What is Oxycodone?

Dosage, Side Effects, and Overdose

What is Oxycodone?

Dosage, Side Effects, and Overdose

What is Oxycodone?

Oxycodone is a prescription pain medication that belongs to a group of drugs known as opioids. Opioids are drugs that interact with opioid receptors in the brain, resulting in pain relief and relaxation. Oxycodone is typically used to treat moderate to severe pain and comes in a number of different forms, including capsules, tablets, and liquids.

History of Oxycodone

Today, heroin is known to be an extremely addictive illegal substance, but in the late 1800s and early 1900s, heroin was marketed by the German corporation, Bayer, as an opioid pain killer. Once the dangers of heroin addiction were discovered, it was banned in the U.S. As a result, two German scientists created oxycodone in 1916, an opioid meant to replace heroin and morphine as a non-addictive pain killer.

Oxycodone Timeline

1916

Oxycodone is created in Germany

1916
1939

Oxycodone is first introduced in the U.S.

1939
1950

Percodan, a combination medication containing both oxycodone and aspirin, is introduced to the U.S. physicians for prescription

1950
1970

The Drug Enforcement Administration (DEA) labels oxycodone as a Schedule ll drug in the Controlled Substances Act

1970
1974

Percocet, a combination medication containing oxycodone and acetaminphen is approved by the Food and Drug Administration (FDA)

1974
1996

Purdue Pharma, a pharmaceutical company, releases the drug OxyContin, which is a medication that contains only oxycodone

1996
2007

Purdue Pharma agrees to pay over $600 Million in fines for misleading regulators, doctors, and patients about the addictive properties of OxyContin and its potential for abuse

2007
2019

As of June 2019, 48 states, including California, Hawaii, and Maine are suing Purdue Pharma for downplaying the risks of OxyContin and exaggerating its benefits

2019

On Oxycontin And The Rise of The Opioid Epidemic

It is no secret that the pharmaceutical business is highly profitable. The promotion and marketing of OxyContin was no exception. In order for Purdue Pharma to successfully profit from OxyContin sales, it was important to downplay the risks of the drug and exaggerate the benefits.

Purdue Pharma, unlike any other distributor of oxycodone medications, promoted OxyContin as a medication that could be used for less serious forms of pain. This type of marketing increased the number of prescriptions for less serious types of pain from about 670,000 prescriptions in 1997 to about 6.2 million prescriptions in 2002.​​​1

Another reason that the marketing of OxyContin was so successful was the bonus system that encouraged sales representatives to increase OxyContin sales in their regions. In 2001, Purdue Pharma paid its sales representatives nearly $40 million in sales bonuses.

Purdue Pharma promoted OxyContin in a way that no other Schedule II opioid had ever been promoted. They used a patient starter coupon program that provided patients with a free prescription for a 7 to a 30-day supply of OxyContin. When the program ended in 2001, approximately 34,000 coupons had been redeemed across the U.S. Purdue Pharma also released a number of promotional items such as OxyContin fishing hats, stuffed plush toys, and music compact discs.​​​1

Purdue Pharma's Impact

The reason that Purdue Pharma was able to successfully market and sell OxyContin was by minimizing discussions about the risk of abuse and addiction that can result from OxyContin use. It is estimated that approximately 3% to 16% of the general population will suffer from substance use disorder caused by OxyContin use.​​​1 In most of its promotional campaigns and materials, Purdue Pharma claimed that the risk of addiction was very small. Sales representatives were trained to deliver the message that the risk of addiction was less than one percent.

Because the dangers of OxyContin were largely unknown at the time, sales of OxyContin increased from $44 million (316,000 prescriptions) in 1996 to nearly $3 billion (over $14 million prescriptions) in 2001 and 2002.1

Between 2002 and 2004, lifetime nonmedical use of OxyContin increased from 1.9 million to 3.1 million people.4 In 2004, there were 615,000 new nonmedical users of OxyContin, and at this point, OxyContin became the most prescribed opioid to be abused in the United States.​​​1

Types of Oxycodone

There are two types of oxycodone: immediate-release (IR) oxycodone and extended-release (ER) oxycodone. While immediate-release oxycodone (such as the drug Percocet) works more quickly and is used on an as-needed basis, extended-release oxycodone is used for around-the-clock treatment of pain. Extended-release oxycodone (such as the drug OxyContin), releases small doses of oxycodone over a 12-hour period and is typically prescribed to cancer patients, patients who have just had an operation, or patients with chronic (on-going, long-term) pain issues.

