Oxycodone (Encyclopedia of Drugs and Addictive Substances)
- What Is It Made Of?
- Are There Any Medical Reasons for Taking This Substance?
- Usage Trends
- Three Types of Doctor Shoppers
- Treatment for Habitual Users
- For More Information
What Kind of Drug Is It?
Oxycodone is a painkiller derived from the opium poppy plant. It is a synthetic drug, meaning that it is chemically altered in the laboratory. Sold mostly in prescription pill form, oxycodone is meant to be used by people suffering moderate to severe pain that is expected to last for more than a few weeks. The drug must be used with great care, since it can be habit-forming even for people who take it as directed. For those who use it illegally, it can be as addictivend every bit as dangerouss heroin. (An entry on heroin is available in this encyclopedia.)
Oxycodone can be found in many prescription painkillers. But it is mainly associated with three brand-name drugs: 1) Percocet, a combination of oxycodone hydrochloride and acetaminophen (Tylenol); 2) Percodan, a combination of oxycodone hydrochloride and aspirin; and 3) OxyContin, a time-release formula of oxycodone hydrochloride. These prescription medicines also find their way into drug dealers' hands and are sold to users who want to get high. Since its introduction in the mid-1990s, OxyContin, in particular, has become a widely abused drug in some parts of the United States. The federal government and the maker of the drug, Purdue Pharma, are working together to reduce OxyContin abuse.
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 . (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 ( 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 doses0 and 160 mgere 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.
What Is It Made Of?
Oxycodone is created from thebaine, one of twenty compounds in the opium poppy plant. Of the various alkaloids in opium, the most important are morphine, codeine, and thebaine. Thebaine does relieve pain, but it also causes the opposite of euphoria, better known as dysphoria (diss-FOR-ee-yuh), a feeling of depression and anxiety. Thebaine is altered to form oxycodone. The drug works more like morphine and codeine. At comparable doses, oxycodone is not as strong as morphine but is stronger than codeine.
When mixed with over-the-counter analgesics such as aspirin or acetaminophen, oxycodone provides a boost of pain relief beyond the power of the over-the-counter drugs. These products come in pill or liquid form. OxyContin, which also comes in pill form, is simply oxycodone hydrochloride with no other active ingredients. The oxycodone is embedded in a slow-dissolving, inactive compound that releases the medicine into the bloodstream at regular intervals. Because the drug releases slowly, each OxyContin pill has a high dose of the drug, much more than the patient needs hour by hour.
How Is It Taken?
The immediately acting forms of oxycodone are best known under the brand names Percodan, which contains aspirin, and Percocet, which contains acetaminophen. They come in pill or liquid form and are meant to be taken every four to six hours as needed for pain. Doctors prescribe Percodan for patients who have swelling or inflammation because aspirin reduces swelling. The pills generally begin working within thirty minutes and wear off slowly. Patients using Percodan and Percocet need to follow doctors' orders, as an overdose of aspirin can lead to internal bleeding, and an overdose of acetaminophen can cause liver damage. (An entry for over-the-counter drugs is available in this encyclopedia.)
OxyContin comes in pill form and begins working within minutes of being swallowed. Its continuous-release formula sends small amounts of the painkiller into the bloodstream regularly, so that patients do not feel the return of pain or "breakthrough" pain during the twelve hours when the dose is in the body. (Breakthrough pain is a bout of intense pain that occurs rapidly and lasts several hours, despite the patient's use of longer-acting pain medicine.) Because the oxycodone releases slowly, patients using the medication properly also do not feel the side effects of opiate use, or feel the effects only slightly as a bit of dizziness or drowsiness. Upset stomach sometimes occurs with Percodan and Percocet, but is usually not seen with OxyContin.
Are There Any Medical Reasons for Taking This Substance?
Almost everyone will experience a period of pain sometime in life. Doctors deliver babies, remove wisdom teeth, set broken bones, and perform surgery on the internal organs. In almost all of these cases, recovering patients receive some sort of opiate or painkiller for various periods of time after a medical procedure. Usually patients in these cases are eager to quit using the pain pills as they start feeling better. These patients either cease using the prescription drugs and move to over-the-counter drugs, or they just stop all pain medication.
