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Oxycontin Addiction, Abuse and Treatment
OxyContin is an opioid agonist first introduced in 1995. It is a Schedule 11 controlled drug used in the treatment of severe pain disorders. OxyContin is a long acting formulation of oxycodone, the medication's active ingredient. Today, various formulations of oxycontin are available.
The drug is a powerful pain killer and widely used in clinical medicine. However, because of its mood altering effects, Oxycontin, like morphine, can be abused and unlawful possession may be subject to criminal prosecution. Over the past decade, OxyContin has become a popular drug and its mood altering effects has led to a significant increase in illicit usage.
Introduction
Besides pain, oxycontin can decrease anxiety, cause euphoria, mental relaxation, respiratory depression, constipation, meiosis (papillary constriction) and suppression of cough. Like all opioid analgesics, with increasing doses there is increasing pain relief. With oxycontin, like morphine, there is no definite maximum dose; the upper limit of pain control is controlled by side effects- the most dangerous of which is respiratory depression. The precise mechanism of oxycontin is unknown. However, it may interact with opioid receptors located in the brain and spinal cord.
Therapeutic uses
OxyContin can be used to treat moderate to severe pain associated with trauma, injuries, muscle pain, dislocations, fractures, neuralgia, arthritis, lower back pain, and pain associated with cancer. Because of the potency of oxycontin and potentially serious side effects, the drug has to be monitored. Treatment should be continuously assessed and adjusted based upon the patient's own reports of pain and side effects and the physician’s clinical judgment.
Since the drug is a controlled substance, a prescription is required to obtain it. Today, it is the most frequently prescribed opioid pain killer in North America.
Dose
OxyContin tablets are available as a controlled-release oral formulation of oxycodone hydrochloride and indicated for the management of moderate to severe pain when a continuous, daily analgesia is needed for a long period of time. The drug is always administered orally. The controlled-release product has a long duration of action (8-12 hours). It is recommended that OxyContin not be used for sporadic pain relief.
OxyContin tablets should be swallowed whole. It is recommended that the tablets not be broken, chewed or crushed, otherwise a rapid release of the drug can occur and lead to severe side effects.
The drug should always be started at the lowest dose in patients who have never been on opioids before, or in those patients who are receiving concurrent treatment with muscle relaxants, sedatives, or other CNS depressants. Concomitant analgesia can be provided with non steroidal anti inflammatory drugs to minimize side effects. Patients should not receive any other type of opioid drugs while on Oxycontin
Oxycontin Abuse and Withdrawal
Since the introduction of OxyContin in 1995, there has been a dramatic increase in abuse of this narcotic. Unlike hydrocodone and its derivatives, whose potential for abuse is limited by the presence of aspirin/paracetamol, OxyContin contains only oxycodone. The drug is easily abused by simply crushing the tablets and either ingestion, injection, inhalation or placed rectally. The drug can have serious side effects when injected as it has a prolonged extended action.
Oxycontin is frequently made more available by "doctor shopping," where individuals, who do not have a legitimate illness, repeatedly visit many doctors to acquire large amounts of controlled substances. Other methods of obtaining oxycontin include pharmacy diversion, robbery, fake/stolen prescription, the internet and improper prescribing practices by physicians.
Recent reports indicate that non medical use of Oxycontin is relatively high among teenagers. The increased misuse of the drug has led to a numerous emergency admissions and even deaths. Many States have introduced legislation to decrease the illegal use of Oxycontin. Numerous States have also introduced prescription monitoring and banned the sale of the drug over the internet. Despite all the increased efforts by the FDA, DEA, and state/local authorities, the illicit use of Oxycontin is at an all time high. Over the last decade the increased illicit use of oxycontin has led to the manufacture of “fake” oxycontin pills all over north America.
Sudden stoppage of oxycontin can result in serious withdrawal symptoms. The withdrawal syndrome may be characterized by restlessness, lacrimation, restlessness, anxiety, rhinorrhea, yawning, perspiration, chills, myalgia, and mydriasis. Other symptoms also may develop, include irritability, vague pain, weakness, abdominal cramps, insomnia, nausea, anorexia, vomiting, diarrhea, or increased blood pressure, respiratory rate, or heart rate.
Both physicians and pharmacies now maintain careful record-keeping of prescribing information, including quantity, frequency, and renewal requests. Adequate evaluation of the patient, proper prescribing practices, frequent assessment of pain, proper dispensing and storage are recommended steps that may help limit the abuse of OxyContin.
