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Oxycodone Addiction Explained

What Is Oxycodone?

Oxycodone is a semi-synthetic opioid analgesic. It has been used in medical treatment since it was first synthesised in Germany in 1917. Oxycodone was actually created as an alternative medication after the United States instituted a ban on heroin. (1)

The German scientists responsible for the successful synthesis of oxycodone claimed it was not addictive. Oxycodone was always a popular opioid, but its use in medical settings and for recreational purposes rose dramatically after Oxycontin, a medication containing oxycodone, was released in 1996. It is now a growing concern in the United Kingdom and many other nations. (1)

The WHO estimates that approximately 275 million people worldwide used drugs at least once in 2016, and about 27 million were affected by an opioid use disorder. Approximately 45% of drug users with an opioid addiction experience a nonfatal overdose, while 70% witnessed another person experiencing an overdose. Heroin accounts for the majority of opioid abuse disorders, but the proportion of disorders associated with prescription opioids is increasing. (2)

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Oxycodone brand and street names

Oxycodone is present in numerous medications from several manufacturers. It is sold under a variety of brand names such as OxyContin, Oxaydo, Oxycodone CR, Endocet, Percodan, Percocet and Roxicet or Roxicodone. Street names include hillbilly heroin, roxies, oxies, kickers and oxycotton. (3, 7)

Street names like blues, greenies, pinkies, 40s or 80s refer to dose or colour of the pills. Oxycodone under the brand of Roxicet or Roxicodone is an extremely popular street drug. It is available in very small instant-release tablets of 5, 10, 15 or 30 milligrams, and it is easily crushed to snort or inject. The milligrams coordinate with colours, so recreational users define them by colour. (3)

Available forms and routes of administration of oxycodone

Oxycodone can be administered orally, rectally, intravenously or through an epidural. Intravenous administration relieves pain faster than oral or rectal administration. IV oxycodone is usually given in a hospital emergency room or after surgery. Intravenous oxycodone is also used in hospice facilities to relieve severe pain and control rapid or laboured respiration. (4)

Oxycodone administered via epidural is an extremely effective analgesic during childbirth and some surgical procedures. Oxycodone tablets, capsules or liquids are given orally or rectally. Rectal and oral routes of administration have similar bioavailability and onset of action. Oxycodone, usually in liquid form, can be given through G-tubes. Tablets can be crushed, but extended-release tablets or capsules should not be crushed or altered in any way. (4, 5)

Medical uses of oxycodone

Oxycodone is used to relieve moderate to severe pain. It is sometimes used short-term to relieve acute pain after an injury or surgery, and it is also used for chronic pain. It is recommended for chronic pain only after non-opioid pain medications are tried and found to be ineffective. (6)

Oxycodone is an option for people who are unable to tolerate non-opioid pain medications such as NSAIDs or paracetamol. Paracetamol is contraindicated for people with liver disease or damage. NSAIDs can cause or aggravate ulcers and other gastrointestinal health problems. (6)

Oxycodone extended-release medications should not be used for acute pain or as a taken as-needed pain medication. Extended-release oxycodone is meant for chronic pain that requires around-the-clock medication to control. (11)

The Pharmacology of Oxycodone

Oxycodone is a semi-synthetic opioid-receptor agonist. This means that it binds to opiate receptors in the brain, but it is not a naturally occurring phenanthrene alkaloid in opium. Opium is the sap removed from poppy heads. Codeine, morphine and thebaine are the original alkaloids. Synthetic opioids are produced by altering the chemical structure of natural alkaloids. Most semi-synthetic opioids, including oxycodone, are derived from thebaine. (7)

Oxycodone’s analgesic properties are roughly equal to morphine, but oxycodone has a longer half-life and increased bioavailability. (4) Oxycodone causes less frequent and less severe side effects than morphine. Researchers believe that morphine causes more severe side effects due to an accumulation of metabolites that may reach toxic levels. Metabolites are the compounds produced in the body when a drug is metabolised. Metabolisation of oxycodone produces less metabolites than morphine. (7, 8)

If we take OxyContin for example, it takes effect, on average, after one hour, and the effects last for 12 hours. There are two metabolites that are activated by the drug, oxymorphone, which is very strong, and noroxycodone, which is relatively weak.

