A narcotic pain medication prescribed to treat acute pain, OxyContin is made up of the opioid drug oxycodone. Opioid drugs block pain sensations by binding to opioid receptors in the brain, slowing down functions of the central nervous system and promoting relaxation. They can also create a euphoric “high” and are often misused and abused for this purpose. Oxycodone is a semisynthetic opioid drug derived from the opium poppy plant, much like other narcotics such as morphine and codeine.
OxyContin was mass marketed by Purdue Pharma in the mid-1990s and touted as a painkiller that worked better and lasted longer than others on the market. OxyContin became one of the biggest selling pain relievers in the United States and has been blamed for inciting a painkiller abuse epidemic in America. The Los Angeles Times reports that in the last two decades of its reign, around 7 million Americans have abused OxyContin. The drug was marketed for 12-hour pain relief, and its addictive nature was downplayed, which has led to numerous lawsuits, charges, and settlements related to Purdue Pharma over the past several years.
In 2010, in response to the enormous backlash and extremely high rates of diversion and abuse of OxyContin, Purdue Pharma reformulated the drug, and the FDA approved the new abuse-deterrent formulation. The drug now turns to a gelatinous mush when crushed in an attempt to inject, snort, or smoke the resulting powder. Abuse of OxyContin in the new form is still possible, but it’s not as easy to do. Rates of OxyContin abuse did seem to drop with this safety measure, Forbes publishes; however, opioid addiction was already formed in many cases and people started turning to heroin, an illegal opiate that is often cheaper and easier to obtain.
The National Institute on Drug Abuse (NIDA) estimates that somewhere around 30 million people abuse opioid drugs globally. Opioid abuse and addiction are considered to be a major public health crisis in the United States, as the Centers for Disease Control and Prevention (CDC) warns that 91 people die from an opioid overdose daily. Deaths from prescription opioids, including oxycodone products like OxyContin, have quadrupled in America since 1999. OxyContin is an extremely potent and powerful drug that should only be taken with legitimate medical need and under the close eye of a highly trained medical professional.
Recognizing OxyContin Abuse
Taking a medication when there is no need to do so, or taking it beyond its prescribed dosage or purpose, is considered drug abuse. People may take OxyContin between prescribed doses, taking it more often than is actually necessary, when abusing the medication. An individual may continue to take OxyContin after a prescription has run out, or go to multiple doctors in a practice called “doctor shopping,” to try and get more prescriptions. Anytime the drug is taken in a way it isn’t meant to be, such as chewing it or altering it to smoke, inject, or snort it, is considered abuse.
Individuals may go to great lengths to obtain OxyContin, asking friends or relatives for it, buying it on the street, stealing it, or forging prescriptions to get it. The National Survey on Drug Use and Health (NSDUH) publishes that the majority of people who misuse prescription medications get them for free from a relative or friend, however.
Some signs of OxyContin abuse include:
- Mood swings from happy and mellow when intoxicated to depressed and irritable when “coming down”
- Extreme relaxation or sedation, sluggish movements, and slurred speech
- Impaired motor coordination and potential falls or accidents as a result
- Increased risk-taking behaviors and lowered inhibitions
- Evidence of empty pill bottles in trash, pills or pill bottles in easy-to-reach locations, and/or the presence of drug paraphernalia and white powder residue on flat surfaces, face, or clothes
- Increased secrecy
- Less concern about grades, work performance, and familial obligations
- Possible shift in personality
- Strange sleep patterns
- Appetite and weight changes
- Decreased attention to personal hygiene practices
OxyContin is also called oxy, hillbilly heroin, OC, and kicker on the street.
Abuse to Addiction
The drug labeling for OxyContin warns users of the high risk for drug dependence and addiction that can occur when taking the product even as directed with a specific and legitimate medical need. When a person takes it on a regular basis, the brain can become tolerant to its effects and more OxyContin will be needed with each dose in order for the drug to keep working as intended.
