OxyContin Addiction and Abuse

Oxycodone is the dominant ingredient in many painkillers prescribed for moderate to acute pain. This medication is manufactured by altering thebaine, an organic compound present in opium. Oxycodone is categorized as an opioid or semi-synthetic opiate that is generally classed along with heroin, hydrocodone, and oxymorphone. It is listed as a Schedule II drug under the Controlled Substances Act, indicating that while it has a legitimate medical purpose, it also retains a high potential for abuse.

Oxycodone pills come in various shapes, colors, and sizes, depending on the dosage and brand. Oxycodone can also be found in a liquid form. This medication is often prescribed as a combination with other drugs, such as acetaminophen, aspirin, and ibuprofen. Oxycodone-based painkillers are generally prescribed for patients battling cancer, arthritis, physical trauma, and post-surgery pain relief. Prescription forms of oxycodone are purely formulated to provide relief around the clock. Some of the most popular brand names for oxycodone-based drugs are:

Consuming higher doses of oxycodone than initially prescribed, taking the medication for longer than recommended, consumption of oxycodone without a prescription, and consuming the pill in a manner that was not recommended are all regarded as oxycodone abuse.

Most people tend to abuse oxycodone due to its euphoric effects. As an opioid, the effects of oxycodone are remarkably similar to that of heroin. Street names of oxycodone may include oxy, OC’s, oxycet, oxycotton, hillbilly heroin, berries, killers, percs, and Roxi’s.

In a bid to tackle the growing opioid epidemic, particularly oxycodone, most oxycodone-based products are now marketed with abuse-deterrent mechanisms, such as invariable ingredients that render you sick when consumed in higher doses. Most extended-release versions are also now inbuilt with film coatings or beads that make injecting or snorting the drug practically impossible, or at the least, less desirable.

The effects of oxycodone use are:

• Relief from pain
• Diminished anxiety
• Confidence
• Relaxed state
• Drowsiness
• Calmness
• Dizziness
• Euphoria

Individuals who tend to abuse oxycodone initially start off by taking the prescribed amount. However, as their body develops a drug tolerance, patients may consume more and more of the drug to achieve the desired effect.

The signs of oxycodone abuse are:

• Dilated pupils
• Apathy
• Drowsiness
• Sense of calmness
• Short attention span
• Sedation

Since prescription painkillers are openly accepted within society, it may be difficult to recognize or resolve oxycodone misuse. Particularly in cases of valid prescriptions, it can be hard to ascertain the difference between the recommended dose and abuse. However, a strong tell-tale sign of abuse is when a person runs out of his/her prescription before their next script is available for refill. The leap from prescribed use to addiction can be very swift and dangerous. Individuals who routinely begin to misuse oxycodone are likely to develop dependency and addiction to the drug.

Oxycodone’s immediate side effects can range from slightly uncomfortable to potentially fatal. Even individuals who strictly adhere to the prescribed doses can experience side effects after prolonged consumption. Side effects may include:

• Headaches
• Seizures
• Depressed breathing rate
• Nausea
• Vomiting
• Dizziness
• Low blood pressure
• Vivid dreams
• Dry mouth
• Blurred vision
• Euphoria
• Relaxed state
• Reduced anxiety
• Pain relief
• Sedation
• Drowsiness
• Lack of appetite
• Constipation
• Flushing
• Sweating
• Weakness
• Mood swings

Prolonged abuse of oxycodone may result in physical and psychological disorders.

• Heart failure
• Constipation
• Insomnia
• Depression
• Aches and cramps
• The increased pressure of the spinal fluid
• Coma
• Swelling of the limbs
• Death

As per the Diagnostic and Statistical Manual of Mental Disorders (DSM – 5),, there are 11 criteria for diagnosing oxycodone addiction. The severity of addiction can be measured through the number of criteria met by a patient. These criteria may include:

• Hazardous use – Have you consumed oxycodone in a manner that is harmful to yourself?
• Social or interpersonal issues – Has oxycodone use contributed to estranged relationships and conflicts with family and friends?
• Neglected commitments – Have you failed to fulfill obligations and responsibilities at work, school, or home?
• Withdrawal – Are you experiencing withdrawal symptoms when you attempt to quit or reduce oxycodone consumption?
• Tolerance – Do you require more oxycodone over time to attain the same effects?
• Prolonged consumption – Are you consuming higher doses of oxycodone over a longer period than prescribed?
• Repeated attempts to control the drug use – Have you tried to quit or cut back on oxycodone, only to relapse?
• An indefinite amount of time spent using the drug – Do you spend most of your time using and recovering from the drug?
• Physical or psychological issues – Has your oxycodone use affected your mental and physical health negatively?
• Giving up on activities – Have you lost interest in pastimes or activities that you once enjoyed?
• Craving – Do you experience intense cravings for the drug?

In order to diagnose someone with oxycodone use disorder, the patient must meet two or more of the above criteria.

The initial indications of an oxycodone addiction are the development of tolerance and dependence on the drug. Patients who form a tolerance will require higher doses of the medication to feel the desired effects. The prolonged usage of oxycodone may result in the gradual development of dependence due to the chemical changes in the brain. During this stage, patients may experience withdrawal symptoms during the abrupt cessation or the reduction of the medication. In many instances of oxycodone abuse, patients may resort to illegal methods to acquire the drug after the end of their prescription.

Some of the most common signs of addiction are:

• Purchasing the drug with fake prescriptions.
• Doctor shopping for new prescriptions.
• Stealing or borrowing pills from family or friends with a prescription.
• Purchasing the substance from a drug dealer.

Individuals who form an addiction to oxycodone will continue the use of the drug even at the risk of personal, professional, and health consequences.

Although oxycodone brings essential relief for many patients battling with traumatic pain, the dangers of the drug can no longer be ignored. The greatest risk associated with oxycodone abuse is the potential for a fatal overdose. Oxycodone depresses a person’s respiration and reduces blood pressure. These symptoms can easily result in seizures, comas, or cardiac arrest, particularly when oxycodone is crushed and ingested, snorted, or injected. The risk of fatal overdose is dramatically higher when oxycodone is taken with alcohol or other CNS depressants. As per Dr. Nora Volkow  in testimony to congress, prescription drugs were linked to more deaths compared to cocaine or heroin by 2002.

Alcohol and benzodiazepines are a few of the most dangerous substances when combined with oxycodone. Since oxycodone, alcohol, and benzos are central nervous system depressants, mixing them together can be incredibly harmful and potentially fatal. This deadly cocktail will slow down your breathing and cardiac function to the extent of complete failure. Even if the combination does not result in death, it can cause irreversible damage to the brain and major organs. In addition, individuals with an addiction to oxycodone also tend to abuse marijuana, benzodiazepines, and stimulants to either magnify or mitigate the effects of oxycodone.

• As per the United States Department of Justice (DOJ), over 13 million Americans abuse oxycodone, including children as young as 12 years of age.
• In 2010, there were approximately 5,500 first-time oxycodone abusers each day.
• About 100,000 people are admitted to hospitals every year due to painkiller misuse.
• Between 2004 and 2008, OxyContin’s misuse rose by 152 percent, leading to over 105,000 ER visits in the United States per year.
• OxyContin and oxycodone-based painkiller addiction led to more than 35,000 deaths in 2010 alone.

Once dependence on oxycodone develops gradually, the discontinuation of the medication will result in unpleasant and potentially painful withdrawal symptoms. Many experts believe that while oxycodone withdrawal is unpleasant, it is rarely life-threatening.

Oxycodone withdrawal symptoms usually develop within 8-12 hours of the last dose. Mild or moderate oxycodone abusers may experience less painful withdrawal symptoms than those with a severe addiction. The symptoms of oxycodone withdrawal may resemble flu-like symptoms, similar to that of heroin withdrawal.