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Chemical Formula – C18H22ClNO4

Oxycodone hydrochloride has the chemical structure C18H22ClNO4. It is a hydrochloride salt made with methylether of oxymorphone and semi-synthetic opioid agonists. Oxymorphone is also a semi-synthetic opioid, but it has much weaker antitussive properties than most opioids. (7)

An antitussive suppresses the urge to cough. Synthetic non-opioid agonists in the chemical process to create oxycodone have analgesic and antitussive properties. Other chemical labels of oxycodone include Oxycodone HCl, 124-90-3, and its ChEBI identification is 7859. (3, 7)

Oxycodone Legal Status (UK)

Oxycodone is a schedule 2 controlled medication in the United Kingdom. Prescriptions are tracked, monitored and recorded in a special register. The prescription documentation must include total quantity, number of doses, drug strength and the correct legal name of the recipient. Each prescription is valid for 28 days, and patients sign for their medications at the pharmacy. (9)

People may pick up prescriptions for oxycodone, or other schedule 2 medications, for others that are unable to do so. The person picking up the medication must show proof of identity, sign the prescription and complete any required forms. Most pharmacies require a letter of authorisation from the intended recipient. (9)

Doctors and dentists can prescribe oxycodone, but doctors prescribing opiates for controlling addiction need a license from the Home Office. Specially trained nurses prescribe oxycodone (OxyContin or another brand name for this medication) for specific reasons, such as palliative care. Midwives have limited prescribing abilities for pain during childbirth. (9)

Oxycodone Addiction and How It Develops

Oxycodone, like all opioids, becomes less effective with time. Pain relief and feelings of euphoria, or ‘highs’, decrease over time. Everyone develops physical dependence on opiates after long-term use, but only some people develop an addiction. Physical dependence means that withdrawal symptoms occur without the drug. (10)

Addiction is the compulsive, continuous psychological need to have oxycodone. The compulsion can override everything else in a person’s life. People using the drug without regard to safety guidelines or instructions from a doctor are at risk of addiction. Substance users often think they have their use under control or feel that addiction ‘happens to others’. In reality, very few people can use opioids carelessly without eventual problems. (11)

Why is oxycodone addictive?

Oxycodone is addictive because it is derived from opiates. It interacts with the same receptors in the brain as heroin. The interaction with opiate receptors provides an analgesic effect and a rush of dopamine that creates feelings of euphoria.

The euphoria is commonly described as a ‘high’. Opioids actually change brain chemistry. The changes lead to tolerance, which means that increasing doses of oxycodone are required to achieve the same effects. (12)

Common Drug Combinations with Oxycodone

No pain medication is effective for every illness, injury or condition. A combination of analgesic drugs improves patient compliance, relieves pain more effectively and reduces adverse effects. Oxycodone is often combined with paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs) morphine, gabapentin or pregabalin. (13)

Providing safe, effective pain relief can be very challenging. Pharmacological advances have created a wide variety of medications to manage pain, but many people still experience uncontrolled pain.

Several factors contribute to uncontrolled pain. Elderly and mentally ill populations experience compliance and accessibility challenges. Doctors sometimes have a poor understanding of analgesic medications, and excessive legal restrictions frequently prevent or discourage doctors from prescribing opioid medications to help their patients. (13)

NSAIDs and other non-opioid pain medications are encouraged, but the risk of adverse effects rises sharply as doses of these medications increase. The analgesic properties of such medications are limited, regardless of side effects. There is a point where more paracetamol or NSAIDs will not have stronger effects, no matter how much the dose increases. (13)