OxyContin was released to the U.S. market at a time when patients and medical providers were voicing concerns about the need for better pain management for a number of chronic, or ongoing, pain disorders. Cancer patients often suffer a great deal of long-lasting pain as growing tumors press on nerves and vital organs. People with back injuries and herniated disksA rupture of a spinal disk that puts painful pressure on nerves in the spinal column. suffer constant pain that disrupts sleep and activity. Arthritis is a condition of abnormal bone growth that can cause intense pain, stiffness in joints, and difficulty in movement. Some types of nerve damage result in pain or numbness in the limbs, hands, and feet. Patients with these illnesses sometimes cannot function very well or at all without a treatment program of prescription pain relief.
When properly administered by a doctor who understands the properties of opiates, oxycodone products provide relief for moderate to severe pain without the more sedating side effects of morphine-derived medications. The products have a legitimate medical use.
Shortly after its introduction into the prescription market in the mid-1990s, OxyContin became one of the most popular medications for moderate to severe pain. By 2001 it was the nation's top-selling prescription pain reliever, according to the GAO report. More than 7 million prescriptions were being written for the drug each year. This success provided 90 percent of Purdue Pharma's sales income for the year 2002. The drug was being marketed not only to cancer, arthritis, and back pain patients, but also to those with acquired immunodeficiency syndrome (AIDS), people injured in automobile crashes or sporting events, and people with many kinds of moderate pain.
Abuse on the Rise
Beginning in the rural areas of Appalachia, law enforcement officers saw OxyContin falling into illegal use. Some sources claim that the Appalachian region has physically difficult jobs in coal mining and timber production. Thus, many people there need pain pills. Some of the area's people are also poor. Some patients discovered that they could get a prescription for OxyContin at a cost of two to four dollars per pill and then sell the drug illegally for as much as forty dollars per pill. Theft of prescriptions from homes, and theft of OxyContin from pharmacies, followed.
Illegal use of OxyContin only accounts for a small percentage of its users, however. Doctors prescribe the vast majority of the medicine to people who report pain. Of course, some doctors are dishonest, and some patients are not honest either. Some patients "doctor shop," moving from one doctor to another, reporting the same symptoms, and getting prescriptions from each doctor. A number of doctors have been arrested and jailed for writing too many prescriptions for narcotics such as OxyContin. Sometimes thieves steal prescription pads and write their own orders for drugs.
According to the Monitoring the Future survey, OxyContin abuse is now widespread throughout the United States, and it is growing. The report noted that 5 percent of twelfth graders, 3.5 percent of tenth graders, and 1.7 percent of eighth graders had used OxyContin at least once in 2003. A 2004 Newsweek story declared that illegal OxyContin use had spread to twenty-three states, including areas of New England, the Mid-Atlantic, the Southeast, Ohio, and Alaska. The hardesthit state is Kentucky.
In 2005, the Partnership for a Drug-Free America released the results of its study on teens and substance abuse. The survey found that teens were increasingly abusing prescription drugs such as OxyContin, Vicodin, Ritalin, and Adderall (see chart). As a result of this trend, youth were called "Generation Rx." However, oxycodone is not just abused by teens. Use of the drug reaches all segments of societyoung and old, rich and poor, males and females. In 2003, the Orlando Sentinel reported that most of the deaths in Florida from oxycodone "were middle-age white men." As such, the drug's nickname "hillybilly heroin" is misleading.
Effects on the Body
Pain relievers such as aspirin and ibuprofen work at the site of the pain to reduce irritation. Oxycodone works differently. It moves into the brain and central nervous system and binds to receptors (nerve endings) that seek pleasure-enhancing and painkilling . Once the brain receives the medicine's message in its receptors, the patient no longer feels the pain. The condition causing the pain does not change, but the patient relaxes and the sensation of the pain is gone.
