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OxyContin Abuse: Signs of Addiction and Next Steps

OxyContin is the brand name for a formula of oxycodone, a prescription opioid painkiller that comes in an extended-release form. This brand-name drug was approved by the U.S. Food and Drug Administration (FDA) in 1996 and touted as safe and less addictive than opioid drugs that led to an epidemic of substance abuse in the 1960s and 1970s. However, OxyContin has now been implicated as the primary driver in the current, severe opioid abuse and overdose epidemic that is taking place in the U.S.

According to the U.S. Centers for Disease Control and Prevention (CDC), between 1999 and 2016, more than 630,000 people died because of drug overdoses, and 66 percent of those people died because of one or more opioid drugs. Many of these were prescription opioids, most often OxyContin, until very recently when heroin—an illicit drug since the passage of the Controlled Substances Act (CSA) in the 1970s—overtook prescription medications as the cause of overdoses. As of 2018, about 115 people die in the United States every day because of opioid abuse.

What Is OxyContin?

Oxycodone, especially in the brand-name form of OxyContin, is a narcotic analgesic designed to relieve moderate to severe pain. The time-release form, OxyContin, contains between 10 and 80 milligrams of painkiller that release slowly and relieve pain for up to 12 hours. This allows people with chronic or terminal illnesses who have severe pain live relatively healthy, pain-free lives.

However, when OxyContin first hit the prescription market in the late 1990s, it was not limited to just people with chronic pain. People experiencing pain from injuries or after surgery were given this potent, long-lasting drug. Liberal prescribing practices for this opioid are now believed to have led to the current opioid addiction and overdose epidemic plaguing not just the U.S., but much of the world.

According to the National Institute on Drug Abuse:

  • Between 21 and 29 percent of people who are prescribed opioids for chronic pain abuse these drugs.
  • About 8 to 12 percent of these individuals develop an opioid use disorder.
  • About 4 to 6 percent of those misusing prescription opioids eventually turn to heroin.
  • Nearly 80 percent of people addicted to heroin report developing an addiction to prescription opioids first.

People who became addicted to OxyContin compare the high to heroin. Many of them found ways to bypass the time-release aspects of the drug so they could take a huge dose of opioid painkiller all at once; other people took several doses at the same time; and still others added alcohol or benzodiazepines to the mix, increasing the high by combining central nervous system (CNS) depressants.

The History of OxyContin and the Current Opioid Abuse Epidemic

The FDA approved the very first prescription version of oxycodone in 1976. Percocet and Vicodin—oxycodone and hydrocodone, respectively—became seriously problematic drugs, and under President Gerald Ford, federal guidelines for prescribing practices focused on avoiding opioid painkillers if at all possible.

In 1980, however, a short letter printed in the New England Journal of Medicine disagreed that using opioid painkillers to treat many kinds of moderate or severe pain was risky. Although opioids were prescribed in rare cases, debate about their safety raged in the medical community until the 1990s. Doctors wanted to appropriately treat pain in their patients who suffered, especially for patients with long-lasting injuries, chronic pain problems, or serious illnesses. Opioids were believed to be the best approach.

Purdue Pharmaceuticals developed OxyContin in response to this debate, testing the drug in 1994 and having it approved by 1996. The company also heavily marketed the drug, not just to doctors and medical professionals but the public. After Purdue Pharma released OxyContin marketing videos, the number of opioid prescriptions in the U.S. rose from about eight million at the end of 1996 to 11 million by the end of 1998. By 2001, opioid prescriptions were the default treatment for most patient reports of pain.

By 2009, however, the opioid epidemic had become so serious that the Joint Commission removed their statement to “assess all pain” in patients from their medical recommendations. While doctors should be concerned about pain in their patients, the default of prescribing opioids to treat pain directly had caused a spike in the number of people abusing opioid narcotics.

Around 2010, many pharmaceutical companies, including Pursue Pharma, were focusing their efforts on developing tamper-proof narcotic drugs. Purdue released a tamper-resistant formula of OxyContin, leading to a drop in people abusing that drug. However, many of the people who stopped abusing OxyContin had not overcome their addiction; they had moved on to heroin abuse instead.

