prescriptions was 22 million.4

What is OxyContin?

OxyContin is the brand name of an opioid (narcotic) pain medication called oxycodone. It is a prescription drug. This means you cannot get it without a doctor’s prescription. OxyContin is available in the form of extended-release tablets.

Each tablet contains 10 to 80 mg of the drug. The effects of the drug usually become apparent in 20 to 30 minutes and last about 12 hours. Doctors prescribe OxyContin to treat long-term moderate-to-severe pain resulting from injuries, arthritis, cancer, and other conditions.

OxyContin’s History in the US: Journey from a Blockbuster Drug to a Killer

1995

The US FDA approved OxyContin for the treatment of long-lasting moderate-to-severe pain.

1996

Purdue Pharma marketed the drug as a less addictive alternative for moderate-to-severe pain.

1996-2000

Annual sales ballooned from $48 million in 1996 to more than $1 billion in 2000.

2004

OxyContin was one of the leading drugs of abuse by the end of the year.

2007

Purdue was fined $600 million for misinforming consumers, falsely claiming that OxyContin had lower addiction potential than other similar medications.

2010

Purdue introduced new hard-to-crush (abuse deterrent) pills. Surprisingly, one study revealed that abuse-deterrent OxyContin has directly cause a surge in the spread of hepatitis C.5

2019

Purdue Pharma filed for bankruptcy and offered more than $10 billion to settle thousands of lawsuits against the company. To date, OxyContin sales have generated more than $35 billion.

OxyContin Class

Oxycodone, the drug in OxyContin, is a member of the opioid (narcotic) class of pain medications. Opioids are powerful pain medications. They relieve pain by blocking pain signals in the brain cells. Moreover, they enhance feeling of well-being and calm.

Examples of drugs in the opioid class are:

Fentayl citrate (Actiq, Fentora, Abstral) 

Hydrocodone + Acetaminophen (Vicodin, Norco, Lorcet) 

Oxymorphone Hydrochloride (Opana)

Methadone (Methadose) 

Where is OxyContin on the Schedule?

OxyContin is a Schedule II Controlled Substance. Drugs in Schedule II have FDA-approved medical uses. However, they also have high abuse potential, so they can cause severe physiological and psychological dependence, especially if they are not used properly.

Other opioids in Schedule II are hydromorphone (Dilaudid), methadone (Dolophine), meperidine (Demerol), morphine, and codeine.

Street Names of OxyContin

Hillbilly heroin

Oxycet

OxyCotton

OC

OX

Oxy

Kicker

Killer

Oxy80

Is OxyContin Addictive?

Understanding the Difference between Tolerance, Abuse, Dependence, and Addiction

All opioid medications, including OxyContin, are addictive. OxyContin increases the release of a brain chemical known as dopamine. Increased dopamine levels in the brain provide feelings of well-being and reward. Certain brain areas record these feelings and cause cravings when drug use stops.

Tolerance

Repeated OxyContin use can cause tolerance. Tolerance occurs when larger doses are required to induce the effects formerly caused by smaller doses. Stopping drug use can cause many undesirable effects known as withdrawal symptoms. Tolerance is not the same thing as addiction. However, drugs that cause tolerance can be addictive. Moreover, only those who have developed tolerance experience withdrawal symptoms.

Abuse

OxyContin abuse refers to using the medication in a way that was not recommended by a doctor. Using a friend’s medication or snorting medication to get high or to get a buzz is called abuse. Long-term abuse can lead to dependence and addiction. People may abuse prescription medications like OxyContin to:

Feel better

Relieve stress

Deal with low moods

Prevent withdrawal

Fit in with a friend or a social circle

Dependence

Drug dependence occurs when the person who is taking the drug becomes unable to function normally without taking the drug. Dependence can be physical or psychological. Strong drugs such as OxyContin cause both physical and psychological dependence.

Addiction

Addiction is a long-term medical disorder. It is characterized by an ongoing and compulsive pattern of drug use. A person who has an addiction continues to use a drug despite the known hazards of use. Luckily, addiction is treatable, and timely treatment can lead to complete recovery.

