Opioid prescription pain relievers are some of the most widely used drugs in the United States, as the Centers for Disease Control and Prevention (CDC) reports that analgesics are one of the most prescribed therapeutic drug classes. Opioid analgesics block pain sensations, enhance moods, and suppress some of the autonomic functions of the central nervous system, such as respiration, body temperature, heart rate, and blood pressure. These drugs work by filling opioid receptors in the brain and along the central nervous system, thus increasing pleasure while decreasing anxiety and stress. They are commonly abused and considered to be highly addictive.
OxyContin is a 12-hour formulation of the opioid drug oxycodone, and prescribed to treat chronic pain on a continual basis. As a Schedule II controlled substance, the Drug Enforcement Administration (DEA) classifies it as one of the most tightly controlled substances with an accepted medical use in the United States. It is related to the illegal opioid drug heroin, which is a Schedule I drug.
OxyContin is known by a variety of slang names, such as hillbilly heroin, oxy, OC, ox, and kicker. It is abused orally via ingesting too much of the drug, chewing and then swallowing the pills, or heating and then inhaling the drug. It also may be crushed and then dissolved in liquid to be injected and used intravenously (IV). In addition, the pills are sometimes crushed to be snorted. After alcohol and marijuana, prescription and over-the-counter (OTC) drugs are some of the most regularly abused substances by Americans aged 14 and older, the National Institute on Drug Abuse (NIDA) publishes.
The Rise and Fall of OxyContin Abuse
OxyContin was first released in 1996 as an answer for long-term pain relief, and it quickly became the number one selling prescription painkiller in the United States, the LA Times reports. In 1998, the makers of OxyContin, Purdue Pharma, released a video touting the long-reaching benefits of the drug on chronic and extended pain, and as a result, the number of opioid painkiller prescriptions jumped from 8 million in 1996 to 11 million within a year after the video was released, CNN reports. Sales of OxyContin skyrocketed from $48 million in 1996 to $1.1 billion by the year 2000, the American Journal of Public Health publishes.
As with other addictive and mind-altering drugs, however, with increased availability and more prescriptions being dispensed come higher abuse rates. OxyContin abuse rose quickly in the early years, rising 40 percent for 12th graders from 2002 to 2005 until one in every 20 high school seniors reported abusing the drug at least once, NPR publishes. The American Journal of Public Health reports that by 2004, OxyContin was one of the number one drugs of abuse in the United States.
In 2010, in an attempt to stop people from crushing OxyContin tablets and then snorting or injecting the powder, Purdue Pharma reformulated the drug, creating a supposed “abuse-deterrent” formulation that turned to mush when crushed, CNN publishes. The effort was somewhat successful in that abuse rates dropped from 35.6 percent to 12.8 percent in the following 21 months, the New England Journal of Medicine (NEJM) found. While nearly a quarter of those abusing it still found a way around the new formulation, 66 percent switched to another opioid (namely heroin), NEJM further publishes.
The opioid abuse epidemic is still raging today, as the National Survey on Drug Use and Health (NSDUH) reports that 4.3 million Americans (over the age of 11) abused a prescription painkiller at the time of the 2014 survey. The 2015 Monitoring the Future (MTF) survey published by NIDA shows that almost 4 percent of 12th graders reported past-year OxyContin abuse. NSDUH indicates that opioid prescription pain relievers are most often abused by those between the ages of 18 and 25, although this class of drugs is abused by virtually all age demographics.
The LA Times publishes that in the past two decades, around 7 million adults in the United States have abused OxyContin at some point in their lifetime. Addiction rates for opioid drugs are rather high as well, as the American Society of Addiction Medicine (ASAM) reports that over 2.5 million Americans suffered from an opioid use disorder in 2014.
Short-term Effects of OxyContin Abuse
OxyContin disrupts brain chemicals, stopping the transmission of pain signals and elevating levels of dopamine (which signals pleasure). While taking OxyContin, a person may become drowsy or dizzy; feel lightheaded; suffer from impaired cognitive abilities; make poor decisions; become constipated or nauseous; have headaches, dry mouth, and chest pain; and breathing may be labored. Individuals may be more likely to take unnecessary risks and therefore suffer an accident or get into trouble with the law.