The common symptoms of oxycodone withdrawal are:

• Nausea
• Vomiting
• Fatigue
• Depression
• Cough
• Diarrhea
• Runny nose
• Teary eyes
• Profuse sweating
• Anxiety
• Shaking
• Muscle aches
• Rapid heart rate
• Body ache and pains
• Irritability
• Lack of concentration
• Mood shifts
• Unable to feel pleasure

The duration of oxycodone withdrawal tends to differ between individuals, based on factors such as:

• How frequently the individual took oxycodone.
• How much oxycodone the individual took each time.
• How long the individual has been indulging in oxycodone.
• Presence of polydrug abuse.
• Method of consumption (Snorting, injecting, eating, etc.)
• The individual’s mental health and medical history, including gender and weight.

Once oxycodone withdrawal symptoms gradually set in, symptoms may remain between a few days to a week. In most cases, symptoms may peak within 72 hours after the last dose. The most intense psychological and physical withdrawal symptoms also referred to as acute withdrawal, tend to linger on for up to a week.

Symptoms that remain for more than a week are recognized as Post-Acute Withdrawal Symptoms (PAWS). PAWS can remain for up to 18 – 24 months but tends to gradually fade once the patient masters how to manage and cope with them. Some of the most common PAWS symptoms may include lack of concentration, increased anxiety, depression, inability to feel pleasure, lack of energy, mood swings, irritability, agitation, and poor sleep.

Treatment for oxycodone addiction usually begins with a medically supervised detox program, accompanied by an inpatient or outpatient rehab and ongoing mental health counseling and support.

Oxycodone withdrawal can be excruciatingly painful and unpleasant. Thus, a gradual reduction of the drug is often the most convenient and effective way to detox. The gradual reduction of oxycodone in detox is usually conducted through an Opioid Treatment Program (OTP), referred to as a Medication-Assisted Treatment (MAT). This long-term medication maintenance is an ideal option for individuals with a history of chronic relapse. The most widely used MAT medications may include Suboxone or Subutex.

During detox, medications may be prescribed to help ease off certain withdrawal symptoms. These drugs operate by misleading the brain into thinking that it is still being supplied with oxycodone. A few of the most common medications used during oxycodone detox are:

Inpatient rehabs that facilitate medical detox are the safest choice for patients with moderate to severe addictions. Inpatient rehabilitation offers a structured, monitored atmosphere that is vital during the initial stages of recovery. It also helps patients engage in counseling and therapy without stressors or triggers that cause relapses.

Most rehabs offer a variety of treatment services to help former oxycodone users break their psychological dependence on the drug, such as:

• Cognitive-behavioral therapy
• Individual therapy
• Family counseling
• Group therapy
• Holistic therapy
• Motivational Enhancement Therapy

Inpatient or residential rehabs typically offer 30-day, 60-day, or 90-day services, but the actual duration of a patient’s stay at a rehab depends mainly on the severity of his/her addiction.

Once a patient starts to reintegrate back into his/her life and daily routine, it is essential to continue with treatment to attain prolonged sobriety. Outpatient treatment is an excellent follow-up after the completion of detoxification and inpatient care for those with moderate to severe addiction. An outpatient program is also an ideal option for those who are diagnosed with a mild addiction as they provide therapy, guidance, and support for their patients.

There are three main forms of outpatient treatment:

• Partial Hospitalization Programs (PHPs) typically include a residential element and 6-8 hours of treatment per day for 5-7 days per week.
• Intensive Outpatient Programs (IOPs) typically include 3 hours of treatment per day for 3-5 days per week, without a residential element.
• Standard Outpatient Programs (OPs) usually conduct 2-3 sessions per week.

Support groups, such as Narcotics Anonymous (NA) and SMART Recovery, are also beneficial during recovery. These groups tend to connect patients with like-minded individuals who understand and empathize with the challenges posed during recovery. People in these groups often form an integral part of a patient’s support network.

It is necessary to ensure that individuals receive the additional support they require to nurture healthy recoveries, such as the ability to travel to therapy sessions, financial support, and placement assistance. A significant element in recovery is that patients continue to participate in the recovery program even after the completion of rehab programs. Research shows that individuals who continue to participate in recovery programs for 5 to 7 years after being sober have a higher success rate. It is important to understand that addiction is a chronic illness that requires lifelong treatment; hence the longer you seek treatment, the higher the chances of recovery.