History of Oxycontin as Treatment
Oxycontin is the time-release formulation of Oxycodone, a semi-synthetic opiate developed in Germany in 1916. It (Oxycodone) was created in order to be an improvement over other opiate painkillers in use at the time. Oxycodone is a derivative of Thebaine, an opiate alkaloid. Although a major component of opium, unlike morphine and codeine, Thebaine is considered a stimulant rather than a depressant. At a high enough dose, Thebaine resembles strychnine in its effects on users.
As pain relievers, Oxycodone delivers faster, though not as long-lived, pain relief – up to four hours; Oxycontin is slower in delivering its pain relief, but a dose lasts two to three times longer than Oxycodone. They are considered agonist opioids, meaning they stimulate nerve receptors to block pain. Their effects, in addition to pain relief, include euphoria. These two responses are what make them highly addictive if there use is not monitored or it is abused.
Uses for Oxycontin
Both Oxycontin and Oxycodone are used to relieve moderate to severe pain. Oxycontin, in a class of medications called opiate (narcotic) analgesics, works by changing the way the brain and nervous system respond to pain.
It is only recently that Oxycontin is available in generic form – oxycodone ER. However, because of legal issues, it has been pulled from the market. Oxycodone, on the other hand, has numerous manifestations. When combined with acetaminophen it is marketed as Endocet, Percocet, Roxicet, Tylox, or other names; when combined with aspirin it is marketed as Endodan, Percodan, Roxiprin, and others; it is also combined with ibuprofen under the name Combunox.
Origins of Oxycontin
Oxycodone was first synthesized at the University of Frankfurt in 1916 by two chemists, Freund and Speyer, a few years after Bayer had stopped the mass production of heroin because of problems with its abuse and addiction. The belief was that a Thebaine-derived drug, while retaining the analgesic effects of morphine and heroin would not be addictive. The new derivative brought moderate success. Though still addictive, dependence took longer, making monitoring is use easier. The first prescribed use of Oxycodone was in 1917. It appeared in American pharmaceutical circles in the United States in 1939.
Manufacturer of Oxycontin
Purdu Pharma produces Oxycontin. In 1995, it received approval from the USDA and entered the U.S. pharmaceutical market in 1996. By 2001, it was the best-selling non-generic narcotic pain reliever in the U.S. Data from the U.S. Drug Enforcement Administration found that retail sales of oxycodone reached over two billion dollars by 2008. In China, Europe, and Australia, Mundipharma is the distribution company of Oxycontin for Purdu Pharma.
Physicians are the typical prescribers of Oxycontin. Its analgesic effectiveness is acknowledged, and following dosage instructions greatly reduces the risk of dependence and addiction. The medication typically begins with a low dose and may increase over time if it is warranted. Tolerance of Oxycontin is an issue, and if pain continues, the dosage may need increasing. It is here that the danger of addiction becomes possible.
Oxycontin of Abuse
Instances of recreational use of Oxycontin began increasing in the U.S. in the late 1990s, at first in rural areas of various parts of the country (thus the street name “hillbilly heroin”). Illegal acquisition of Oxycontin is gained through forged prescriptions, doctor shopping, over-prescribing, and pharmacy theft.
Three factors are believed to contribute to Oxycontin’s rise as a recreational drug:
- The large concentration of oxycodone in Oxycontin compared with other types of oxycodone containing pills
- Oxycontin’s warning not to crush the controlled-release tablets, led to many people crushing the tablets and injecting or snorting the drug in order to bypass the time-release mechanism
- Increased availability brought about by increased sales in a relatively short period of time
In 2001, Purdue Pharma permanently suspended distribution of 160 mg tablets in the U.S. because of the “possibility of illicit use of tablets of such high strength.”
Beginning in 2010, the brand name Oxycontin was reformulated to prevent the misuse and abuse of the tablets, mostly to prevent tablet grinding for inhaling or injecting, and to maintain its extended release characteristics. This reformulated product is Oxycontin OP.
In an ironic twist, one study found that abusers have turned to heroin because it is cheaper, and acts more quickly than Oxycontin OP.
Media coverage of Oxycontin
While the reception for Oxycontin among the medical community and general public has been favorable. Purdu Pharma has come under fire for some of its marketing practices. In addition, the evolution of Oxycontin into the highly addictive street drug it has become has raised several issues about how easily it can be obtained and distributed.
Purdue Pharma has been highly criticized for ignoring public health issues because of its intense lobbying practices concerning Oxycontin. In South Carolina, a strong attempt was made by Purdu Pharma to overturn the state’s requirement of prior approval before Medicaid recipients can receive Oxycontin. In 2005, the company paid almost 20 million dollars in fines for their marketing practices. The primary reason was for encouraging more frequent dosing with Oxycontin without revealing hazardous and harmful consequences.
In 2007, Purdue Pharma pleaded guilty in a Virginia federal court to charges that they misrepresented Oxycontin by claiming it did not create euphoria, and that people taking the drug at low doses could stop taking it suddenly, without symptoms of withdrawal. The company was fined over $600 million for this episode.
Most notoriously, Oxycontin has been at the center of the “doctor shopping” and “prescription shopping” scandals in Florida. In these instances, individuals simply move from clinic to clinic and obtain prescriptions for Oxycontin. Because physician and pharmacy databases are not adequately linked, tracking how frequently any one person receives and/or fills a prescription is difficult. This technique of legally obtaining the drug opens the door for it to make its way to the street and into recreational use.
Advice for families seeking help
In dealing with the possibility of addiction to Oxycontin, it is important to know the signs of abuse. These include, depression, loss of sleep, respiratory ailments, loss of memory, apathy, indifference to issues at home, work, or school, and changes in general habits and circles of friends. While many of these occur normally in the day-to-day course of life, multiple symptoms should trigger a concerned response.
If Oxycontin addiction does exist, the first step in rehabilitation is detoxification, and this requires going through withdrawal. The symptoms of oxycontin include nausea, cold sweats, diarrhea, muscle and joint pain, goose bumps, dilated pupils, a runny nose, and depression. The severity of these symptoms depends upon the level of addiction. While withdrawal is most unpleasant, it is generally not life threatening. Detoxification should always take place under medical supervision.
There are three approaches to the treatment of oxycontin withdrawal. One is abrupt cessation of the drug with no treatment – quitting “cold turkey.”
A second approach is to treat each individual symptom with a non-opiate medication; this is the most common approach in an inpatient environment. One medication is given for anxiety, another for nausea, another for diarrhea, and so on. This approach is less uncomfortable than quitting cold turkey, and is not prolonged through the use of substitute opiate medications.
The third approach is to treat withdrawal using a substitute opiate. The two substitute medications used for this are methadone and suboxone. Of the two, suboxone is preferred because it contains buprenorphine. When it binds to the opiate receptors in the brain, half the time it activates them and half the time it does nothing.
The benefit to using methadone or buprenorphine is that they stay in the body a long time and result in a more stable state that allows an individual to function in their everyday life. The patient is taken off methadone or suboxone by slowly decreasing the dosage thus avoiding severe withdrawal symptoms.
After detoxification, Oxycontin addiction needs to be treated. Long term rehab programs have the greatest success because they treat not only the substance addiction, but any co-occurring disorders that may be present. Additionally, long term therapy allows for more complete incorporation of coping skills and reformation of habits to decrease the chances of relapse.
In any addiction rehabilitation program, it is vitally important that family members participate at every level, including individual and group therapy as a family unit in order to address all the problems that accompany a family member who has an addiction. Careful study and interview with healthcare professionals at any facility will provide you with the important information you need to find a reputable treatment facility.