Brand Names

Single Agent Drugs that Contain Only Oxycodone

Oxaydo, OxyContin, Oxyfast, Roxicodone, RoxyBond, Xtampza ER​​​2

Combination Drugs that Include Oxycodone

Combunox, Endocet, Endodan, Moxduo, Oxycodan, Percocet, Percodan, Primley, Roxicet, Xartemis XR ​​​2

OxyContin

OxyContin is a popular drug whose only active ingredient is oxycodone. It is an extended-release tablet that comes in 10 mg, 15 mg, 20 mg, 30 mg, 40 mg, 60 mg, and 80 mg doses. Each strength signifies the amount of oxycodone per tablet. Up until 2001, there was a 160 mg dosage available that was suspended as the potential for abuse was too high.

Introduced in 1996 by Purdue Pharma, a privately held pharmaceutical company, OxyContin was strongly marketed and promoted as a new, non-addictive opioid. Between 1996, when it was first introduced, and 2000, sales of OxyContin grew from $48 million to almost $1.1 billion.​​​1

While Purdue Pharma promoted the message that the chances of OxyContin abuse and addiction were very low, this was not in fact true. The widespread promotion and availability of OxyContin meant that by 2004, OxyContin had become the leading drug of abuse in the United States.​​​1

Percodan

Introduced in the U.S. in 1950, Percodan is an immediate-release combination drug that contains both oxycodone hydrochloride and aspirin (another type of pain medication). It comes in tablet form with each tablet containing 4.8355 mg of oxycodone hydrochloride and 325 mg of aspirin.

Percocet

Introduced in the U.S. in 1974, Percocet is an immediate-release combination drug that contains both oxycodone hydrochloride and acetaminophen (another type of pain medication). It comes in tablet form in the following strengths:

2.5 mg of oxycodone hydrochloride and 325 mg of acetaminophen

5 mg of oxycodone hydrochloride and 325 mg of acetaminophen

7.5 mg of oxycodone hydrochloride and 325 mg of acetaminophen

7.5 mg of oxycodone hydrochloride and 500 mg of acetaminophen

10 mg of oxycodone hydrochloride and 325 mg of acetaminophen

10 mg of oxycodone hydrochloride and 650 mg of acetaminophen

Oxycodone Addiction

Addiction is defined by Medical News Today as “a psychological and physical inability to stop consuming a chemical, drug, activity, or substance, even though it is causing psychological and physical harm.”

While it is less likely for a patient who has been prescribed oxycodone under a physicians’ care to experience oxycodone addiction (since they are more likely to be monitored and controlled), those who use or abuse oxycodone outside of a physicians’ care are much more likely to experience oxycodone addiction. One of the reasons that oxycodone addiction is highly possible is that it has many similarities with other drugs of abuse such as alcohol, heroin, and marijuana in that it increases dopamine levels which increase a person’s pleasure. This means that over time, oxycodone use changes the brain, making it difficult for users to stop using it on their own. If a user does stop using oxycodone, especially suddenly, there is a high likelihood that the user will experience withdrawal symptoms.

How Much Does Oxycodone Cost on the Street?

While an 80mg OxyContin pill costs about $6 at a pharmacy, it sells for around $80 on the street. In comparison, 80mg of heroin sells for approximately $45 on the street.​​​3

How Oxycodone is Taken

Oxycodone medication can be taken in a number of ways: it can be injected into the muscle, into the bloodstream, under the skin, or taken orally by swallowing tablets or pills.

Oxycodone should be taken exactly at the right amount and duration as prescribed.

Crushing, chewing, breaking, or dissolving oxycodone medications can lead to a potential overdose. Inhaling the crushed powder or mixing it into a liquid to inject into the vein can lead to an overdose or death.

When is Oxycodone Not Safe to Take?

If a person has:

A head injury, brain tumor, or seizures

Liver or kidney disease

Urination problems

Drug or alcohol addiction, mental illness

Thyroid disorder

Gallbladder or pancreas

Lung disease

Adrenal disease

Drug Interactions

Opioid medications can interact with other drugs and cause dangerous side effects. Medication that might potentially interact with oxycodone:

Other opioid medications

Prescription cough medication

Sedative medications (such as alprozolam, Xanax, clonazepam, Klonopin, diazepam, Valium, lorazepam, Ativan, temazepam, Restoril)3

Sleeping pills

Muscle relaxants or tranquilizers

Medication for depression, anxiety, or other mental illnesses

Medication for Parkinson’s disease

Migraine medication

Medication used to prevent nausea and vomiting

Cold or allergy medications

Asthma medication

Medications for motion sickness, irritable bowel syndrome

Effects of Oxycodone

Side effects may include:

  • Drowsiness or tiredness
  • Headache
  • Nausea
  • Red eyes
  • Difficulty urinating
  • Dizziness or faintness
  • Constipation
  • Vomiting
  • Stiff muscles
  • Confusion and difficulty concentrating
  • Negative mood
  • Mild allergic rash or hives
  • Stomach pain
  • Itching
  • Dry mouth
  • Excess sweating or flushing
  • Slow pulse

Serious effects that require medical help include:

