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The American Society of Addiction Medicine (ASAM) publishes that close to 2 million people in the United States who are over the age of 11 are considered to be suffering from a prescription opioid substance use disorder. One of the side effects of addiction is often drug dependence.
OxyContin, the brand name for the generic synthetic opioid oxycodone, is one of the most prescribed opioid narcotic pain relievers in America, with close to 60 million prescriptions written for oxycodone products in 2013, the Drug Enforcement Administration (DEA) reports. It is also widely abused. Opioid drugs are highly addictive as they work to relieve pain, increase relaxation, and also raise endorphin levels, which induces pleasure. When taken regularly, even when taken within the recommended doses and with a legitimate prescription, OxyContin use can cause a person to become tolerant and then dependent on the drug. The prescribing information published by the U.S. Food and Drug Administration (FDA) even warns users of OxyContin of the risks for addiction and dependence when taking it.
A tolerance to OxyContin occurs when the drug stops being effective at the current dosage, and the individual needs to take more of it in order for it to keep working. The more OxyContin a person takes regularly, the higher the probability that the person will become dependent on it. There are many factors involved in drug dependency, including biological, environmental, and emotional factors. Someone who has a family history of addiction may have a genetic predisposition to drug dependency, for instance, while someone who lives in a highly stressful environment may be more prone to it as well. In addition, mental health or medical conditions can make it more likely for a person to suffer from addiction or drug dependency.
OxyContin dependence may also be furthered by abuse of the drug, or using it beyond its medicinal scope. Snorting, smoking, or injecting the drug can increase the level of dependency on the drug. The National Survey on Drug Use and Health (NSDUH) estimated that in 2014, close to 4.5 million American adults (aged 12 and older) were considered to be currently abusing prescription pain relievers.
Withdrawal from a powerful opioid like OxyContin can be like a really bad case of the flu physically. Since the reward pleasure centers in the brain are affected by the drug, it can also be psychologically intense. In the case of opioid drugs, dependency is both physical and psychological, and the side effects of withdrawal are often best managed with medical detox.
Detox is highly individual and everyone experiences it differently. It is not recommended to ever stop taking OxyContin without professional help after a dependency is established.
Medical detox is the most comprehensive form of detox in that it is offered in a secure environment in a specialized facility that can provide around-the-clock medical care, supervision, and the use of medications to ease withdrawal.
The intense portion of opiate detox typically lasts between 5-10 days; however, in some instances, long-term replacement medications may be used, stretching the complete detox process to weeks or months. As with all cases of withdrawal, specific detox timelines vary according to each individual.
Early withdrawal symptoms include:
OxyContin is considered a relatively short-acting opioid, as oxycodone has a half-life of around 3-5 hours for the immediate-release formulations and 12 hours for the controlled-release types, the journal Clinical & Translational Oncology reports. Generally speaking, the half-life of a drug indicates how long it will be effective in the body, and after it stops working, or wears off, withdrawal side effects can begin. Withdrawal from OxyContin, therefore, typically begins 8-24 hours after the last dose, depending on the dosage and method taken.
OxyContin withdrawal is typically broken down into early and late-stage withdrawal, with the early stage symptoms likely peaking in 3-5 days.
After a few days, OxyContin withdrawal may progress and include more symptoms, such as:
The physical side effects of OxyContin withdrawal likely abate in a few days to a week, depending on the level of dependency; however, the psychological ones may persist a bit longer. Medical detox can help to manage and reduce withdrawal symptoms by using certain medications and therapeutic tools to minimize specific symptoms.
Medical detox can smooth out OxyContin withdrawal by providing 24/7 medical and mental health support, as well as attendance to and concurrent treatment for any co-occurring medical or mental health disorders. In addition, medications may be used to alleviate or reduce withdrawal symptoms.
There are a few classes of medications used during opioid detox, including opioid replacement medications, adjunct medications, and supplemental products. The FDA, as published by the Office of National Drug Control Policy (ONDCP), currently approves three medications specifically for opioid dependence: buprenorphine, methadone, and naltrexone.
Buprenorphine and methadone are opioid agonists that fill up the same opioid receptor sites in the brain and along the central nervous system that OxyContin does. Methadone, however, has a longer half-life, averaging around 30 hours, the National Highway Traffic Safety Association (NHTSA) publishes. This means that it can stay in a person’s system longer, therefore requiring lower doses less often. Methadone (Dolophine) is dispensed in federally regulated clinics in once-a-day tablets. It is still an opioid drug with a potential for abuse and dependency, however.
Buprenorphine (Subutex) is a partial opioid agonist, meaning that it doesn’t activate opioid receptors in the same way that full agonists do. While helping to keep drug cravings and withdrawal symptoms at bay during detox, it should not produce the euphoric effect that full agonists do.
Further deterrents to abuse include the way buprenorphine ceases to be effective after a certain dosage, making it less likely to give an individual the desired “high,” and the addition of naloxone, an opioid agonist, to some buprenorphine products (Suboxone, Bunavail, and Zubsolv).
Opioid agonists fill up opioid receptor sites and prevent other opioids from attaching to them. In the case of buprenorphine/naloxone combination products, the naloxone remains dormant unless the medications are crushed and injected, or abused. Opioid antagonists, such as naloxone and naltrexone, are generally reserved for later in treatment, as the introduction of an antagonist drug before other opioids are out of the system can precipitate, or bring about, withdrawal symptoms, the Substance Abuse and Mental Health Services Administration (SAMHSA) reports.
In addition to other opioid drugs, adjunct medications can be beneficial during detox to help with specific side effects or symptoms of withdrawal. Medications that act on the gastrointestinal or noradrenaline systems, or those that have sedative or anxiolytic effects, may also be helpful during opioid withdrawal, per the NICE Treatment Guidelines.
Clonidine and lofexidine are blood pressure medications that calm the noradrenaline system, potentially helping to ease some of the hyperactivity of these nerve firings that may occur during opioid withdrawal. Antidepressant medications can also be used to manage depression during OxyContin detox as can other mood stabilizers. SAMHSA reports that mental health disorders co-occur with substance abuse disorders in about 8 million Americans, and integrated treatment is most beneficial for recovery. Vomiting, nausea, diarrhea, and stomach cramps are common side effects of OxyContin withdrawal that can be managed with medications that target these symptoms specifically.
Sleep aids or antipsychotic medications like benzodiazepines may help during opioid withdrawal to quell anxiety and insomnia. These drugs, however, can also be abused and carry a risk of dependence. As a result, they should be used under the supervision of a trained professional and sometimes avoided altogether, depending on personal circumstances.
Medications can interact with each other in a variety of unintended ways, so it is essential to disclose any and all medications taken when entering detox. Detox should be followed with therapy and counseling in the context of a substance abuse treatment program for optimal results. Detox does not constitute treatment on its own.
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