Behind marijuana and alcohol, prescription and over-the-counter (OTC) drugs are the most commonly abused substances in the United States by individuals who are 14 years old or older, the National Institute on Drug Abuse (NIDA) reports. Opioid painkillers are one of the most hotly abused classes of prescription drugs, NIDA further publishes.
Oxycodone and OxyContin
Oxycodone is a semisynthetic opioid drug made from thebaine, which comes from opium. Oxycodone is the active ingredient in the brand name prescription pain reliever OxyContin. Oxycodone is also marketed in generic form and in combination medications containing analgesics that are not narcotics, such as acetaminophen (Percocet) and aspirin (Percodan). Oxycodone is designed to treat acute pain as it controls pain sensations and fills opioid receptors in the brain to induce relaxation and sedation.
The drug names oxycodone and OxyContin are often used interchangeably; however, there are some marked differences between the two. For one, oxycodone can be administered intravenously in a liquid or via tablet form while OxyContin is taken orally as a tablet.
OxyContin is an extended-release formulation of oxycodone that is meant to control pain around the clock on a daily basis. It is commonly prescribed to those who may not respond as well to other treatments or medications, or to people who are tolerant to other opioids already. It is marketed as a tablet that is swallowed once every 12 hours. The manufacturers of OxyContin, Purdue Pharma, publish that the medication comes in strengths ranging from 10 mg of oxycodone to 80 mg of oxycodone and that individuals should take the lowest dosage possible that will still be effective for their pain.
The Drug Enforcement Administration (DEA) reports that OxyContin is attractive to people who abuse opioid drugs because of the high dosage of oxycodone contained in the controlled-release medication. The high dosage is because the drug is designed to slowly be doled out in the body in a time-released fashion and not all at once. In contrast, with oxycodone on its own and in immediate-release formulations, the entire dosage of the medication enters the bloodstream at once and takes rapid effect. It has a relatively short half-life around three hours, which means that the drug stops being effective after around six hours or so.
Oxycodone may be prescribed to treat acute pain in the short-term, while OxyContin is designed more for chronic or ongoing pain management. Both can be habit-forming and are classified as Schedule II narcotics by the DEA, which means that they have a high potential for diversion, abuse, and addiction. In general, both OxyContin and oxycodone contain the same active ingredient, both work to treat pain, both are regularly abused and can be addictive, and both can lead to fatal overdose.
Abuse of OxyContin and Oxycodone
The DEA reports that as of 2012, approximately 16 million American adults had reported abusing an oxycodone product in their lifetime. In 2016, the Monitoring the Future (MTF) survey of high school students published by NIDA reports that nearly 3.5 percent of high school seniors admitted to past-year OxyContin abuse. The Substance Abuse and Mental Health Services Administration (SAMHSA) publishes that almost 4.5 million people in the United States abused a prescription painkiller in the month leading up to the 2014 National Survey on Drug Use and Health (NSDUH).
Opioids, when abused, can make a person feel euphoric, or “high.” Pain, stress, anxiety, and sadness may seem to melt away, and the drug may provide a temporary respite from reality. Opioids interact with the levels of dopamine in the brain, a naturally occurring chemical that helps to regulate moods. They also act as central nervous system depressants and slow down breathing, blood pressure, and heart rate while lowering body temperature. They can make a person feel sluggish and uncoordinated as well as impair cognitive and decision-making abilities. Short-term memory can be affected as can rational thoughts and actions. Opioid intoxication can make a person more likely to get into an accident, be the victim of a crime, or do things they might not normally do.
Traditionally, OxyContin may have been preferred over oxycodone as a drug of abuse because of its high dosage and the ability to crush it to then inject, snort, or smoke the entire dose all at once for an intense high. Purdue Pharma changed the formulation of OxyContin to make it harder to abuse, and in 2010, the U.S. Food and Drug Administration (FDA) approved the abuse-deterrent form of the drug. The drug now turns into a gelatinous mush if it is crushed in an attempt to extract the oxycodone. Of course, it can still be abused by ingestion or by those who have found ways around the tamper-resistant formula.