How to Know if Someone is Addicted to OxyContin

The signs and symptoms of OxyContin addiction can include:

Taking larger doses, or taking doses more frequently, than a doctor recommended

Loss of ability to control drug use behavior

Inability to function normally without taking the drug

Spending too much time and money to obtain the drug

Poor performance at work or college

Developing tolerance 

The physical signs and symptoms of OxyContin abuse and addiction can include:

Reduced grequency of bowel mobements (constipation)

Itching 

Increased sweating

Reduced appetite

Nausea and vomiting 

Weakness 

Headaches 

Mental confusion 

Sleep problems 

Anxiety and depression 

Increased irritability 

Hallucinations 

Decreased breathing rates

Drowsiness 

Changes In Addiction Rates

The rate of OxyContin abuse dropped by almost half to 2.3% in 2018 from 5.5% in 2005.6 In 2018, 0.80% 8th graders, 2.20% 10th graders, and 2.30% 12th graders reported abusing the drug in the past year.7

How Should OxyContin be Taken?

The correct way to use OxyContin is to swallow the entire tablet. Doctors recommend taking a tablet every 12 hours with or without food. If you have not used oxycodone in the past, you should not take more than 40 mg in a single dose.

How is it Abused?

Because the tablets are easy to crush, OxyContin is frequently abused. People with substance use disorders abuse the drug in various ways, such as:

Some people chew the tablets to break the thin layer on a tablet and releases large amounts of the drug into the bloodstream.

Snorting the powdered drug is the most common method of abuse. The snorted drug reaches the bloodstream within 5 minutes after use. Snorting puts a greater amount of the drug into the bloodstream compared to swallowing.

Injecting drugs significantly increases the risks of many potentially fatal diseases, such as heatitis and HIV/AIDS. Injecting a solution prepared from the powdered drug causes rapid absorption of the drug into the bloodstream and immediate effects. 

How People Get Illegal OxyContin

The average daily dose of OxyContin is in the range of 180 mg. Someone may illegally obtain the drug through:

  • Pharmacy diversion – involves the illegal purchase of the drug from pharmacy workers
  • Doctor shopping – involves visiting more than one doctor to obtain multiple prescriptions
  • Using fake prescriptions or altering a prescription
  • Pharmacy burglaries

Is OxyContin Safe?

A drug is considered safe after it has obtained FDA approval. The FDA approves new products/formulations/uses only after reviewing their safety and effectiveness. Drugs that pass several tests in animals and humans become available for marketing. However, the FDA has a limited role in monitoring the promotion of controlled substances.

For long-term back pain and cancer pain, OxyContin showed comparable safety and efficacy to other opioids such as morphine. Nonetheless, aggressive promotional activities by Purdue Pharma led to its overprescription. As a result, its availability increased in many regions of the US. Several studies suggest a direct link between increased availability and higher abuse rates.

The National Institute on Drug Abuse (NIDA) states that OxyContin can be safely used to treat pain.8 People who use the drug may become dependent. However, dependence alone does not lead to addiction. Patients can beat dependence by gradually decreasing the dose under medical supervision.

The bottom line is that OxyContin’s benefits for treating severe pain are greater than the risks of addiction.

Patients, as well as doctors, have a critical role in ensuring drug safety. This means an FDA-approved drug is safe only if it is used properly.

Effects

What are the Short-term Effects of OxyContin?

The short-term effects of OxyContin abuse can include:

  • Enhanced sense of well-being and pleasure
  • Slowed breathing
  • Nausea and vomiting
  • Constipation

Long-term Effects of OxyContin

Prolonged use of the drug can cause:

  • Addiction
  • Dependence
  • Tolerance
  • Heart infection
  • Lung infection
  • Muscle pain
  • Sleep problems
  • Breathing difficulties
  • Bone loss and brittle bones
  • Reduced sex drive
  • Impotence
  • Hot flushes
  • Increased pain sensations
  • Weakened immune system
  • Tooth decay due to decreased salivation
  • Emotional numbness
  • Kidney diseases
  • Liver damage
  • Coma
  • Death

Overdose

What Causes an OxyContin Overdose?

An overdose may occur if the drug is taken:

At a dose higher than the doctor recommended. Experts believe that even a single dose can cause death if its not taken properly. 

In ways other than those recommended by a physician. For example, OxyContin should always be swalled whole. Swallowing a crushed tablet can cause death.

For longer than recommended. 

More often than recommended.

Along with other drugs (see next section).

Important Numbers on Overdose Deaths

Oxycodone, methadone, and hydrocodone are the top three drugs involved in prescription opioid overdose deaths.9 In 2002, there were 464 deaths involving OxyContin overdoses. In 2005, about 42,810 emergency department visits involved oxycodone.10

The states with the highest numbers of deaths involving OxyContin are Kentucky, Ohio, Virginia, and West Virginia.11

People often use OxyContin with other drugs. Among overdose deaths, more than 96% involved cocaine, alcohol, antidepressants, and benzodiazepines.10 Thus, it is difficult to pinpoint the cause of death.