  • Severe allergic reaction: hives, difficulty breathing, swelling of the face, lips, tongue, or throat
  • Slowed or stopped breathing, and blue colored lips
  • Seizure/convulsions
  • Symptoms of serotonin syndrome: agitation, confusion, fever, seating, fast heart rate, chest pain, feeling short of breath, muscle stiffness, trouble walking, feeling faint

Long-Term Effects

Dental problems

Mood swings

Reduced sex drive

Decreased level of testosterone in males

Menstrual problems in females

Needing to use more of the medication to get the same effect (tolerance)

Financial, work, or social problems

Risks of Oxycodone Use for Pregnant and Nursing Mothers

Using oxycodone while pregnant can cause the baby to become dependent on the drug and to suffer from withdrawal symptoms after birth. Babies who become dependent on oxycodone may need medical treatment for several weeks after birth. Oxycodone can be passed onto a baby through breast milk, which can cause drowsiness and breathing problems for the baby.

Symptoms of Overdose

An oxycodone overdose can occur when too much of the medication has been taken at once. This usually occurs when the drug is being misused or taken differently than instructed.

Chest pain or discomfort

Small pupils

Decreased awareness or responsiveness

Extreme drowsiness and loss of consciousness

No muscle tone or movement

Slow or irregular heartbeat

Risks of Injecting Oxycodone

  • Tetanus
  • Infection
  • Vein damage

Risks of Sharing Needles

  • Hepatitis B
  • Hepatitis C
  • HIV
  • AIDS

Withdrawal

The extended use of oxycodone can lead to the development of withdrawal symptoms when oxycodone use is stopped. Withdrawal occurs when the body becomes used to and adapts its functioning to a certain drug. When that drug is no longer taken, the body craves it in order to function, which results in unpleasant withdrawal symptoms. Withdrawal from oxycodone use can result in the following symptoms:

Physical

  • Writhing
  • Tremors
  • Nausea
  • Diarrhea
  • Muscle aches
  • Sweating
  • Coughing
  • Runny nose
  • Weight loss
  • Cramping/aches

Emotional/Psychological

  • Cravings
  • Mood swings
  • Anxiety
  • Depression

Rates of Use and Abuse

The consumption of oxycodone increased by almost 500% from 1999 to 2011.​​​4

The number of people who admitted to using OxyContin for non-medical purposes increased from about 400,000 in 1999, to 1.9 million in 2002 and 2.8 million in 2003 in the U.S.4

By 2010, over 6 million people in the U.S. reported using OxyContin for non-medical purposes.

3 tons (2722kg) of oxycodone were consumed worldwide in 1990, and by 2009, this number rose to 77 tons (69,853 kg). Of these 77 tons of oxycodone, Americans consumed 81% (62 tons/56,245 kg), making them the leaders in oxycodone consumption worldwide.​​​5

The National Survey on Drug Use and Health showed that about 27.9 million people aged 12 or older (10.4% of the population) had used oxycodone products as of 2015.4

4.3 million of these people reported having misused these products in the past year, representing 1.6% of the U.S. population aged 12 or older.4

Between 2000 and 2009, the average size of an oxycodone prescription increased by 69.7%.​​​2

Oxycodone Addiction Treatment

Medication for Opioid Addiction Treatment

Methadone

Methadone is a medication used for opioid addiction that helps decrease withdrawal symptoms and cravings. It works by targeting the same areas of the brain as opioids but does not make the user feel high. Methadone helps to restore balance to the parts of the brain that are affected by addiction, allowing the brain to heal while working towards recovery. Methadone can be safely taken for extended periods of time but should be used under the care of a healthcare provider. Methadone is also the only treatment drug that has been approved for women who are pregnant or breastfeeding.3

Buprenorphine

Similar to methadone, buprenorphine is a treatment medication used for opioid addiction that helps decrease withdrawal symptoms and cravings while tricking the body into thinking that it is still receiving the opioid. Initial doses of buprenorphine should be given only after a patient is in withdrawal. Doses range from 6 mg to 16 mg daily and should be dispensed by a pharmacist.3

Naltrexone

Naltrexone works differently than methadone and buprenorphine because it does not help with withdrawal symptoms or cravings. Alternatively, it eliminates the high that one typically feels when taking opioids. For this reason, naltrexone is used to prevent a relapse rather than to try and stop using opioids such as oxycodone. In order to take naltrexone, a patient should be off of oxycodone for at least 7-10 days in order to avoid withdrawal symptoms.3

Naloxone

Naloxone is not so much of a treatment medication as it is more of a first aid response to an overdose. If a person has overdosed on oxycodone, they are likely to stop breathing as oxycodone suppresses the central nervous system. Naloxone can be administered by injection or nasal spray and reverses the lack of breathing. Naloxone only lasts for about 30-90 minutes on the brain and is used as a first-aid treatment before first responders arrive or the patient is taken to a hospital. Naloxone is a prescription drug that is non-addictive.3

How much do medication treatments cost?