With increasing dosage and regular use, physical dependence can occur as the chemical changes that the drug makes to the brain become more pronounced. Opioid drugs like oxycodone interfere with the brain’s natural chemical messengers, or neurotransmitters. OxyContin changes the rate that some of these neurotransmitters are produced, how they are moved around the brain and central nervous system, and then how they are reabsorbed. Levels of these brain chemicals are then impacted by the presence of OxyContin. Neurotransmitters like dopamine, which plays a big role in the brain’s reward processing, learning and memory, and movement centers, are disrupted. OxyContin elevates levels of dopamine in the brain, causing the high, and when it wears off, these levels can dip drastically, impacting moods and some physical attributes. Withdrawal symptoms can start to occur in between OxyContin doses or when the drug wears off after this physical dependence has formed.
Physical dependence is often a sign of addiction, but not everyone who is dependent on OxyContin will suffer from addiction. Addiction is not only a physical brain disease, but also a behavioral disorder. When someone battles addiction, they will not be able to control how much OxyContin they take, and they will often take more of it at a time or take it for longer than they intended to. Many attempts to stop taking the drug are likely made and then unsuccessful.
A person may continue to take OxyContin in potentially hazardous situations and regardless of any potential physical, emotional, or social harm that will come from doing so. Other activities and regular obligations are set aside and left unattended to as the majority of a person’s time may now be spent obtaining, using, and recovering from the drug. Financial strain, relationship struggles, failing grades, trouble at work, physical health decline, emotional upheaval, and difficulties at home are all hazards of OxyContin abuse and addiction.
Potential Side Effects of OxyContin Use and Abuse
Abusing OxyContin has both short-term and long-term health effects and many potentially dangerous side effects. When OxyContin is taken, the central nervous system is suppressed, which means that breathing, blood pressure, heart rate, and core body temperatures are all lowered. Movements become sluggish and uncoordinated. Thinking and decision-making processes are impaired. A person is more prone to accident or injury while under the influence of OxyContin. Poor choices can include risky sexual encounters that may result in unwanted pregnancy or the contraction of sexually transmitted or infectious disease, like hepatitis and HIV/AIDS.
How the drug is abused can lead to a variety of specific health risks. For instance, snorting OxyContin can damage the nasal and sinus cavities, leading to frequent nosebleeds or a chronic runny nose, a diminished sense of smell, and respiratory infection or disease. Smoking it can damage the respiratory system, cause burns to the hands and face, and lead to a chronic cough and possible lung disease. Abusing drugs via injection can cause collapsed veins, skin abscesses or infections, cardiac complications, and an increased risk for the spread of infectious diseases. Swallowing or ingesting OxyContin may lead to gastrointestinal problems and/or stomach ulcers.
OxyContin interferes with cardiac, gastrointestinal, and respiratory functions, and prolonged use or abuse can damage these systems. The immune system may be negatively impacted by long-term abuse of OxyContin as can the musculoskeletal, endocrine, and central nervous systems, the Primary Care Companion for CNS Disorders reports.
More than 150,000 people in the United States received emergency medical care in an emergency department (ED) for a negative reaction to the abuse of an oxycodone product in 2011, the Drug Abuse Warning Network (DAWN) publishes. Constipation, sedation, increased rate of fractures, intestinal blockage, risk of overdose, and addiction are all possible side effects of OxyContin abuse, and the risks go up with elevated doses and prolonged use. The longer and more often a person takes or abuses OxyContin, the higher the risk for addiction as well.
The American Society of Addiction Medicine (ASAM) publishes that around 2 million Americans battled prescription opioid painkiller addiction in 2015. Genetics, biological and environmental factors, polydrug abuse, and any potential underlying co-occurring mental or medical disorders can all contribute to a higher risk for addiction.
One of the biggest potential risks of OxyContin abuse is fatal overdose. Since OxyContin slows down the central nervous system, an overdose can cause a person to stop breathing and the heart and cardiovascular system to not work properly. In 2015, the Chicago Tribune publishes that prescription opioids such as OxyContin caused nearly 20,000 American deaths, as drug overdose fatalities rose to an all-time high in the United States, surpassing car crashes and remaining the number one cause of accidental death.
An opioid overdose is recognizable by the following signs:
- Difficulty breathing
- Skin that is cold and clammy to the touch
- Bluish tinge to nailbeds, lips, and skin
- Slow pulse
- Nausea and/or vomiting
- Pinpoint pupils
- Uncoordinated movements
- Mental confusion
- Sedation, loss of consciousness, or even possible coma
An OxyContin overdose can be reversed if swift medical attention is received. The opioid antagonist Narcan (naloxone) can be administered to block the opioids from the receptors in the brain and help to overturn their side effects. If the brain is deprived of oxygen for too long, however, brain damage or even death may occur. Overdose risks are increased in those who have a history of addiction or overdose, have respiratory system issues, and those who use or abuse other central nervous system depressants at the same time (like benzodiazepines or alcohol, for instance), the New England Journal of Medicine (NEJM) warns.