Some types of pain, such as nerve damage, do not respond to NSAIDs or paracetamol. Gabapentin and pregabalin treat nerve pain, but they can have serious side effects as well. Doctors sometimes prescribe combinations of oxycodone with NSAIDs to relieve pain from injuries or arthritis. Oxycodone in combination with pregabalin and gabapentin is used for chronic injuries and nerve pain. (13)

Oxycodone can even be combined with morphine and other opioids to increase pain relief. Immediate-release formulations of oxycodone are used in conjunction with extended-release or long-acting pain medications. The immediate-release oxycodone treats breakthrough pain, while the extended-release medications are taken on a set schedule. (13)

Causes and Risk Factors for Oxycodone Addiction

Oxycodone triggers a rush of dopamine in the brain that causes euphoria. People taking oxycodone after an injury, illness or surgery may experience cravings for the euphoric effects. Patients may tell their doctors that they still need pain relief after the prescription expires. The request could be legitimate, so patients claiming to experience pain should not be dismissed out of hand. (11, 14)

It is important to understand the risk of addiction and proper use of oxycodone when it is prescribed. Individuals should assess their own thoughts and actions to decide if they really need more pain relief or if they are craving the psychological effects of oxycodone. The risk of addiction increases significantly if oxycodone is used outside of medical supervision. (13, 14)

Some researchers attribute 40% to 60% of an individual’s risk of addiction to genetics. Family life is also a risk factor. Young people in an unhealthy or precarious living situation, especially if they are exposed to addiction and associated behaviours, are at high risk of developing an addiction. Peer pressure from friends and age when drug use begins are also significant factors. (14, 15)

Method of delivery plays a large role in addiction. Snorting oxycodone results in faster onset of action than oral consumption. Injecting oxycodone intravenously causes more extreme and rapid mood changes. Smoking oxycodone also results in rapid onset of action, but the effects wear off very quickly. (14, 15)

Teen OxyContin Abuse

Teen OxyContin abuse is a growing problem. After consuming this drug, teenagers report believing that they are invincible. The areas in the brain related to making good decisions and risk evaluation do not fully develop until people reach their early 20s. Teenagers do not try oxycodone believing they will become addicted.

They almost always believe they can use ‘a few times’ or ‘once in a while’. Unfortunately, teenagers are even more at risk of addiction than adults. (15, 16)

Addiction is more likely for people who begin using at young ages. Teens have faster metabolisms than adults, so a drug’s onset of action is faster. Faster metabolism also means the effects wear off quickly. Teenagers can develop a tolerance to oxycodone in a relatively short period of time. Peer pressure plays a significant role in teenage drug use. Resolve to avoid drugs or ‘just say no’ can wear down quickly if friends are using. The excitement and drama of using OxyContin can attract teenagers almost as much as the drug’s effects. (15)

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How teens get access to OxyContin

A teenager interested in OxyContin probably looks in a parent’s medicine cabinet first. Old prescriptions may contain a remnant of the drug from a past surgery or injury. Sometimes older prescriptions have been completely forgotten by adults in the home, but teenagers will still find them, even if by chance. (15)

The biggest source of OxyContin, and challenge for parents and rehabilitation professionals, is friends at school. Parents cannot control substances offered to their teenage children at school or social events. Friends offer drugs for free, at first. Once addiction sets in, teenagers may begin selling drugs to pay for their own use. Instead of a friendly offering to share, they pressure friends and peers to buy the drugs. (15)

Teenagers often believe that prescription medications are safer than street drugs such as cocaine or heroin. This belief wears down a teen’s resistance to using. Teenagers convince themselves that a prescription pill isn’t really a drug, and it must be safe if a doctor prescribed it. (15)

Signs and Symptoms of Oxycodone Abuse and Addiction

Behavioural symptoms

  • Trying to illegally obtain a prescription for oxycodone or attempting to acquire this drug via another illicit means
  • Trying to borrow or steal money or goods to get oxycodone
  • Stealing oxycodone that has been prescribed to someone else
  • Missing work or school
  • Declining performance at work or school
  • Using oxycodone when it is obviously risky or reckless to do so
  • Using oxycodone even after experiencing negative outcomes

