We’ve been hearing a lot about OxyContin in the news recently, namely with regard to a serious abuse problem that is developing around this drug. On the other hand it seems to have the ability to revitalize the lives of patients who, without it, are incompacitated by pain. What I’m not getting from the news is the exact nature of the abuse that is going on. I know it’s addictive, but there are plenty of other addictive painkillers that are legally prescribed. Is there something about OxyContin specifically that makes it more addictive, or in some way more attractive to drug abusers? Or was it initially touted as being non-addictive, and overprescribed in the beginning?
I doubt any opiate, in this day and age, was thought to lack addiction potential (heroin was, when Bayer first brought it to market, considered a non-addictive cure for morphine addiction, IIRC). I believe the drug in question is prescribed in time release pill form that abusers crush and ingest. The proprietor is supposedly working on a form of time-release dosage that will be rendered inert if crushed - a so-called “smart pill.”
Oxycontin is designed to be slow-release oxycodone, a very potent opiate. When swallowed whole, its pain-relieving effects last for 12 hours.
But abusers don’t swallow it whole. They grind it up and swallow, snort, or inject it, getting the high dose of drug intended to be leached out of the pill over half a day, in just a few minutes. This is what makes it so abusable. That and the fact that unlike percocet and other similar pain-killers, it contains no acetaminophen (tylenol). Which can prevent the abuser from taking too much of it at a time, as an overdose of acetaminophen can kill.
So there you have it, pure oxycodone in high doses, when crushed giving rapid release of the drug. They are planning to make a version containing naltrexone, a drug which blocks opiate receptors, and stops the effect of the pain-killer opiate. The naltrexone would not be released if the pill was swallowed whole, but would be released, and block the effect of the drug, if the pill were crushed.
Qadgop, MD
And that answers that. If the moderators want to close this thread, by all means let them proceed.
Well one more tidbit:
There was an NPR story last week on OxyContin, and there was mention of Purdue Pharma marketing the drug as being much less addictive than other narcotic painkillers.
Well, if taken as directed, the drug does give less euphoria than percocet, demerol or morphine, because of it’s slow-release properties. In some people’s minds less euphoria = lower addiction potential. So I don’t think that argument by Purdue was totally out of line.
Opiates are extremely good for dulling pain. The problem is they are also very addictive. Their addictive potential is directly related to their euphoric effects. A general rule is that quick-release/short-acting opiates induce the most euphoria, and hence are the most addictive. Slow-release formulations of codeine and morphine have been developed “Oxycontin” and “MSContin” are the brand names. These depend on their coatings and binding agents for the slow release, which is easily defeated by crushing the tablets in the mouth or crushing them and taking them parenterally (by injection or snorting).
There are two long acting opiates, methadone and levorphanol, that are long-acting/slow-release by virue of their chemistry and metabolism. These are the drugs I prefer to use to treat chronic non-malignant pain. They are highly effective and are the most difficult opiates to abuse.
What’s the shelf-life of oxycodone pills in the form of Percocet? I have a perscription of 5/375 perco that my oral surgeon gave me when he yanked my wisdom teeth. I didn’t take any; pain wasn’t that bad. I’m probably going to toss them when I move in a week here - one less thing to lug around. But I’m curious how stable they are and how long they’d stay active for sitting in your average medicine cabinet. Also, is there any kind of disposal info I should know about this drug? I’m not going to get in trouble with the law just tossing them in the trash, am I?
-Ben
Very true, Neurodoc. But I’ve got a few addicts on methadone, and it’s truly hell trying to get them off of it. The withdrawal lasts about 6 weeks, as opposed to 3 days or so for oxycodone. And a good addict can abuse and become dependent on surprising substances. Ever deal with a dextromethorphan addict? I have. But your point about long-acting analgesics is well taken and appreciated.
modronin2 I think we’ll need a pharmacist to answer your question about shelf life. If you want to get rid of them, just flush them down the sink or toilet.
Very true, Neurodoc. But I’ve got a few addicts on methadone, and it’s truly hell trying to get them off of it. The withdrawal lasts about 6 weeks, as opposed to 3 days or so for oxycodone. And a good addict can abuse and become dependent on surprising substances. Ever deal with a dextromethorphan addict? I have. But your point about long-acting analgesics is well taken and appreciated.
modronin2 I think we’ll need a pharmacist to answer your question about shelf life. If you want to get rid of them, just flush them down the sink or toilet.
You are right, Quagdop. Methadone is notoriously hard to “kick” for addicts. In medical terms, it leads to a more severe “abstinance syndrome” than shorter acting opiates, like morphine and heroin. On the other hand, if it is being used for chronic pain that should not be a problem. And both methadone and levorphanol are quite excellent pain-killers with the least euphoric effects of all strong opiates.
And it is definitely the euphoria that drives addicts to abuse opiates. An opiate naive person (such as myself) would probably get very “stoned” if he took a standard does of methadone or levorphanol. That would last for a few doses, but would soon wear off, while the analgesic effect would continue.
As regards opiate “addiction” and “tolerance” it has been my experience that a specific addictive personality is required for these to become a clinical problem in chronic opiate treatment for pain. I have treated many patients with chronic pain who have done well on long-term non-escalating doses of opiates for non-malignant chronic pain. Invariably these patients have never had problems with substance abuse. Those who seem to have problems, mainly addictive behaviors and the need to use escalating doses, have been among those who have had a history of substance abuse, including alcohol.
In my experience, having the disease of addiction tends to lead to “the addictive personality” rather than the reverse.