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Prescription drug abuse is on the rise in the United States. According to the 1999 National Household Survey on Drug Abuse, in 1998, an estimated 1.6 million Americans used prescription pain relievers non-medically for the first time. This represents a significant increase since the 1980s, when there were generally fewer than 500,000 first-time users per year. From 1990 to 1998, the number of new users of pain relievers increased by 181 percent. In total, in 1999, an estimated 4 million people — almost 2 percent of the population aged 12 and older — were abusing certain pain relievers.
OxyContin® is a powerful drug that contains a much larger amount of the active ingredient, oxycodone, than other prescription opiate pain relievers. While most people who take OxyContin as prescribed do not become addicted, those who abuse their pain medication or obtain it illegally may find themselves becoming rapidly dependent on, if not addicted to, the drug.
OxyContin is a semi-synthetic 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,” “OC.,” 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.
OxyContin abusers either crush the tablet and ingest or snort it or dilute it in water and inject it. Crushing or diluting the tablet disarms the timed-release action of the medication and causes a quick, powerful high. Abusers have compared this feeling to the euphoria they experience when taking heroin. In some areas, the use of heroin is overshadowed by the abuse of OxyContin.
Abuse of prescription pain medications is not new. Two primary factors, however, set OxyContin abuse apart from other prescription drug abuse. 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. While a 40- milligram pill costs approximately $4 by prescription, it may sell for $20 to $40 on the street, depending on the area of the country in which the drug is sold. OxyContin abusers may use heroin if their insurance will no longer pay for their OxyContin prescription, because heroin is less expensive than OxyContin purchased illegally.
Many reports of OxyContin abuse have occurred in rural areas that have housed labor-intensive industries, such as logging or 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
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.
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.
In short, 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.
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 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, psychological, and/or physical onsequences. Addiction is often (but not always) accompanied by physical dependence, withdrawal syndrome, and tolerance. Physical dependence is defined as state of adaptation to a substance. The absence of this substance produces symptoms and signs of withdrawal. Withdrawal syndrome is often characterized by over-activity 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 may sometimes develop a physical dependence during treatment with opioids. 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.
Many U.S. treatment facilities do not offer medication-assisted treatment. However, due to the strength of OxyContin and its powerful addiction potential, medical complications may be significantly increased by quickly withdrawing individuals from the drug. Premature withdrawal may cause individuals to seek heroin, and the quality of that heroin will not be known.
In addition, these individuals, if injecting heroin, may also expose themselves to HIV and hepatitis. Most people addicted to OxyContin need medication-assisted treatment. Even if individuals have been taking OxyContin legitimately to manage pain, they should not stop taking the drug all at once. Instead, their dosages should be tapered down until medication is no longer needed. It is important to refer patients to facilities where they can receive appropriate treatment.
Two types of treatment have been documented as effective for opioid addiction. One is a longer term, inpatient, therapeutic community type of treatment and the other is long-term, medication-assisted medical detoxification program. Clinical trials using medications to treat opioid addiction have generally included subjects addicted to diverted pharmaceutical opioids as well as to illicit heroin. Therefore, there is no medical reason to suppose that the patient addicted to diverted pharmaceutical opioids will be any less likely to benefit from medication-assisted treatment than the patient addicted to heroin.
Some opioid-addicted patients with very good social supports may occasionally be able to benefit from antagonist maintenance with naltrexone. This treatment works best if the patient is highly motivated to participate in treatment and has been adequately detoxed from the opioid of abuse. Most opioid-addicted patients in a medical detoxification unit will do best with medication that is either an agonist or a partial agonist. Methadone and levo alpha acetylmethadol (LAAM) are the two agonist medications currently approved for addiction treatment in this country. Presently there is no partial agonist approved by the Food and Drug Administration (FDA) for use in narcotic treatment, although buprenorphine holds great promise.
Methadone or LAAM may be used for OxyContin addiction treatment or, for that matter, treatment for addiction to any other opioid, including the semi-synthetic opioids. This is not a new treatment approach. For instance, Alaska estimates that there are 15,000 prescription opioid abusers in the State and that most methadone patients are not heroin-addicted individuals. In addition, a significant percentage of patients in publicly supported methadone programs were not being treated for heroin addiction but for abuse of semisynthetic opioids (e.g., hydrocodone). For certain patient populations, including those with many treatment failures, methadone is the treatment of choice.
It is important to assess an individual’s eligibility for medication-assisted treatment with methadone or LAAM to determine if an individual is eligible for this type of treatment and if it would be appropriate. The assessment may take place in a medical detoxification facility such as Rimrock’s. Final assessment of an individual’s eligibility for medication-assisted treatment must be completed by licensed treatment program staff. The preliminary assessment should include the following areas:
For further information on Rimrock Foundation’s treatment of OxyContin Addiction, call Jamie Hixson, Admissions Supervisor at 1-800-227-3953 or 1-406-248-3175, or visit our website at rimrock.org. For more educational information on OxyContin Addiction, contact the Rimrock Foundation Library at 1-800-227-3953 or 1-406-248-3175.