The number of emergency department visits due to the abuse of extended-release oxycodone products such as OxyContin is almost four times that of visits due to the release of immediate-release products (Oxaydo, Roxicodone, and Roxybond).12 The OxyContin 40-mg tablet is the most in-demand oxycodone product among users. The average street price of a 40-mg tablet is $40.4

Signs and Symptoms of Overdose

  • Reduced breathing rate
  • Abnormally small pupils (miosis)
  • Low body temperature (less than 95 F or 35 C)
  • Slow heart rate
  • Low blood pressure
  • Mental confusion
  • Memory problems
  • Impaired judgment

Bystander Response to an OxyContin Overdose

In the event of an overdose, bystanders should immediately call the poison control helpline at 1-800-222-1222. Relevant information is available online at https://www.poisonhelp.org/help.

Call emergency services at 911 if a person has:

  • Lost consciousness
  • Seizures
  • Breathing problems
  • Problems regaining consciousness

Professional Treatment of an OxyContin Overdose

An overdose death usually occurs due to slowed or stopped breathing. Thus, monitoring breathing is critical to reducing the risk of overdose-related deaths. Moreover, a doctor also monitors blood pressure, pulse, and body temperature.

In the meantime, they can order blood and urine tests. These tests help detect other drugs in the body and the levels of electrolytes. A CT scan and an ECG may be necessary to monitor the functions of the heart and other vital organs.

Treatments can include:

Naloxone – An antidote for oxycodone overdose is available. This is known as naloxone (Narcan or Evzio). Naloxone can reverse the effects of an opioid overdose. A health care professional can inject naloxone into a vein or under the skin. Narcan is a nasal spray that can be used by anyone, which also reverses the effect of opiates.

Activated charcoal – Activated charcoal can help reduce the absorption of oxycodone into the bloodstream. It may be of use if someone has swallowed the drug. However, using activated charcoal is not recommended if a person reaches the hospital more than one hour after swallowing the drug.

Laxatives – Using laxatives can enhance drug removal through stools. Both activated charcoal and laxatives are used only if breathing rates are not too low.

Ventilator – If the breathing rates are too low, a person may need to use a machine (ventilator) to support breathing.

When To Stop Using OxyContin

Doctors decide when patients should stop using OxyContin or any other opioid. Patients who decide to stop on their own may experience withdrawal symptoms. The symptoms are more likely to be severe for those who suddenly stop taking the drug. Such sudden stopping can also increase pain.

The CDC recommends the following steps for patients to help ensure the safe and effective use of opioids:13

Consulting with a doctor about other pain medications that may be effective. 

Visiting a doctor regularly and discussing when the drug can be discontinued or the dosage reduced. For addictive medications like opioids, the dose may be decreased gradually. This is known as tapering. 

Talking to a doctor immediately about any severe or persistent side effects. 

Taking the drug in the recommended doses, at the recommended requency, for the recommended duration. 

Avoiding sharing the drug.

Never using the drug with alcohol or medications such as benzodiazepines (Xanax and Valium), muscle relaxants (Soma or Flexeril), and sleeping pills (Ambien or Lunesta).

Properly dispose of any unused medications through a Drug take back program or other approved disposal method to prevent use or abuse by friends or family.

What is Withdrawal from OxyContin Like?

Reducing the dose or stopping the drug after two or more weeks of use can cause many withdrawal symptoms. Notably, the symptoms are more severe if the drug is discontinued suddenly. Most people experience withdrawal symptoms within 6 to 12 hours after the last use.

Early symptoms of withdrawal include:

  • Agitation
  • Increased anxiety
  • Muscle aches
  • Increased production of tears
  • Inability to fall or stay asleep
  • Excessive nasal drainage
  • Sweating
  • Yawning

Late symptoms of withdrawal include

  • Stomach aches
  • Diarrhea
  • Dilated pupils
  • Goosebumps
  • Nausea
  • Vomiting

How Long Does Oxycodone Stay Detectable In The Body?

A drug’s half-life is the time it takes to remove half of the drug (in the bloodstream) from the body. Usually, a drug is no longer detectable in a blood sample after five half-lives.

Oxycodone (in extended-release formulations) has a half-life of about 5 hours. This means that blood will not contain detectable amounts of the drug 25 hours after ingestion. Nonetheless, hair, urine, or saliva may contain detectable amounts of the drug for longer periods.