Method of abuse, amount used, and the frequency and duration of use can increase the odds for a life-threatening overdose. OxyContin is often formulated as an extended-release pain medication and if the drug is altered to be abused (e.g., by chewing it or by crushing it to then inject, snort, or smoke), the slow-release format is bypassed and the whole dosage is introduced into the system at once. This can have disastrous and tragic effects quickly, leading to a toxic overwhelming of the body and to overdose. If overdose is suspected, immediate medical care should be sought as many first responders carry the overdose-reversal drug and can provide prompt care.
Drug Dependence and OxyContin Withdrawal
OxyContin can be habit-forming when taken as directed and also when it is abused. Physical dependence can be formed rather quickly as brain chemistry and circuitry is impacted by the drug. OxyContin should not be stopped suddenly as dependence can lead to significant withdrawal when the drug wears off. Instead, opioid drugs are often slowly tapered, or weaned, off in a controlled fashion in order to minimize withdrawal.
Withdrawal from OxyContin can start within 12 hours of the last dose and can be both physically and emotionally intense. The National Library of Medicine (NLM) reports that the following are common side effects of opioid withdrawal:
- Runny nose
- Increased tearing
- Agitation and irritability
- Muscle, back, and joint pain
- Nausea and stomach upset, including possible vomiting and diarrhea
- Dilated pupils
Acute withdrawal usually peaks in the first 2-3 days, and then, the symptoms generally begin to subside. Low mood, sleep disturbances, and cravings may last a little longer. The duration of withdrawal is typically around 7-10 days with protracted withdrawal symptoms lasting a few weeks to months when dependence is pronounced. OxyContin withdrawal often mirrors a bad case of the flu physically; emotionally, cravings, depressed moods, and cognitive deficits are often significant. These side effects are not usually life-threatening, but they can be severe enough to entice a person to keep using the drug, resulting in relapse or even a potential overdose.
Treatment Options for OxyContin Addiction
Since OxyContin withdrawal can be so uncomfortable, medical detox is considered the optimal method for safely allowing the drug to process out of the body. During detox, OxyContin can be slowly tapered off or replaced with another longer-acting opioid, such as methadone or buprenorphine. These replacement medications may be used both during detox and during opioid addiction treatment to mitigate cravings and promote further abstinence. Combination medications containing the opioid agonist naloxone, as well as the partial agonist buprenorphine, are used later in treatment to enhance compliance; if the drug is altered for abuse, it can precipitate uncomfortable withdrawal symptoms.
In a medical detox program, vital signs can be closely monitored and other medications may be used to reduce specific physical or psychological symptoms of withdrawal. Detox typically lasts about 5-7 days and is optimally carried out in a specialized facility that can provide care 24/7.
After OxyContin processes out of the body in detox and physical stability is reached, the other facets of the disease of addiction can be managed. OxyContin addiction is ideally treated with a complete treatment program that will include behavioral therapies, counseling, educational programs, support group meetings, relapse prevention tools, aftercare programs, and adjunctive therapies and options.
NIDA recommends at least 90 days in a treatment program that may be either inpatient or outpatient. Inpatient programs are generally considered to be more comprehensive as the person can be attended to around the clock. Schedules are structured, and mealtimes, meetings, sessions, life skills trainings, and workshops are all built in. This type of program can allow time for the brain to heal and for healthy habits to be formed and practiced in a safe environment.
Behavioral therapies serve to help individuals identify negative and potentially destructive thoughts and habits as well as possible triggers for drug abuse and relapse. A person can learn how to properly manage stress and reduce cravings during group and individual sessions. Families can join in with therapy sessions as well and work together as a unit to improve communication as a whole.
Opiate addiction is a disease that can encompass a wide range of behavioral, social, emotional, and physical attributes, and treatment should therefore be wide-ranging. With comprehensive help, individuals can stop all abuse of OxyContin and embrace a stable life in recovery.