Purdue Pharma now faces dozens of lawsuits from state attorneys general all over the U.S. In 2018, the company laid off 350 employees after previously downsizing its workforce, and the major insurance company Blue Cross Blue Shield of Tennessee reported it would no longer cover prescriptions for OxyContin because it is too risky. Unfortunately, damage already has been done, so it is important to know how to help yourself if you struggle with OxyContin or other opioid abuse.

Side Effects

Taking any opioid painkiller as directed, including OxyContin, can lead to side effects. However, someone who abuses a potent drug like OxyContin is more likely to experience side effects because they take more than prescribed; they take much more than is reasonably safe; and they do not report side effects to a medical professional to have their dose adjusted.

There are common side effects from OxyContin. They include:

  • Stomach cramps
  • Nausea and vomiting
  • Appetite loss
  • Constipation
  • Dizziness
  • Dry mouth
  • Face or skin flushing
  • Sweating
  • Physical weakness
  • Headache
  • Mood changes or swings

There may be other, more serious side effects that require medical attention. They are:

  • Allergic reaction symptoms like rashes or hives, itching, trouble swallowing, or swelling in the face, lips, or tongue
  • Extreme confusion
  • Falling from feeling faint or lightheaded
  • Difficulty urinating
  • Unusual weakness or tiredness
  • Seizures

Overdose

People who abuse OxyContin or other opioids are at a very high risk of overdosing on these drugs. The euphoria associated with opioid abuse can lead to taking larger and large doses, causing the body’s tolerance to the drugs and dependence on them to rise quickly. Taking too much can cause an overdose, which may be deadly.

If you see someone displaying symptoms that are similar to those of an opioid overdose, it is important to call 911 immediately to get them medical help. Opioid overdoses can be fatal due to oxygen deprivation, and the only way to survive this is with hospitalization and appropriate medical treatment.

There are specific signs of an overdose on OxyContin. They are:

  • Pinpoint pupils
  • Constipation
  • Abdominal cramping
  • Nausea and vomiting
  • Weak pulse
  • Low blood pressure
  • Drowsiness 
  • Passing out and unable to be roused
  • Breathing changes, including depressed, shallow, irregular, or stopped breathing
  • Bluish tint to the skin, especially around the nose or lips, or under the fingernails, because of oxygen deprivation
  • Muscle damage from being immobile while passed out

Even when an opioid overdose is not deadly, it can cause brain and muscle damage that may lead to permanent disability or mental impairment.

Withdrawal

Opioid withdrawal comes in three basic stages. They are:

  • Early: Symptoms like agitation, anxiety, and insomnia may be linked to compulsive behaviors that are not acted on, or they may occur because opioids are CNS depressants that can cause rebound effects like tension when the drug is not present. Physical symptoms like muscle aches, watery eyes, runny nose, sweating, and excessive yawning will occur as the drug is metabolized out of the body. This will start within a day or two after the last OxyContin dose.
  • Peak: The most intense symptoms occur between days three and five. These will feel like a bad flu, with nausea, vomiting, loss of appetite, diarrhea, goosebumps, ongoing aches and pains, and general discomfort and malaise.
  • Decline: Physical and emotional symptoms will decrease after day four or five, although cravings and anxiety may linger.

Typically, opioid withdrawal that does not involve replacement medications takes no more than 10 days; however, it is important to get medical oversight to manage withdrawal because drugs like OxyContin are associated with a high relapse rate. Additionally, if you try to quit without professional help, your body will have less tolerance to the drug than you expect, and when you relapse and take the dose you crave, you are at a greater risk of overdose and death.

Fortunately, there are various evidence-based, well-researched approaches to treating opioid addiction that have helped many overcome this problem.

Help Overcome Substance Abuse

Since the U.S. has struggled through several waves of opioid epidemics, there are some well-understood approaches to treatment. Medication with behavioral therapy is the foundation of any approach, but it is important to work with a doctor or therapist to get the specific treatment that best suits your needs.

Before any treatment plan begins, your doctor or addiction specialist will assess your withdrawal symptoms using a scale like the Clinical Opioid Withdrawal Scale (COWS). This involves a series of physical measurements along with self-reporting of symptoms, which helps the physician understand if medication needs to be prescribed to manage withdrawal, and if so, what kind and how much.