Common immediate effects of oxycodone abuse

  • Headaches
  • Seizures
  • Depressed breathing rate
  • Nausea and vomiting
  • Dizziness
  • Low blood pressure
  • Vivid dreams
  • Dry mouth
  • Blurred vision
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Physical symptoms of oxycodone abuse

  • Shallow, slow and/or laboured breathing
  • Problems with balance, coordination and reflexes
  • Numbness to pain
  • Itchiness
  • Faint pulse
  • Excessive yawning
  • Drowsiness
  • Dilated pupils
  • Heart failure
  • Constipation
  • Insomnia
  • Depression
  • Aches and cramps
  • Increased pressure of spinal fluid
  • Coma
  • Swelling in limbs

Cognitive symptoms of oxycodone abuse

  • Poor focus
  • Poor concentration
  • Poor memory
  • Impaired memory
  • Impaired judgment

Psychosocial symptoms of oxycodone abuse

  • Paranoia
  • Loss of interest in significant activities
  • Mood swings
  • Anxiety

Impact of Long-Term Oxycodone Abuse on the Brain

Heroin, oxycodone and other opiates or opioids travel through the bloodstream to the brain. They attach to receptors on the surfaces of opiate-sensitive neurons, or brain cells. Attaching to the receptors activates them and triggers biochemical processes that release dopamine and other neurotransmitters. (17)

These neurotransmitters are part of a rewards process when people engage in pleasurable activities such as eating or sex. The motivation for compulsory use of the drug is twofold. People taking medication for pain relief feel much better when the pain is suppressed, but everyone feels the pleasurable, euphoric effects from opioids. (11)

The brain creates a long-lasting record, or memory, associating good feelings with the circumstances and environmental factors surrounding drug use. This creates conditioned associations that cause cravings for oxycodone or other drugs. The cravings can become strong enough to drive users to seek more drugs, regardless of negative consequences or obstacles. (17)

The mesolimbic, or midbrain, system in the brain is activated by opioids. The mesolimbic system generates signals in the ventral tegmental area (VTA) of the brain. The VTA triggers a rush of dopamine in another area of the brain called the nucleus accumbens, or NAc. (17)

Co-Occurring Disorders with Oxycodone Addiction

Oxycodone addiction is often accompanied by other mental health disorders. This is known as dual diagnosis or co-morbidity. Anxiety and depression are the two most frequent co-occurring disorders with oxycodone addiction. Post-traumatic stress disorder (PTSD), bipolar disorder and borderline personality disorder are also common co-occurring disorders. (18)

A mental health disorder increases the risk of addiction. It is important to treat both substance abuse and the co-occurring disorder. This can be challenging because the symptoms of addiction and other mental health disorders overlap. The underlying condition may be missed entirely if a person does not receive help until addiction is already underway. (18, 19)
Sometimes addiction is a result of self-medicating. People use oxycodone and other drugs to relieve guilt, shame, anxiety or depression. Depression causes sombre feelings and sometimes leads to feeling hopeless. People use oxycodone to relieve the feelings of depression. (18)

Self-medication is dangerous. Relief only lasts until the drug’s effects wear off. Depressive symptoms may be more severe for a person coming down from a high. The increasingly severe symptoms trigger more substance use, and it becomes an unrelenting cycle. People are at risk of suicide when tolerance builds and oxycodone no longer triggers euphoria. It is also a risk during untreated withdrawal. (19, 20)

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Oxycodone Overdose Explained

Oxycodone is a pure agonist opioid like hydrocodone, codeine or fentanyl. This means there is no upper limit on the drug’s effects. Increasing doses produce stronger effects. Opiates affect the medulla of the brain. These effects are responsible for respiratory depression and cough suppression. (21)

Patients with end-stage lung disease or similar conditions benefit from respiratory depression to a limited extent, but doses are managed carefully by medical professionals. Respiratory depression is the most common cause of death from oxycodone overdose for recreational users. Intravenous use carries the highest risk of fatal overdose, but overdose can occur through other methods of administration too. Once the medication is in the body and binds to opiate receptors in the brain, respiratory depression continues until effects of oxycodone wear off. Medications like naltrexone can sometimes reverse effects of an overdose by forcing oxycodone molecules out of the opiate receptors. (21)

Signs and Symptoms of Withdrawal

What are the withdrawal symptoms of oxycodone?