Taken as directed, oxycodone-containing medicines generally cause few side effects. Patients may feel slightly nauseous, drowsy or dizzy, or have a little less energy. They may also experience constipation, the inability to have a bowel movement, which is a common side effect of all opiate medicines. When the patient's pain improves, the doctor may slowly taper the dose of painkiller so that the patient does not experience any symptoms of withdrawal from the medicine. Gradually the dose is lowered until it is no longer needed. The recovery is complete.
For patients with ongoing or chronic pain, such as those suffering from cancer, the doctor may increase the dose of oxycodone over time as the pain worsens. The patient may also develop a tolerance to the drug and need more medicine to achieve the same results. This can be done safely if the patient has been taking opiate medications for some time.
A Dangerous Addiction
When oxycodone painkillers are abused, their effects are similar to the heroin high. This is because each extended-release dose of oxycodone contains a large amount of the drug. It is designed to be taken slowly, not to flood the body all at once. When crushed and eaten, snorted, or injected, a high dose of oxycodone floods the body and causes a rush of euphoria. The drug literally overwhelms all of the brain's receptors that search for endorphinsA group of naturally occurring substances in the body that relieve pain and promote a sense of well-being. (natural pleasure-enhancing molecules) and (molecules that act to relieve pain and to produce drowsiness). The user feels free of pain, anxiety, and unhappiness.
After a few minutes of this intense euphoria, the user settles into a longer period of general pleasurable drowsiness and a dreamlike state. A mild allergic reaction may cause the skin to itch or to break out in a rash. Gradually, as the drug exits the brain, the heightened pleasure is replaced by a sensation of unease return to "normal" that may send the user in search of another dose of the drug.
OxyContin is particularly dangerous in abuse situations because crushing it releases a very high dose of the drug. All opiates work on the part of the brain that controls breathing. An overdose of any of them can cause a user to stop breathing. If the user is alone at the time, he or she could die of suffocation. The inability to breathe is one of the leading causes of death in oxycodone overdose cases. (Warning labels on each bottle alert the user to this possibility.) In the case of an oxycodone overdose, which leads to coma and irregular breathing, the patient should be rushed to an emergency room,
where doctors will administer the drug naloxone (Narcan), a chemical that quickly rids the body of opiates.
Some drugs need to "build up" in the body before the user suffers a fatal overdose. That is not the case with opiates. They can be fatal with the first use, or at any time. Even people with a high tolerance for oxycodone can experience breathing problems if they take the medicine improperly. Abusers run a high risk of fatal breathing problems each time they mishandle a pill.
Repeated use of oxycodone, especially to get high, causes tolerance and addiction. Users will need higher and higher doses of the medicine to achieve the high. As the drug wears off, the body will react with uncomfortable withdrawal symptoms. These include yawning, restlessness and anxiety, insomnia, "goose bumps," cold sweats, sharp pains in the stomach, vomiting, diarrhea, muscle aches and tremors, and runny nose. As the abuser faces these uncomfortable symptoms, he or she is aware that more of the drug will ease these effects. The knowledge that the drug can make one feel better, even if only for a short period, becomes the greatest difficulty facing the recovering addict. Users sometimes forget that the short-lived high will again be followed by uncomfortable withdrawal symptoms.
Even after the immediate withdrawal symptoms ease, the addict will feel irritable, depressed, and dissatisfied with life syndrome called dysphoria. This general awareness of just feeling bad makes addicts want to return to drug use. And some are unable to fight off their addiction to the drug. A former OxyContin abuser told the Washington Times that the drug "put me on a path straight for hell with no exit ramps. That pill was made by the devil himself. It ruins your family and your relationships, your children's lives, your closest family to you, your job. One day you try to quit and two or three days later, you're puking your brains out."
Reactions with Other Drugs or Substances
Patients who receive a prescription for a drug containing oxycodone should talk to their doctors about all other medicines they are taking. Since oxycodone is a painkiller, it is dangerous to combine it with over-the-counter pain relievers, cold and flu remedies, allergy medications, sleep aids, and even some herbal dietary supplements. This is particularly true of the Percodan and Percocet combinations, since they already contain over-the-counter pain relievers. Overdose of aspirin and acetaminophen can be life-threatening.
