What
Is OxyContin?
OxyContin
is a semisynthetic opioid analgesic prescribed for chronic or long-lasting
pain. The medication’s active ingredient is oxycodone, which is
also found in drugs like Percodan and Tylox. However, OxyContin contains
between 10 and 160 milligrams of oxycodone in a timed-release tablet.
Painkillers such as Tylox contain 5 milligrams of oxycodone and often
require repeated doses to bring about pain relief because they lack the
timed release formulation.
OxyContin,
also referred to as “Oxy,” “O.C.,” and “killer”
on the street, is legitimately prescribed as a timed-release tablet, providing
as many as 12 hours of relief from chronic pain. It is often prescribed
for cancer patients or those with chronic, long-lasting back pain. The
benefit of the medication to chronic pain sufferers is that they generally
need to take the pill only twice a day, whereas a dosage of another medication
would require more frequent use to control the pain. The goal of chronic
pain treatment is to decrease pain and improve function.
How
OxyContin Abuse Differs From Other Pain Med Abuses
Abuse
of prescription pain medications is not new. Two primary factors, however,
set OxyContin abuse apart from other prescription drug abuse. First, OxyContin
is a powerful drug that contains a much larger amount of the active ingredient,
oxycodone, than other prescription pain relievers. By crushing the tablet
and either ingesting or snorting it, or by injecting diluted OxyContin,
abusers feel the powerful effects of the opioid in a short time, rather
than over a 12-hour span. Second, great profits are to be made in the
illegal sale of OxyContin. A 40-milligram pill costs approximately $4
by prescription, yet it may sell for $20 to $40 on the street, depending
on the area of the country in which the drug is sold (1).
OxyContin
can be comparatively inexpensive if it is legitimately prescribed and
if its cost is covered by insurance. However, the National Drug Intelligence
Center reports that OxyContin abusers may use heroin if their insurance
will no longer pay for their OxyContin prescription, because heroin is
less expensive than OxyContin that is purchased illegally
(2).
Crime
and OxyContin Abuse
Many
reports of OxyContin abuse have occurred in rural areas that have housed
labor-intensive industries, such as logging or coal mining. These industries
are often located in economically depressed areas, as well. Therefore,
people for whom the drug may have been legitimately prescribed may be
tempted to sell their prescriptions for profit. Substance abuse treatment
providers say that the addiction is so strong that people will go to great
lengths to get the drug, including robbing pharmacies and writing false
prescriptions.
Likelihood
of OxyContin Addiction
Most
people who take OxyContin as prescribed do not become addicted. The National
Institute on Drug Abuse (NIDA) reports:
“With
prolonged use of opiates and opioids, individuals become tolerant…require
larger doses, and can become physically dependent on the drugs.... Studies
indicate that most patients who receive opioids for pain, even those
undergoing long-term therapy, do not become addicted to these drugs.”(3)
One
NIDA-sponsored study found that “only four out of more than 12,000
patients who were given opioids for acute pain actually became addicted
to the drugs….
In
a study of 38 chronic pain patients, most of whom received opioids for
4 to 7 years, only 2 patients actually became addicted, and both had a
history of drug abuse.”4 In short, most individuals who are prescribed
OxyContin, or any other opioid, will not become addicted, although they
may become dependent on the drug and will need to be withdrawn by a qualified
physician. Individuals who are taking the drug as prescribed should continue
to do so, as long as they and their physician agree that taking the drug
is a medically appropriate way for them to manage pain.
Signs
of OxyContin Addiction
When
pain patients take a narcotic analgesic as directed, or to the point where
their pain is adequately controlled, it is not abuse or addiction. Abuse
occurs when patients take more than is needed for pain control, especially
if they take it to get high. Patients who take their medication in a manner
that grossly differs from a physician’s directions are probably
abusing that drug.
If
a patient continues to seek excessive pain medication after pain management
is achieved, the patient may be addicted. Addiction is characterized by
the repeated, compulsive use of a substance despite adverse social, psychologic,
and/or physical consequences. Addiction is often (but not always) accompanied
by physical dependence, withdrawal syndrome, and tolerance. Physical dependence
is defined as a physiologic state of adaptation to a substance. The absence
of this substance produces symptoms and signs of withdrawal. Withdrawal
syndrome is often characterized by overactivity of the physiologic functions
that were suppressed by the drug and/or depression of the functions that
were stimulated by the drug. Opioids often cause sleepiness, calmness,
and constipation, so opioid withdrawal often includes insomnia, anxiety,
and diarrhea.
Pain
patients, however, may sometimes develop a physical dependence during
treatment with opioids. This is not an addiction. A gradual decrease of
the medication dose over time, as the pain is resolving, brings the former
pain patient to a drug-free state without any craving for repeated doses
of the drug. This is the difference between the formerly dependent pain
patient who has now been withdrawn from medication and the opioid-addicted
patient: The patient addicted to diverted pharmaceutical opioids continues
to have a severe and uncontrollable craving that almost always leads to
eventual relapse in the absence of adequate treatment. It is this uncontrollable
craving for another “rush” of the drug that differentiates
the “detoxified” but opioid addicted patient from the former
pain patient. Theoretically, an opioid abuser might develop a physical
dependence, but obtain treatment in the first few months of abuse, before
becoming addicted. In this case, supervised withdrawal (detoxification)
followed by a few months of abstinence-oriented treatment might be sufficient
for the non-addicted patient who abuses opioids. If, however, this patient
subsequently relapses to opioid abuse, then that would support a diagnosis
of opioid addiction. After several relapses to opioid abuse, it becomes
clear that a patient will require long-term treatment for the opioid addiction.
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Notes
(1)
Bonfield, Tim, “OxyContin users wary of backlash,” Cincinnati
Enquirer , February 26, 2001, retrieved March 2, 2001, Enquirer.com
(2) Tina Renee Bullins,
CEO, Life Center of Galax, interview by Cheryl Serra, March 2, 2001.
(3)
Roch, Timothy, “The potent perils of a miracle drug.” Time,
February 28, 2001.
