Oxycodone - Overview
Overview
For many thousands of years, people have used the dried sap of the opium poppy plant to ease pain and to experience a feeling of well-being. (An entry on opium is available in this encyclopedia.) Ancient writings from Greece, Egypt, and Rome all describe many uses for opium, including its ability to poison and kill people. In 1524 Swiss doctor Paracelsus (1493-1541) mixed opium with alcohol and called it laudanum, the Latin word for "to be praised." In the nineteenth century, chemists figured out how to separate opium into its three main components or active ingredients: morphine, codeine, and thebainepronounced thee-BAIN; one of the active alkaloids in opium, used to create synthetic painkillers. . (Entries for morphine and codeine are available in this encyclopedia.)
Oxycodone is created in laboratories using thebaine. It was first developed in Germany in 1916, in one of many attempts to formulate a painkiller that would not be habit-forming. Earlier attempts to isolate the painkilling features of opium from its mind-altering and addictive traits were unsuccessful. Oxycodone proved to be no different. It worked as an analgesic, or painkiller. However, it also created euphoria, a state of extreme happiness or feelings of well-being. Euphoria occurs with all opiatesAny drug derived from the opium poppy or synthetically produced to mimic the effects of the opium poppy; opiates tend to decrease restlessness, bring on sleep, and relieve pain..
In the twentieth century, oxycodone was used primarily as a short-term pain reliever in cases where aspirin or acetaminophen (Tylenol) did not produce enough relief. People who had dental surgery, minor injuries, or post-childbirth discomfort would typically take Percodan or Percocet for a few days or weeks. Then they stopped the medicine without side effects when the pain went away. Percodan was usually prescribed for pain accompanied by swelling or inflammation.
Typically, Percodan and Percocet tablets work for about four to six hours. They can cause upset stomach or nausea. Therefore, they are not very useful for people suffering from long-term pain caused by cancer, osteoarthritis (arthritisPainful swelling of joints caused by abnormal bone growth or wear and tear on the joint. of the bones), severe back injuries, and certain neurological (nerve) disorders. Patients with these disorders might find themselves waking up in the middle of the night, in pain, with the medicine having worn off. Many pharmaceutical companies worked to find strong pain relievers that would last twelve hours or longer, so people could take fewer doses of medicine during the day and sleep through the night.
Viewed as a Breakthrough in Pain Management
When Purdue Pharma introduced OxyContin in 1995, the company was confident that it had created a product to help the millions of people suffering chronic (ongoing) moderate to severe pain. OxyContin pills were formulated to dissolve slowly and release oxycodone into the bloodstream at a regular rate. One OxyContin tablet is meant to last twelve hours. When used properly, it does not cause major mind-altering effects. In terms of strength, OxyContin falls between morphine, a powerful painkiller, and codeine, a milder variation usually used in cough medicines. The chemists at Purdue Pharma thought they had created a safe product that, when used correctly, could help people in pain to function normally and to sleep at night.
OxyContin was released as a Schedule II controlled substance requiring a prescription from a doctor certified by the U.S. Drug Enforcement Administration (DEA). It was originally available in doses of 10 milligrams (mg), 20 mg, 40 mg, 80 mg, and 160 mg. The lower doses could be prescribed to people who had never used opiate painkillers before. The higher doses—80 and 160 mg—were recommended only for people with some tolerance, or prior use, of opiates. Tolerance occurs when users need more and more of a drug to create the medication's original effect. The scientists at Purdue Pharma also believed that, in some cases, OxyContin could be prescribed for use "as needed" for flare-ups of pain that were not constant, or for minor post-surgical pain.
Beginning in 1996, Purdue Pharma started an aggressive campaign of marketing and education about OxyContin. The company sought to teach not only pain specialists about the drug, but also primary care doctors ("family doctors") who might not know as much about opiate medicines. At the same time, the Food and Drug Administration (FDA) required that every OxyContin prescription contain a warning that crushing or chewing the pills would release a massive dose of oxycodone all at once, with possible deadly results.
Sales and Misuse Skyrocket
What happened over the next four years took both the FDA and Purdue Pharma by surprise. Legal sales of OxyContin skyrocketed. "By 2001, sales had exceeded $1 billion annually, and OxyContin had become the most frequently prescribed brand-name narcoticA painkiller that may become habit-forming; in a broader sense, any illegally purchased drug. medication for treating moderate-to-severe pain in the United States," noted researchers for the U.S. Government Accountability Office (GAO) in America's Intelligence Wire. At the same time, the GAO report stated, drug abusers quickly learned that crushing and snorting, eating, or injecting OxyContin could produce a fast high similar to that of heroin. "The safety warning on the label that advised patients not to crush the tablets … may have inadvertently alerted abusers to a possible method for misusing the drug," the report concluded.
Within three years of OxyContin's release, abuse of the drug was reported in Appalachia, the mountainous parts of the states of Virginia, West Virginia, Maryland, Kentucky, and Pennsylvania. Illegal use also occurred in Maine, Ohio, Florida, and some of the large cities in the northeastern United States. The DEA confirmed 146 deaths from OxyContin overdose between 2000 and 2001. Some of these deaths occurred in patients who were prescribed the product legally for relief of pain. However, most of the deaths were related to recreational use, which is using the drug to get high, not for medical reasons. During the same period, drug abuse clinics in rural areas began to see many more patients suffering from addiction to OxyContin.
In 2001, the FDA and Purdue Pharma introduced a "risk management plan" to try to stop OxyContin from entering the illegal drug market. The highest dose of the medication was removed from the market. Purdue launched a Web site aimed at teens called painfullyobvious.com to alert abusers to the dangers of addiction and sudden death from improper use. The FDA also strengthened the language in the warning labels placed on OxyContin products. Even so, in 2001 and 2002, sales of OxyContin exceeded $1 billion per year, according to the GAO report. The 2004 Monitoring the Future survey reported a "significant increase" in OxyContin abuse among teenagers between 2002 and 2004.
The Problems of Abuse
The fallout from abuse of OxyContin has been devastating for legal users and abusers alike. Patients suffering from real pain find it difficult to get prescriptions for the product because doctors fear being seen as lawbreakers. People who have used OxyContin recreationally face all the difficult physical and psychological issues of addiction and withdrawal. People undergoing withdrawal experience various physical and psychological symptoms as they gradually reduce the amount of drug taken until they can stop all use. Purdue Pharma is working on variations of OxyContin that will not be suitable for abuse. However, the company predicts it may be years before such a product finds its way into pharmacies.
While overall use of illegal drugs is down in the young adult population, the misuse of prescription painkillers is on the rise. National drug task forces and "risk management plans" seek to educate all users about the dangers of strong opiate medications and the harmful effects their misuse can have.
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