Few other medications are as widely used as prescription painkillers, and one of those is the generic drug oxycodone. Oxycodone is an opioid painkiller, which means it is derived from the natural compounds found in the opium poppy. First synthesized in the early 1900s, this drug has been in use for nearly 100 years under its generic name, several brand names, and in combinations with other types of painkillers.
As with other opioids, oxycodone is a potent and powerful painkiller. It has helped many people struggling with chronic pain and certain medical conditions. On the other hand, oxycodone, and specifically the brand name drug OxyContin, have been blamed for starting an epidemic of painkiller abuse, addiction, and overdoses. Purdue Pharma, the maker of OxyContin, has had to pay up to the federal government, but those parts of the country hardest hit by the epidemic are asking for more.
What is Oxycodone?
Oxycodone was first made in a laboratory in Germany in 1917. It was derived from thebaine, a compound found in opium. Opium had long been known to be both a drug of abuse and to have medicinal value. Today oxycodone is indicated for use as a painkiller for moderate to severe pain. It is particularly useful for relieving the pain associated with cancer.
Oxycodone is sold as a generic and under several different brand names. It comes in regular and extended release formats; the latter is designed to treat pain for twelve hours with one pill. Oxycodone also comes in combination with aspirin or acetaminophen. Brand names for oxycodone include OxyContin, Roxicodone, Oxaydo, OxyIR, and Oxecta. Combination products include Percocet, Endocet, Targiniq, and Combunox.
How it Works
Oxycodone, like other opioids, acts on opioid receptors in the central nervous system. In the brain, oxycodone acts at these receptors to interfere with pain signals by changing the compensation and concentration of various neurotransmitters, or brain signaling chemicals. The effect also includes a sense of relaxation and euphoria and a lessening of anxiety and depression, all of which contribute to the relief of physical pain.
In addition to the euphoria and relaxation that come along with pain relief, oxycodone causes certain common side effects in some people. These include nausea and vomiting, stomach pain, flushing, sweating, dry mouth, loss of appetite, weakness, headaches, and mood swings. These should be reported if any become severe or persist.
Oxycodone products come with a black box warning as required by the U.S. Food and Drug Administration (FDA) about a potentially life-threatening side effect. Some people may have breathing difficulties caused by the oxycodone that can be fatal if not treated immediately. Anyone with asthma or chronic obstructive pulmonary disorder is at particular risk for this problem and may be told not to use oxycodone. Other factors that increase the risk include drinking alcohol or using street drugs, and using certain prescription medications in conjunction with oxycodone.
Potential for Abuse
In addition to the less severe side effects and the life-threatening breathing problems, oxycodone has a high potential for abuse, which can lead to addiction. It is listed as a Schedule II controlled substance by the Drug Enforcement Administration for this reason. The feelings of euphoria and relaxation contribute to this potential for abuse. Some people may seek oxycodone out just to get the high, but also some people using it as prescribed may start to abuse it as they become dependent on the pleasant feelings and sense of pain relief they get from the drug.
It isn’t just the psychological sense of well-being that leads some people to abuse oxycodone. This drug can also cause physical dependence, even in people who are taking it as directed by a doctor. There are two main signs of physical dependence. One of these is tolerance, which means that it takes larger and more frequent doses to get the same effect.
The other sign of a physical dependence is withdrawal. The symptoms of withdrawal from oxycodone kick in when a user stops taking it. These symptoms make it very difficult to stop using the medication. They include nausea, anxiety, insomnia, fever and other flu-like symptoms, muscle pain, and irritability. The cycle of dependence on oxycodone begins with its potential for abuse, which leads to tolerance, which in turn causes withdrawal.
The OxyContin Controversy
Dependence on oxycodone became epidemic in the late 1990s and early 2000s when Purdue Pharmaceutical introduced OxyContin. This is an extended release version of oxycodone. One tablet of OxyContin contains enough of the drug for a 12-hour dose, but it is released slowly for patients who need consistent pain relief.
People who wanted to abuse oxycodone, and those already dependent on it and with a high tolerance, figured out that they could crush the OxyContin pills to get the full dose all at once. This huge dose of a highly addictive drug led to an epidemic of abuse, addiction, and accidental overdoses. The epidemic was especially high in rural Kentucky. In response to the problem, Purdue Pharmaceutical reformulated OxyContin to make it more difficult to crush or dissolve. The FDA allowed the company to relabel this formula as abuse-resistant in 2013.
Since OxyContin came on the market and triggered so many instances of abuse, addiction, and overdose, the epidemic of prescription painkiller abuse has only grown. All types of opioid painkillers are susceptible to abuse and the growing epidemic has even led to a rise in the use of heroin, an illegal drug related to opioids. Many experts blame Purdue for initiating the now two decades-long epidemic of prescription and heroin abuse along with thousands of overdose deaths.
Oxycodone Addiction and Treatment
Being addicted to oxycodone is a serious situation. It can lead to death by overdose or from other complications, but addiction has other lifelong effects. If you become addicted to a prescription drug, you may get in trouble with the law, lose your job, lose friends and family or do permanent damage to relationships, and suffer from any number of related health conditions.
Anyone with a history of addiction or substance abuse is at a greater risk for becoming addicted to oxycodone. A family history is also a risk factor, as is having a condition that causes chronic pain. Addiction to oxycodone by itself can be fatal, but the odds of dying from it are even greater for anyone who mixes this drug with other drugs or with alcohol.
For most people addicted to this drug, professional treatment is the only way to beat it. Treatment usually involves a combination of therapy and medications that reduce cravings and withdrawal symptoms, or that block the effects of opioids. Treatment can be conducted in a residential facility or on an outpatient basis, but it takes time and money to heal from this addiction.
All opioid painkillers are susceptible to abuse and may lead to addiction, but OxyContin made the problem worse by providing users with a way to get a big dose all at once. Purdue Pharmaceuticals settled with the federal government in 2007 and was forced to pay $635 million. The state of Kentucky, which was hardest hit by the OxyContin epidemic, is suing for more and the lawsuit has been going on for years.
Kentucky claims that Purdue misled the public about the safety of OxyContin and that they downplayed the risk of addiction. The state originally sought over $1 billion in damages from Purdue, but the pharmaceutical company finally settled for just $24 million after years of trying to avoid the lawsuit. Today, lawmakers, the court system, advocacy groups and others are working hard to correct the epidemic that began with OxyContin. Much of the damage has been done, but preventing future abuse and addiction will save many lives.