Oxycodone causes drowsiness and slows breathing, so it should not be combined with antidepressants, antihistamines (allergy ingredients), , tranquilizersDrugs such as Valium and Librium that treat anxiety; also called benzodiazepines (pronounced ben-zoh-die-AZ-uhpeens)., anti-anxiety drugs, prescription sleeping pills, or muscle relaxants. Mixing alcohol and oxycodone can be deadly, as both substances depress the central nervous system and can lead to breathing problems, loss of coordination, and coma.
Emergency room visits for drug overdose often involve more than one substance. Needless to say, it is highly dangerous to mix oxycodone with any illegal drug, including marijuana, cocaine, hallucinogens such as LSD, ecstasy, or especially heroin.
People being treated for the following conditions should avoid medicines containing oxycodone: 1) liver or kidney disease; 2) thyroid problems (the thyroid is a gland in the neck that produces many hormones that help regulate the body's chemical balance); 3) Addison's disease (a disease of the adrenal glands, which release hormones that are found on top of the kidneys); 4) prostate problems (the prostate is a gland found in men, resting under the bladder, that contributes to the formation of semen); 5) gallbladder disease (the gallbladder is a small sac under the liver that stores bile used in digestion). In addition, anyone who has been treated for a mental disorder, or anyone with a past history of substance abuse, should tell his or her doctor of these issues before beginning oxycodone therapy.
Treatment for Habitual Users
Recovery from opiate addiction is an ongoing process. It cannot be achieved without the help of medical professionals and the support of counselors or programs such as Narcotics Anonymous. Often the drug abuser must face a whole change in lifestyle, in order to avoid the friends, places, and situations associated with the drug abuse originally.
Treatment for oxycodone addiction usually begins in a clinical setting, in a rehabilitation center or hospital. There, the addict is given medications to soothe the withdrawal symptoms and counseling to understand what will happen when he or she returns to daily life. If the rehabilitation is mandatory as a result of a drug arrest, the addict may also have to attend "drug education" classes and take urine tests to prove he or she is remaining drug-free.
Sometimes addicts will undergo several rounds of rehab before finally ending all drug abuse. Self-help groups such as Narcotics Anonymous can be very supportive because the members of the group understand how difficult it is to be drug-free after having a habit. Narcotics Anonymous offers group talk therapy, a "buddy system" that pairs new members with older members, and telephone hotlines for those wishing to end destructive drug use.
In some parts of the country, certain clinics have tried "rapid detox" for opiate addiction. This highly controversial procedure involves putting a patient to sleep and then administering a dose of naloxone to rid the body of opiates. The procedure has not been proven to keep opiate abusers drug-free, and it has potentially dangerous side effects. Most health care workers do not approve of this treatment, and it has been outlawed in the state of New Jersey.
People who take oxycodone for pain relief may also develop a dependenceWhen a user has a physical or psychological need to take a certain substance in order to function. on the drug. It is necessary to have an honest and trusting relationship with the prescribing doctor and to keep that doctor informed of any changes in the level of pain or the mind-altering effects of the oxycodone. Elderly patients in particular should be closely monitored for any dizziness or changes in motor control that may lead to a fall or other injury. Anyone taking oxycodone products should be completely honest with the prescribing doctor about all other prescription medicines being taken and all other doctors and specialists being consulted for ailments. This reduces the risk of drug interactions and dependency.
One of the consequences of oxycodone abuse is that people in real severe pain often cannot get enough medicine to treat their conditions. Cautious doctors sometimes under-prescribe pain medicines, fearful that the government will arrest them if they are seen as too
generous with Schedule II narcotics. Doctors are also aware that some patients might take the painkillers improperly, leading to sudden death. As a result, many people have to live with levels of pain that could be treated effectively. For cancer and AIDS patients, for instance, this can be very frustrating. For some sufferers, it can lead to desperate doctor shopping and, ultimately, the wrong dosage being taken.