Side effects
Respiratory depression is a major severe complication of oxycontin. Respiratory depression is a cause of concern in elderly or debilitated patients, and usually follows after the use of large initial doses in non tolerant patients, or when other opioids are given concurrently. In the community, the majority of OxyContin-related deaths have occurred in individuals who were ingesting large quantities of oxycontin in combination with either alcholol or benzodiazepines.
Oxycontin should be used with extreme caution in patients with significant lung disorders such as chronic obstructive pulmonary disease, heart failure or pre-existing respiratory depression. In such patients, even usual therapeutic dose of oxycontin may suppress the respiratory drive to the point of arrest.
OxyContin may cause severe hypotension. There is an added risk to individuals whose ability to maintain blood pressure has been compromised by a depleted blood volume, or after concurrent administration with drugs such as phenothiazines or other agents which compromise vasomotor tone. Oxycontin, should be administered with caution to patients in circulatory shock, since vasodilatation produced by the drug may further reduce cardiac output and blood pressure.
Like other opioid narcotics, oxycontin can be fatal at high doses or when combined with other brain depressants such as alcohol.
Precautions
Oxycontin, like all opioid analgesics, has a narrow therapeutic index in certain patient populations, especially in those taking other CNS depressant drugs. Its use should be reserved for cases where the benefits of opioid analgesia outweigh the known risks of respiratory depression, altered mental state, and postural hypotension. The administration of oxycontin may obscure the diagnosis or clinical course in patients with acute abdominal conditions. Oxycontin may aggravate convulsions in patients with seizure disorders.
Contraindications
OxyContin is not indicated for use for intermittent or mild pain after surgery. It is not to be used in cases where the pain is not expected to last a prolonged period of time.
Drug Interactions:
Use with CNS Depressants
OxyContin, like all opioid analgesics, should be used with caution in patients who are concurrently taking other CNS drugs like sedatives, anti depressants, tranquilizers or alcohol. Combination of oxycontin with these drugs can lead to respiratory depression, hypotension, and profound sedation or coma and even death. It is recommended that the smallest dose of oxycontin be used if required in these patients.
Pregnancy
The drug should not be taken by pregnant females and nursing mothers. Neonates whose mothers have been taking oxycontin chronically may exhibit respiratory depression and/or withdrawal symptoms, either at birth and/or in the nursery. Breast feeding should not be undertaken while a patient is receiving OxyContin because of the possibility of sedation and/or respiratory depression in the infant.
Pediatric and Elderly Patients
The safety and effectiveness of OxyContin has not been established in pediatric patients below the age of 18. As with all opioids, the starting dose should be reduced to 1/3 to 1/2 of the usual dosage in debilitated, non-tolerant patients. Respiratory depression is the chief hazard in elderly or debilitated patients.
Summary
It is highly recommended that patients receiving OxyContin tablets or their caregivers should be informed about the following:
1. Oxycontin is a strong pain killer and similar to morphine.
2. Oxycontin should be ingested whole and not broken, chewed, or crushed- which can result in a risk of fatal overdose.
3. if pain persists despite oxycontin, patients should see their physicians to optimize therapy.
4. the dose of oxycontin should not be changed unless recommended by the physician.
5. Concerns about abuse and addiction should not deter proper pain management. The development of addiction to opioid analgesics in properly managed patients with pain is rare.
References
1. Hydrocodone and Aspirin (Damason P, Mason). In: PDR Physicians' desk reference. 49th ed. 1995. Montvale, NJ: Medical Economics Data Production Company, 1995: 1434.
2. Gutstein, HB.; Akil, H. Opioid analgesics. In: Hardman JG, Limbird LE. , editors. In Goodman and Gilman’s The Pharmacological Basis of Therapeutics. 10th ed. New York, NY: McGraw-Hill; 2001.
3. Savage SR. Opioid use in the management of chronic pain. Med Clin North Am. 1999; 83:761–786.
4. Stein CS. The control of pain in peripheral tissue by opioids. N Engl J Med. 1995; 332:1685–1690.
5. Internal Analgesics and Antipyretics Table. In: Krogh CME, editor. Self-Medication Product Information. Volume 2, 4th edition. Canadian Pharmaceutical Association, 1993: 205, 207, 208, 211.
Source: www.addictionsearch.com/treatment_articles/article/oxycontin-addiction-abuse-and-treatment_16.html
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