Symptoms of oxycodone withdrawal vary between individuals. The most common symptoms are watery eyes and a runny nose, irritability and anxiety, nausea and vomiting, yawning, sweating, chills, body aches and loss of appetite. People in withdrawal may also experience insomnia, difficulty staying asleep, rapid breathing, rapid heart rate, weakness and panic attacks. (6)

Severe cases of withdrawal can cause elevated blood sugar, low blood pressure and dehydration. Almost everyone experiencing oxycodone withdrawal has intense cravings for oxycodone or any other opioid. The dosage and duration of oxycodone use determine the severity of withdrawal symptoms. (6)

Oxycodone detox process

Oxycodone detox usually takes place in a hospital or inpatient setting, but it can be done on an outpatient basis. Clients are given comfort medications to relieve withdrawal symptoms. Frequently prescribed medications relieve nausea and vomiting and help patients sleep. (10, 20)

Medical professionals monitor clients and address any serious or life-threatening complications immediately. Drugs such as buprenorphine or methadone relieve opioid withdrawal symptoms. Detox can be short-term during acute withdrawal or extended over a longer period of time with tapering. Tapering is the process of slowly decreasing the dose to avoid withdrawal. (10, 20)

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Oxycodone Addiction Treatments

People seeking treatment can ask their general practitioners for referrals or contact drug treatment facilities themselves. The NHS has a helpline to assist people in finding appropriate treatment services within the NHS network. Some charities and private drug and alcohol treatment organisations are also available. (22)

The first appointment consists of questions about drug use, work, family, education and housing situations. Clients are asked for a urine or saliva sample. Keyworkers are available through the NHS to offer support and review treatment options and care plans throughout the recovery process. Treatment options include talking therapy, medication-assisted treatment, medical detox to manage acute withdrawal and supportive services. (22)

Overcoming oxycodone addiction

Overcoming oxycodone addiction has a greater chance of success with help and support instead of cold turkey. Withdrawal from oxycodone and other opioids is not usually life-threatening, but it is best to consult medical professionals and get help with detox. (19, 22)

Serious complications are possible, especially for people with cardiovascular disease. Cold turkey detox is strongly discouraged during pregnancy because it could cause miscarriage or other serious complications. (16)

The first step in overcoming addiction is admitting there is a problem. Several simple actions can strengthen resolve to overcome addiction. A diary helps track of where and when cravings for drugs occur. Writing down goals and keeping the list in a very visible and obvious place serves as a constant reminder of long-term recovery goals. (20)

One of the most challenging aspects of recovery is declining offers to use drugs from friends or family. Rehearse denials, avoid locations associated with drug use and remove all drugs and paraphernalia from the home. Find useful activities such as hobbies, volunteering or any other task to minimise boredom and free time when drug cravings may occur. (20, 22)

Oxycodone Addiction Medications

Buprenorphine-containing transmucosal products for opioid dependency

Buprenorphine-containing products contain buprenorphine or a combination of buprenorphine with naloxone. Both types are used to manage opioid dependence. Examples of products in this category include Subutex sublingual tablets and generic tablet or sublingual forms of Suxobone, Zubsolv, Bunavail and Cassipa. (23)

Buprenorphine

Buprenorphine is a mixed opioid agonist-antagonist. It prevents withdrawal symptoms, and it is often used in addiction treatment programs. Buprenorphine has a ceiling that limits effects of the drug. It binds with opioid-receptors in the brain, but effects are limited. Unlike full opioid-agonists, buprenorphine reaches a point where effects cannot increase anymore. (23)