Taking too much of the drug at one time, altering the drug to bypass its extended-release format and thus sending the whole dosage into the body at once, or abusing OxyContin with other drugs or alcohol can potentially lead to a life-threatening overdose. The CDC calls opioid overdoses an epidemic, as the death toll has risen 200 percent from 2000 to 2014 within the United States. OxyContin and other opioid pain relievers are involved in three-quarters of all drug overdose deaths, USA Today publishes.
OxyContin overdoses are usually caused by impaired respiration rates wherein the individual forgets to breath. A bluish tinge to nail beds, lips, or skin; clammy and cold skin; significant confusion; seizures; loss of consciousness or extreme drowsiness; nausea and vomiting; weak heart rate and pulse; and trouble breathing are all signs of an opioid overdose. An overdose is not always fatal. The Drug Abuse Warning Network (DAWN) reports that in 2011 almost half of all medical emergencies treated in emergency department (EDs) for the misuse of a pharmaceutical drug involved prescription painkillers and a little over 12 percent involved oxycodone directly.
How someone abuses OxyContin can cause variable risk factors as well:
- Swallowing: gastrointestinal issues and potential intestinal obstruction
- Injection: collapsed veins, skin infections, “track marks” or scars at injection site, increased risk for contracting infectious disease when sharing dirty needles
- Snorting: chronic nosebleeds, runny nose, damage to nasal passage and sinus cavities
- Smoking or inhaling: respiratory infections, chronic cough, burns on face and hands
Hazards of Perpetuated OxyContin Abuse
Long-term abuse of OxyContin is most often associated with drug dependence and addiction. Even when taking the drug exactly as prescribed and with a legitimate medical need, it can still lead to dependence. Over a quarter of those taking an opioid drug for relief of chronic and non-cancer pain may be dependent on them, CNN reports.
Taking OxyContin for a period of days or weeks can cause drug tolerance and possibly physical dependence on the drug, Purdue Pharma warns in the prescribing information.
Tolerance is when the drug stops working to block pain when used licitly, or stops inducing the same “high” when being used recreationally, and more OxyContin is needed each dose.
This may encourage a person to up the dosage and heighten the risk for overdose and other adverse side effects. It can also hasten the development of a physical dependence, which occurs as the brain chemistry that is altered by OxyContin use leads to alterations in the way these chemical messengers are transmitted, reabsorbed, and even produced. The brain may rely on OxyContin at this point to function in the way it now perceives as “normal.”
A physical dependence on OxyContin is best recognized by drug cravings and withdrawal symptoms when the drug wears off. These withdrawal symptoms can be intense, and both physical and emotional in nature. The central nervous system, which is suppressed by OxyContin, may become hyperactive during withdrawal as the drug is removed. Physical dependence can occur with both licit use and due to abuse of OxyContin. The significance of the withdrawal syndrome indicates that this drug should not be stopped “cold turkey” and without professional help.
Physical drug dependence, tolerance, and withdrawal symptoms are some of the signs of addiction, although a person may become tolerant and dependent on OxyContin without being addicted to it. Addiction is more than just physical dependence. It requires behavioral and emotional changes as well, leading to a loss of control over drug use. Signs of addiction may include:
- Taking higher doses of the drug, or taking it for a longer time, than initially intended
- Multiple unsuccessful attempts to stop using OxyContin
- Drug cravings
- Obsession with finding where to get the next dose of OxyContin
- Potential “doctor shopping” or going to more than one doctor for a prescription; taking the medication after it is no longer needed; inventing symptoms to try and get prescriptions of OxyContin; or begging, borrowing, or stealing medication from friends or loved ones
- Possible financial or legal trouble related to drug use
- Increasing the dosage of OxyContin or altering it
- Presence of drug paraphernalia (e.g., shoelaces, syringes, rubber tubing, empty pill bottles, straws, rolled-up dollar bills, mirrors, powder residue, etc.)
