Oxycodone: Therapeutic use, Treatment. Oxycodone rehab.
Last modified: Saturday, 20. June 2009 - 2:31 pm
Official names: Endocet, Endocodone, Endodan, M-Oxy, OxyContin, OxyFast, OxylR, Percocet, Percodan, Percodan-Demi, Percolone, Roxicet, Roxicodone, Roxilox, Roxiprin, Tylox
Street names: Hillbilly heroin, poor man’s heroin, oxy, oxies, oxycotton, OCs, killers, oxycons, percs (or perks), pink spoons.
Drug classifications: Schedule II, narcotic analgesic
ANALGESIC: A type of drug that alleviates pain without loss of consciousness.
NARCOTIC: A natural or synthetic drug that has properties similar to opium or opium derivatives.
OPIATE: Drug derived directly from opium and used in its natural state, without chemical modification. Opiates include morphine, codeine, thebaine, noscapine, and papaverine.
PHYSICAL DEPENDENCE: A condition that may occur after prolonged use of an opiate, but differing from addiction because the user is dependent on the drug for pain relief, rather than emotional or psychological relief.
WITHDRAWAL: A group of symptoms that may occur from suddenly stopping the use of a substance such as alcohol or other drugs after chronic or prolonged ingestion.
Oxycodone is a semi-synthetic prescription drug with pain-relieving properties similar to those of morphine and codeine. Although commonly known as an opioid analgesic, it is also known as a narcotic analgesic. The drug’s ability to relieve moderate to severe pain makes it a good choice for the treatment of many painful conditions, including back pain and headache as well as pain due to cancer and some dental procedures.
Oxycodone is derived from thebaine, one of more than 20 components known as alkaloids (including morphine and codeine) found in opium. In addition to being a primary component of oxycodone, thebaine also is a main ingredient of hydrocodone and hydromorphone, two other prescription painkillers.
Long before thebaine was identified and synthesized from opium poppies for use as a pain killer, ancient peoples were using opium to induce euphoria and even to stimulate creativity.
Historically, opium was an important crop as far back as 3400 B.C., when it was referred to as Hul Gil, or the joy plant. The milky liquid from the poppy seeds was dried to produce the powerful opium powder. As a commodity, the opium trade flourished in Egypt during the reigns of Thutmose IV, Akhenton, and the boy king Tutankhamen.
The first medicinal use of opium is credited to Hippocrates, the Greek physician known as the “father of medicine.” In addition to using opium to relieve pain, Hippocrates advocated its use for treating internal diseases and some so-called women’s diseases. Later, the famous physician Paracelsus mixed opium with citrus juice and gold essence and prescribed the compound for use as a pain remedy he called laudenum. In the late 1600s, the English apothecary (the equivalent of today’s pharmacist) Thomas Sydenham introduced his own laudenum compound by mixing opium with sherry wine and herbs. The resulting medication, in the form of pills, was used to treat a variety of painful conditions.
Oxycodone was first developed in Germany in 1916 and marketed under the brand name Eukodal. The first documented medical reports of striking “euphoric highs” in patients taking the drug surfaced in the 1920s. Those reports also included warnings about the apparent habit-forming nature of the drug. In the United States, oxycodone was approved by the Food and Drug Administration (FDA) in 1976. Various formulations followed, including drugs that combined oxycodone with either aspirin or acetaminophen.
Evidence suggests that oxycodone has the ability to lock onto a special cell receptor found primarily in the brain, spinal cord, and intestines. When the drug connects to the receptors in the spinal cord, it causes the nerves that are sending pain signals to be temporarily blocked. Similarly, when the drug connects to the receptors in the brain, it causes an overall sense of well-being and relaxation. However, when the drug connects to the receptors in the intestines, the result is often constipation.
Opioids are praised by pain experts for their effectiveness in treating chronic pain because the drugs directly affect the way the body perceives pain. When properly administered in adequate, appropriate doses, opioids such as oxycodone can allow people with chronic pain from arthritis, back problems, cancer, and severe pain syndromes to lead more normal lives.