Zubsolv (buprenorphine and naloxone) sublingual tablets

Zubsolv is a medication to treat opioid dependence. It contains buprenorphine and naloxone. One daily dose subdues withdrawal symptoms and limits drug cravings for 24 hours. It is usually taken sublingually, or under the tongue. (23)

Bunavail (buprenorphine and naloxone) buccal film

Bunavail is a combination of buprenorphine and naloxone in a buccal film. It is citrus-flavoured and each dose is a yellow, rectangular-shaped film. It is administered by placing it against the buccal, or cheek, lining inside the mouth. (23)

Methadone

Methadone is a synthetic opioid. Methadone maintenance therapy or tapering is an effective method for managing opioid addiction and recovery. It suppresses cravings and has the additional benefit of relieving pain. Individuals struggling with substance abuse and experiencing pain can benefit greatly from methadone. Methadone is used for pain relief and several other purposes in the medical field as well. (24)

Therapy for Oxycodone Addiction

Cognitive behavioural therapy

Cognitive behavioural therapy, or CBT, is a common therapy used for substance disorder treatment. CBT helps clients define the thoughts, feelings and actions that trigger a desire to use drugs. The triggers for drug use are called ‘automatic negative thoughts’. The goal of CBT is to help clients identify and resolve automatic negative thoughts. (20)

Individual therapy

Individual therapy is usually part of a wider treatment plan for substance abuse disorders. It focuses on symptoms of depression, bipolar disorder and other mental health disorders and helps clients work through thoughts and events that trigger cravings. Individual therapy also helps clients understand addiction and any co-occurring mental health disorders. (20)

Family counselling

Family counselling involves the client and family or close friends. Family circumstances often play a large role in addiction. Multiple members of the same family may experience addiction, so family therapy offers support and coping mechanisms for everyone. Family therapy also helps family members who have not experienced addiction to understand what a loved one in treatment is going through. (20)

Group therapy

Group therapy also addresses the triggers and thoughts that cause cravings, but it takes place in a group environment. The benefit of group therapy is peer support and the opportunity to discuss thoughts, problems, history and emotions with other people sharing the same experiences. Group therapy is an important part of long-term recovery. (20)

Holistic therapy

Holistic therapy treats substance abuse with an integrated physical, mental and spiritual approach. Holistic therapy is often referred to as complementary or alternative treatment, and it is often part of a larger rehab treatment plan. Common practices of holistic therapy include acupuncture, massage, Reiki and other types of energy techniques, yoga and meditation, herbal medications, biofeedback or neurofeedback and nutritional therapy. (25)

Motivational enhancement therapy

Motivational enhancement therapy, or MET, takes a person-centred approach to therapy. It focuses on enhancing motivation to change and addresses self-destructive behaviours. MET helps clients recognise ambivalence or other barriers to overcoming addiction and encourages thoughts of health, family life or social functioning. The goal is recognition of the negative impacts of drug abuse and renewed interest in life without drugs. (20)

Post-Rehabilitation Support for Oxycodone Addiction

The ultimate goal of addiction recovery is transitioning to a healthy, meaningful life without drug use. Recovery is a continuous process with many paths to success. Counselling helps clients in recovery develop a strong sense of identity and foundation of self-esteem. Support groups in the community and regularly scheduled therapy sessions help build interpersonal and community relationships. (22)

Some factors that increase risk of relapse are somewhat beyond personal control. Punitive policies related to drug use can make life after addiction harder and more complicated. Social or cultural stigma and discrimination are also problematic. Healthcare professionals, social workers and support groups help individuals cope with these difficulties and develop plans to move forward. (20, 22)

Families and significant others have a large role in long-term recovery. Support from loved ones is one of the most beneficial aspects of addiction recovery overall. Individuals in recovery can also build relationships in local support groups. Meetings and other contact with support groups should be integrated into a regular schedule in the same manner as work hours or medical appointments. (22)

Sources

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