- Taking more risks than usual or out-of-character behaviors
- Mood swings
- Weight loss and altered appetite levels
- Irregular sleeping habits
- Continued use of the drug with the knowledge that it has many negative side effects
- Increased secrecy and time spent online in drug forums or chat rooms
- Changes in social circle, and withdrawal from friends and family
- Disinterest in hobbies, activities, or recreational events that used to be important
- Inability to rely on the person to fulfill regular obligations
- Increased absences at work and/or school and drop in production, output and/or grades as a result
- Decline in physical appearance
- Shift in personality, increased hostility, irritability, and potentially aggression
Managing OxyContin Withdrawal
Since opioid withdrawal can be relatively intense, medical professionals recommend slowly lowering the dosage of OxyContin over a period of time when attempting to stop taking it, instead of stopping its use suddenly. This is called “weaning” off the drug in this tapered approach.
The US Food and Drug Administration (FDA) warns individuals to not stop taking OxyContin without first communicating with a healthcare provider. Detox remove toxins from the bloodstream. Once a physical dependence has set in and an addiction exists, medical detox is the optimal method of removing OxyContin safely from a person’s system. In medical detox, an individual will receive medical and mental health support and monitoring 24 hours a day, seven days a week, until the medication is cleared from the body. Trained professionals may taper the dosage off slowly, in a controlled manner, or they may use an opioid substitution medication, like methadone or buprenorphine. Other medications may also be beneficial for managing certain symptoms of opioid withdrawal during medical detox as well.
Detox generally lasts 5-7 days on average. Higher levels of dependence may require a slightly longer stay in a specialized facility.
Opioid withdrawal generally begins within 12 hours after the last dose, as published by the National Library of Medicine (NLM), peaks within 24-48 hours, and starts to taper off in about a week. Some of the psychological side effects may take a little longer to dissipate fully.
Withdrawal from OxyContin can include the following symptoms: anxiety, agitation, irritability, insomnia, dizziness, dilated pupils, muscle aches, tearing up, yawning, difficulties feeling pleasure, depression, muscle aches, back and joint pain, tremors, muscle weakness, nausea, vomiting, diarrhea, abdominal cramps, sweating, respiratory issues, irregular heart rate and blood pressure, chills, runny nose, and loss of appetite. Physically, the symptoms may be similar to a bad case of the flu while emotional side effects can run the gamut.
The exact duration and significance of these symptoms will be influenced by a person’s level of dependency on OxyContin, any polydrug abuse, possible co-occurring disorders, age when abuse began, length of time abusing the drug, amount and method of abuse, and genetic and environmental factors (family history of addiction and levels of stress and support at home, to name a few). Medical detox will provide encouragement, support, pharmacological aid in reducing and managing withdrawal symptoms, and a safe and secure environment that is supervised by highly trained medical, substance abuse, and mental health providers.
Getting Help for OxyContin Abuse
After detox, it is important to continue with a comprehensive substance abuse treatment program. The World Health Organization (WHO) estimates that around 15 million people around the world battle opioid addiction; however, only about 10 percent receive the treatment necessary for recovery. By addressing the behavioral, social, psychological, and physical components that all factor into addiction, this disease can be treated and managed.
An evaluation and thorough assessment are usually done prior to admission into a specialized treatment program in order to ascertain what treatment methods may be ideal. For example, someone who has a very strong and supportive base at home, and who has obligations that may not be as flexible, may benefit from an outpatient treatment program. Generally speaking, inpatient, or residential, programs offer the highest level of care with the widest range of services and options.
During opioid addiction treatment, individuals attend group and individual therapy, counseling, educational, and life-skills training sessions to improve self-reliance, healthy habits, stress coping mechanisms, and relapse prevention techniques. Behavioral therapies, such as Cognitive Behavioral Therapy (CBT), help to determine individual stressors and work through negative emotional issues and thought patterns that lead to self-destructive behaviors like substance abuse. Family sessions can aid in rebuilding the family unit and improving communication skills.
Set sleeping, waking, and eating times can reset a person’s physical balance and therefore help them to be more able to manage everything else in life. Nutritious meals and fitness programs can enhance physical strength and health as well. Creative therapies, yoga, mindfulness meditation, and other complementary techniques may be beneficial in providing balance between the mind, soul, and body; therefore, they can promote healing and stress reduction when used as adjunct therapies in combination with traditional methods.
With a comprehensive treatment program, individuals can learn tools that can help them to sustain their abstinence and prevent relapse. Treatment can allow time and safety for their brains to heal and new habits to become second nature.