Pain experts have learned that patients who take opioid drugs for long periods of time will build up a physical tolerance and may need higher and higher dosages to achieve adequate pain relief. Unfortunately, physical dependence is sometimes confused with addiction, and patients may be denied appropriate medication by a doctor who cannot tell the difference between physical dependence and psychological addiction. One way to look at it, according to some pain experts, is that the drugs should be used when they improve a person’s functioning (i.e., allow for better overall functioning than what they could achieve without medication).
When drugs interfere with patients’ functioning rather than help them cope with daily activities in the face of severe pain, the line between physical dependence and addiction may have been crossed. According to the Center for Substance Abuse Treatment (CSAT), addiction “is characterized by the repeated, compulsive use of a substance despite adverse social, psychological, and/or physical consequences.”
That fear of giving pain medication because patients might become addicted, what some experts refer to as opiophobia, is unjustified in most cases in which pain medications are needed for proper treatment. Research sponsored by the National Institute on Drug Abuse suggests that most patients will not become addicted when taking opioids. When used properly, the drugs can be tapered or decreased slowly as pain improves. This careful weaning from the drug eliminates the physical dependence and avoids the withdrawal problems that would occur if the person “went cold turkey” and stopped taking the drug too suddenly.
Surprisingly, studies show pain caused by cancer or other terminal disease is often undertreated. Even though the World Health Organization has shown that more than 90% of such pain can be effectively controlled with good pain management, patients who need relief the most are often among those least likely to receive it. In a 1998 study published in the Journal of the American Medical Association, researchers found that 26% of elderly cancer patients living in a nursing home who experienced daily pain did not receive a painkiller. People older than age 85 were more likely than those in other age groups to receive no pain medication at all. The oldest patients were also less likely than those ages 65 to 74 to receive strong pain medications such as opioids, despite the fact that they experienced pain daily.
One additional reason some physicians may knowingly undertreat pain is fear of being prosecuted for over-prescribing certain drugs. In one survey conducted in the early 1990s, more than half of physicians admitted to reducing the dose of opioids they prescribe or switching a patient to a non-opioid pain drug out of concern they might be investigated or even fined by their state medical board for over-prescribing.
For years the leading drug used to treat chronic pain was short-acting opioids. However, in 1995 a new long-acting form of oxycodone became available. The drug, known as OxyContin, has quickly become the preferred medication for chronic back pain and cancer pain, among other conditions, because it has fewer side effects and lasts longer than other similar painkillers.
OxyContin’s sustained release activity means that a steady stream of medication is released into the bloodstream over a 12-hour period. This allows users to sleep through the night without waking to take more pain pills. It also means there is little or no breakthrough pain, as often occurs with shorter-acting pain medications, because the relief lasts until the next dose is taken.
While many doctors and patients consider OxyContin a wonder drug, it has become a controversial and highly abused substance in many parts of the United States that previously had experienced little or no drug problems. Some have gone so far as to call it “pharmaceutical heroin.” Within just a few years of its introduction, OxyContin became the source of many news stories as a large number of people, from celebrities to housewives, developed an OxyContin habit. Physicians and health care providers in some affected areas found themselves unprepared for the speed with which an epidemic of OxyContin abuse developed in their communities. The problem is so bad that pharmacies in some areas have chosen not to even stock the drug anymore for safety reasons, and the Drug Enforcement Administration (DEA) created a special national strategy for dealing with the OxyContin problem.
Although abuse of prescription painkillers is nothing new, OxyContin distinguishes itself by being more powerful than other prescription painkillers. OxyContin contains between 10 and 160 mg of oxycodone, whereas other oxycodone-containing drugs such as Tylox contain only 5 mg. The higher dose of oxycodone makes OxyContin attractive to abusers who crush the pills and either snort or inject the oxycodone for a powerful high.
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