Below are the estimated detection times for oxycodone in different types of samples.

  • Saliva – 24 to 96 hours after the last dose
  • Urine – 72 to 96 hours after the last dose
  • Hair – Up to 3 months after the last dose

Several factors can affect how long a drug remains detectable. These include age, gender, liver and kidney disorders, duration of drug use, and the amount taken.

Treatment for OxyContin Abuse and Addiction

Aggressive treatment may be necessary in most cases. This is critical to preventing relapse and treating co-occurring mental illness. Depression is a common finding in people who abuse OxyContin.

Drug abuse may be the cause or result of depression. OxyContin can cause depressive symptoms in some people. Likewise, people with depression may abuse drugs, including opioids. For this reason, treating any underlying mental illness is an indispensable part of drug abuse treatment.

Treatments can include:

Medications

These include methadone, buprenorphine, and naltrexone. Methadone and buprenorphine act on the brain areas involved in oxycodone addiction. They help to decrease cravings and relieve withdrawal symptoms. Depending on the severity of the addiction, patients may need to use these medications for several months or years.

Naltrexone blocks the effects of opioids on the brain. Thus it helps prevent relapse. That said, it does not help with cravings or withdrawal symptoms. Patients can start naltrexone therapy only after 7 to 10 days without using any opioids.

Counseling and Behavioral Therapies

Cognitive-behavioral therapy (CBT) is usually the most effective non-drug treatment for oxycodone addiction. CBT helps identify and correct problematic thoughts responsible for addictive behaviors, and it also teaches coping skills for dealing with stressors. CBT sessions may be conducted in individual or group settings.

Other therapies, such as motivational enhancement therapy (MET) and contingency management (CM), may be used. MET helps someone who has developed a substance abuse disorder to stay motivated during treatment. CM provides incentives for sticking to a treatment plan.

Medication-Assisted Therapy (MAT)

MAT combines medications, counseling, and behavioral approaches. The combination is usually more effective than any single approach in increasing the odds of successful recovery.

People with co-occurring mental illness may need treatment at an inpatient psychiatric facility. Long-term follow-ups are essential to sustain benefits and prevent relapse. Treatment at a residential or an outpatient facility lasts at least nine months. If a person is undergoing methadone maintenance, treatment typically lasts one year or longer.


Resources

  1. Volkow, Nora D., “America’s Addiction to Opioids: Heroin and Prescription Drug Abuse,” presented to the Senate Caucus on International Narcotics Control, May 14, 2014.
  2. Centers for Disease Control and Prevention’s U.S. Opioid Prescribing Rate Maps
  3. Debra A. Katz and Lon R. Hays, “Adolescent OxyContin Abuse,” Journal of the American Academy of Child and Adolescent Psychiatry, Vol. 42, Issue 2, February 2004, pp 231-34.
  4. Drug Enforcement Administration, “Oxycodone,” July 2019.
  5. David Powell, Abby Alpert, and Raslie L. Pacula, “A Transitioning Epidemic: How The Opioid Crisis Is Driving The Rise In Hepatitis C,” Health Affairs, ˆVol. 38, no. 2, February 2019.
  6. Sarah Bagley, “Opioids and Adolescents,” HHS.gov.
  7. National Institute on Drug Abuse. Opioids. Monitoring the Future Study: Trends in Prevalence of Various Drugs for 8th Graders, 10th Graders, and 12th Graders; 2018.”
  8. DHS Substance Abuse Treatment Advisory. OxyContin: Prescription Drug Abuse-2008 Revision.
  9. Centers for Disease Control and Prevention. Overdose Death Maps. Overdose Deaths Involving Prescription Opioids.
  10. CT Aquina, A.Marques-Baptista, P. Bridgeman, and M.A.Merlin, “OxyContin abuse and overdose,” Postgraduate Medicine, 121(2): pp 163-167, March 2009.
  11. National Drug Intelligence Center, “OxyContin Diversion and Abuse,” January 2001. 
  12. Dr. M. R. Lofwall MD, Dr. D. E. Moody, PhD, Dr. W. B. Fang, PhD, Mr. P. A. Nuzzo MA, and Dr. S. L. Walsh, PhD. “Pharmacokinetics of Intranasal Crushed OxyContin and Intravenous Oxycodone in Nondependent Prescription Opioid Abusers,” Journal of Clinical Pharmacology, March 7, 2013.
  13. Centers for Disease Control and Prevention. “Prevent Opioid Misuse.”