Methadone treatment, including medication, and psychosocial and medical support services, costs approximately $126 per week or $6,552 per year.3

Buprenorphine treatment, including medication and twice-weekly visits, costs approximately $115 per week or $5,980 per year.3

Naltrexone treatment, including medication, drug administration, and related services costs approximately $294 per week or $14,112 per year.3

While these costs may seem high, they are often much lower than costs associated with the criminal justice system, treating babies who are born dependent on oxycodone, treating people with infectious diseases that result from needle sharing, treating overdoses, and treating injuries associated with addiction and/or overdose.

Counseling and Behavioral Therapies

To effectively treat addiction to oxycodone, the following therapies and supports are recommended.

Cognitive-behavioral therapy (CBT)

Helps patients recognize and stop negative patterns of thinking and behavior. CBT teaches patients coping skills, hot to manage stress, and how to change thinking patterns that lead to opioid abuse.

Motivational enhancement therapy

Or Motivational Interviewing (MI) help patients lead their own process of change and stay motivated insticking to a treatment plan.

Group counseling

Helps patients feel less alone. It provides patients with the support of others who are experiencing the same thing. Group counseling can be motivational when hearting success stories of other people who have gone thought the same thing.

Family counseling

Includes family members who the patient is close with and can be beneficial in helping repair and improve family relations, which can often become strained as a result of addiction.

Narcotics Anonymous

A popular 12-step abstinence-based peer support group.

Individual counseling

Helps patients set goals, discuss setbacks, celebrate progress, discussing legal concerns or family problems.

Contingency management

Helps patients by giving them incentives/rewards for positive behaviors such as not using oxycodone.

Medication-Assisted Therapy

Medication-Assisted Therapy (MAT) combines the use of medications with counseling and behavioral therapies to provide a well-rounded, “whole-patient” approach to treatment. Research indicates that the combination of treatments is the most successful in treating opioid addiction and can lead to long term success in recovery. MAT provides a more comprehensive program that is individualized to each patients’ needs. The goal of MAT is a full recovery from addiction. The approach has been shown to improve patient survival, decrease opioid use and other potential criminal activity, increase patients’ ability to gain and maintain employment, and improve birth outcomes among women with substance use disorders.

Residential and Hospital-Based Treatment

Residential programs combine housing and treatment services for those who might need around the clock care. It is great for those who benefit from living with their peers and supporting one another through recovery. Hospital-based programs combine health care and addiction treatment services for people with medical problems. Treatments may include medication, counseling, and behavioral therapies.

Misconceptions About Oxycodone

Misconception #1

Oxycodone and OxyContin are the same thing.

Truth: Oxycodone is the name of the ingredient and OxyContin is the brand name of one of the drugs that contain oxycodone.

Misconception #2

OxyContin is responsible for the majority of opioid prescriptions in the U.S. 

Truth: In 2018, OxyContin prescriptions accounted for less than 2% of the 195 million opioid prescriptions.

Misconception #3

Extended-release (ER) formulations (such as OxyContin) are prescribed more often than immediate-release (IR) opioids. 

Truth: ER formulations account for about 10% of all opioid prescriptions, whereas 90.4% of prescriptions are for IR opioids.

Misconception #4

OxyContin accounts for the majority of oxycodone prescriptions. 

Truth: Between Oct 2017 and Oct 2018, approximately 195 million prescriptions were written for opioids, of which OxyContin accounted for 1.4% of opioid prescriptions and 5.5% of oxycodone prescriptions.

Misconceptions about Opioid Addiction

Misconception #1

Opioid addiction is a psychological disorder that affects people with weak willpower.

Truth: Long-term use of oxycodone alters brain functioning and causes chronic and lasting changes in the brain reward system.

Misconception #2

The best way to tackle opioid addiction is without medication. 

Truth: The reality is that for many people, abstinence based programs (stopping the use of all drugs and medication) lead to relapse. Research shows that medication-based treatments are the most effective treatments for opioid addiction.

Oxycodone is Dangerous, Use it Carefully

Oxycodone is an effective drug for treating pain, but it is highly addictive.  Use it only with a valid prescription and follow your doctor’s instructions carefully.  If you know anyone who may be addicted to oxycodone, urge them to get help right away.


Resources

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622774/
  2. https://www.drugs.com/oxycodone.html
  3. https://link.springer.com/article/10.1007/s11469-017-9827-y
  4. https://www.fda.gov/drugs/information-drug-class/timeline-selected-fda-activities-and-significant-events-addressing-opioid-misuse-and-abuse
  5. https://www.drugabuse.gov/publications/research-reports/medications-to-treat-opioid-addiction/overview
  6. http://www.cesar.umd.edu/cesar/drugs/oxycodone.asp