The New England Journal of Medicine (NEJM) reports that abuse of OxyContin has seemed to drop as a result of the reformulation; however, people have likely just switched to a different opioid like heroin instead. Oxycodone in generic form can still be chewed or crushed for abuse via smoking, snorting, or injection.
Opioid Overdose Epidemic
The Centers for Disease Control and Prevention (CDC) warns that over 15,000 people died from an opioid overdose involving a prescription opioid in 2015, and oxycodone products (including OxyContin) were among the most common drugs cited in the prescription opioid drug fatalities. Overdose deaths in the United States are at record highs, and prescription opioids account for around half of all overdose fatalities.
Opioids can become toxic quickly and cause a person to stop breathing, lose consciousness, fall into a coma, or die. When OxyContin is altered, such as crushed or chewed, and then taken in a way that bypasses the slow and controlled release formulation of the medication, it can have life-threatening consequences. The entire dosage enters the bloodstream all at once, not at all as it was intended to, which can lead to an overdose rather quickly. An opioid overdose is potentially reversible with quick medical intervention, and the administration of the opioid antagonist drug naloxone (Narcan), which many first responders carry.
Other Risks of OxyContin and Oxycodone Abuse
Mental impairment, constipation, irregular heart rate and blood pressure, lowered body temperature, disrupted sleep and appetite patterns, and sedation are all possible side effects of oxycodone and OxyContin. Since the active ingredient is the same in both, the general side effects and risk factors are also similar. Both can put a person at a higher risk for contracting an infectious disease through the sharing of dirty needles or through unprotected sexual contact that may be the result of impaired thinking.
Ingesting these drugs can result in gastrointestinal issues, such as stomach ulcers or intestinal blockage. Snorting and smoking opioids regularly can damage the respiratory system, lead to respiratory infections and/or diseases, and cause a chronic cough. Snorting drugs wreaks havoc on the sinus and nasal cavities, which can cause a person to suffer from nosebleeds or a perpetually runny nose. In addition to overdose, injecting OxyContin or oxycodone raises the risk for transmitting diseases like HIV/AIDS and hepatitis and for skin infections, collapsed veins, or infections in the lining of the heart. The cardiovascular and respiratory systems are impacted by long-term oxycodone and OxyContin abuse, too, which can lead to irregularities in function as well as increase the odds for infections and diseases.
Physical Drug Dependence, Withdrawal Side Effects, and Addiction
Other than overdose, the biggest risk factors for oxycodone and OxyContin use are their habit-forming properties. Taking either drug regularly can lead a person to develop a tolerance to opioids; in this sense, they will need to take higher doses to keep up with the drug’s desired impact. Physical dependence can occur rather quickly with oxycodone and OxyContin. Brain chemistry is changed by the presence of an opioid drug, and when a person is dependent on the drug, it can take some time for the chemistry to regain normalcy. During the time in between stopping a drug like oxycodone or OxyContin and this physical stabilization, a person can suffer from intense drug withdrawal symptoms.
Side effects of oxycodone and OxyContin withdrawal include:
- Nausea and vomiting
- Muscle aches
- Stomach pain
- Joint, bone, and back pain
- Chills alternating with sweats
- Runny nose
- Teary eyes
- Decreased appetite, anorexia, and malnutrition
- Elevated blood pressure and heart rate
- Dilated pupils
These withdrawal symptoms usually start within 12 hours of the last dose of an opioid drug. Physical dependence on an opioid drug takes time to overcome, and as a result, both oxycodone and OxyContin should not be stopped suddenly once dependence has formed. Withdrawal can be uncomfortable and is best managed through a medical detox protocol that uses both medications and supportive care to help individuals through the process.
Drug dependence is commonly a component of drug addiction, which is a potential long-term risk of chronic oxycodone and OxyContin abuse. When a person battles addiction, they are unable to stop taking drugs, despite their attempts to do so, and they will continue to use them in spite of all the negative consequences that occur as a result of the perpetuated abuse.
Addiction is a brain disease that can impact a person’s life in many ways. A specialized addiction treatment program following medical detox can help a person emotionally, physically, socially, and behaviorally through a complete care plan to help the person achieve and maintain a stable life in recovery.