The consequences of oxycodone abuse are similar to those of heroin abuse. In periods of heavy use, people become consumed by the drug and spend all their money and time trying to find more of it. Some oxycodone addicts resort to theft or robbery to obtain money and drugs. They might turn to drug dealing to support their habits. They may also engage in prostitution to earn money for drugs. All of these criminal activities put people at risk for arrest and imprisonment.
One consequence of oxycodone abuse may come back to haunt the recreational user years later. If it is difficult for cancer patients with no history of drug abuse or mental illness to receive prescriptions for oxycodone, it is far more difficult for past drug users to receive pain prescriptions when they actually need the medicine. A drug conviction as a youth may lead to suffering from untreated pain as a senior citizen.
People who crush OxyContin tablets and dissolve them in water to inject the drug run several risks. Small, undissolved particles of a pill can lodge in blood vessels and cause damage or blockage. The use of shared hypodermic needles is one of the major ways that people contract human immunodeficiency virus (HIV), the virus that can lead to AIDS, as well as several types of hepatitis, a contagious liver disease.
It should never be assumed that because OxyContin is a prescription drug, it is somehow "safer" to abuse than heroin. Both substances work the same way in the brain. Both lead to addiction and withdrawal symptoms. And both can lead to long-lasting health, legal, financial, and social consequences for individuals and their families.
The drugs in the oxycodone family are Schedule II substances as defined by the U.S. Controlled Substances Act of 1970. The U.S. government deems these medicines useful, but also dangerous due to their high potential for addiction and overdose.
It is against state and federal law to obtain a prescription for oxycodone when not in pain. It is illegal to seek multiple prescriptions from different doctors. That is called "doctor shopping." It is unlawful to sell or give a prescription to someone else, even if that person is sick and in pain. It is also against the law to forge a prescription or to alter a prescriptionor instance, adding another "0" to 30, in order to make it 300. An alert pharmacist can usually spot forged or altered prescriptions and will telephone the prescribing doctor for confirmation.
The DEA monitors doctors who dispense prescriptions for Schedule II drugs. Some doctors have been convicted and imprisoned for writing too many prescriptions for oxycodone drugs, or for selling the drugs on site. In 2002, a Florida doctor was sentenced to more than sixty years in prison after four of his patients overdosed on OxyContin. Florida prosecutors proved that the doctor was running a "pill mill," selling to addicts and drug dealers.
Sentences for possession and sale of Schedule II controlled substances vary from state to state and can be harsh. First-time offenders are usually ordered into rehab programs, placed on probation, and given fines and random drug tests for up to a year after the court date. Dealers often face jail time and criminal records that can forever alter their ability to find good jobs, obtain college loans, and sometimes even hold a valid driver's license.
The U.S. government is working closely with state and local law enforcement, and with the pharmaceutical companies, to curb the illegal use of oxycodone-containing medications. Their goal is to make these substances available only to those who really need them for their intended purposehe relief of pain.
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See also: Codeine; Heroin; Hydromorphone; Methadone; Morphine; Opium; Over-the-Counter Drugs
Oxycodone (Encyclopedia of Drugs, Alcohol, and Addictive Behavior)
Oxycodone is one of the most widely used OPIOID ANALGESICS in the United States, and it is usually used in conjunction with the analgesics aspirin or acetominophen. The combinations have proven effective and are, in some ways, superior to oxycodone alone, since they permit a lower dose of the opioidnd are therefore less likely to produce constipation, drowsiness, and nausea. Oxycodone is a derivative of OXYMORPHONE, the relationship being the same as that between CODEINE and MORPHINE. Like codeine, oxycodone is metabolized to oxymorphone, which is assumed to be responsible for its activity. Pharmacologically, the actions of oxycodone and oxymorphone are quite similar to those of morphine, so toxicity and ADDICTION can occur.
JAFFE, J. H., & MARTIN, W. R. (1990). Opioid analgesics and antagonists. In A. G. Gilman et al. (Eds.), (1990). Goodman and Gilman's the pharmacological basis of therapeutics, 8th ed. New York: Pergamon.
GAVRIL W. PASTERNAK