Medication-assisted treatment (MAT) has long been used to manage opioid withdrawal symptoms. Methadone was the preferred medicine in the U.S. for decades, but buprenorphine was approved in 2002 by the Food and Drug Administration (FDA), and this has allowed more providers to treat more people who struggle with a wider range of opioid addictions.

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Methadone is a full agonist, binding for a long time to the brain’s opioid receptors, so it is sometimes also prescribed as a painkiller. But it also has become a substance of abuse for some people. It can only be dispensed through specific clinics, which have long waiting lists. While it is still prescribed as a treatment for opioid addiction, methadone is typically only used for people who have struggled with very large doses of OxyContin or other potent drugs for many years.

Buprenorphine, often in the form of brand name Suboxone, is the current favorite for MAT. The main drug is a partial opioid agonist, not a full agonist, so it is much less prone to abuse. It also can be dispensed at hospitals, physicians’ offices, and other clinics that aren’t specifically methadone clinics. As long as the physician has the required training to prescribe buprenorphine, they are allowed to dispense it to patients who will benefit from this approach to treatment.

Many people being treated with MAT go through the first stages of rehabilitation while still tapering because the process can take a long time. Behavioral therapy is the foundation of rehabilitation, usually in groups, and often also in individual and family therapy. Once three months of behavioral therapy, in either an inpatient or outpatient program have been completed, you should work with your counselor or treatment leader to create an aftercare plan so that you can manage stress and cravings once you leave.

Sources

(May 23, 2016). Oxycodone vs. OxyContin. Healthline. Retrieved September 2018 from https://www.healthline.com/health/pain-relief/oxycodone-vs-oxycontin#oxycodone-vs-oxycontin

(October 14, 2016). Opioid history: from ‘wonder drug’ to abuse epidemic. CNN. Retrieved September 2018 from https://www.cnn.com/2016/05/12/health/opioid-addiction-history/index.html

(August 30, 2017). Understanding the Epidemic. Centers for Disease Control and Prevention (CDC). Retrieved September 2018 from https://www.cdc.gov/drugoverdose/epidemic/index.html

(October 28, 2014). What Is Oxycodone (OxyContin)? Everyday Health. Retrieved September 2018 from https://www.everydayhealth.com/drugs/oxycodone

(June 19, 2007). OxyContin: Pain Relief vs. Abuse. WebMD. Retrieved September 2018 from https://www.webmd.com/pain-management/features/oxycontin-pain-relief-vs-abuse#1

(March 2018). Opioid Overdose Crisis. National Institute on Drug Abuse (NIDA). Retrieved September 2018 from https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis

(June 20, 2018). OxyContin maker Purdue Pharma cuts remaining sales force. Reuters. Retrieved September 2018 from https://www.reuters.com/article/us-usa-opioids-purduepharma/oxycontin-maker-purdue-pharma-cuts-remaining-sales-force-idUSKBN1JG1W6

(September 12, 2018). Insurer to Purdue Pharma: We Won’t Pay for OxyContin Anymore. NPR. Retrieved September 2018 from https://www.npr.org/sections/health-shots/2018/09/12/646790014/insurers-move-against-oxycontin

(August 31, 2018). Hydrocodone/oxycodone overdose. Medline Plus. Retrieved September 2018 from https://medlineplus.gov/ency/article/007285.htm

(September 2, 2015). Clinical Opiate Withdrawal Scale. National Institute on Drug Abuse (NIDA). Retrieved September 2018 from https://www.drugabuse.gov/sites/default/files/files/ClinicalOpiateWithdrawalScale.pdf

(September 28, 2015). Medication and Counseling Treatment. Substance Abuse and Mental Health Services Administration (SAMHSA). Retrieved September 2018 from https://www.samhsa.gov/medication-assisted-treatment/treatment#medications-used-in-mat

(January 2018). Behavioral Therapies. National Institute on Drug Abuse (NIDA). Retrieved September 2018 from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment/evidence-based-approaches-to-drug-addiction-treatment/behavioral-therapies

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