Oxycodone hydrochloride (C18 H21 NO4 - HCl MW 351.83) is the chemical structural formula for OxyContin, manufactured by Purdue Pharma, L.P. Tablets are an opioid analgesic, and a Schedule II controlled substance with an abuse liability similar to morphine. OxyContin tablets are supplied in 10mg, 20 mg, 40 mg, and 80 mg tablet strengths for oral administration. The tablet strengths indicate the amount of oxycodone per tablet as hydrochloride salt.
OxyContin is a trade name for the drug oxycodone hydrochloride, or oxycodone HCL. Street names for Oxycodone include Oxy, O.C., Hillbilly heroin, Oxycotton and Killer.
Oxycodone is a white, odorless crystalline powder derived from the opium alkaloid, thebaine. Inactive ingredients include ammonio methacrylate copolymer, hydroxypropyl methylcellulose, lactose, magnesium stearate, povidone, red iron oxide (20 mg strength tablet only), stearyl alcohol, talc, titanium dioxide, triacetin, yellow iron oxide (40 mg strength tablet only) , yellow iron oxide with FD&C blue No. 2 (80 mg strength tablet only).
Background:
It is believed that ancient civilizations in Egypt and Greece used opium for its euphoric effects. During the 19th century, laudanum (opium dissolved in alcohol) and other opium products were used in Great Britain and America to treat various ailments, from teething soreness in babies to fever and cough in children and adults.
The milky liquid from the opium poppy plant seed pods is extracted and dried to form opium powder. Various alkaloids from this powder can be isolated to form opioids such as morphine, codeine and oxycodone. The alkaloid in oxycodone is thebaine.
OxyContin was introduced in the United States in December of 1995, and Canada in July 1996, although oxycodone products have been illicitly abused for the past 30 years.
Indications:
OxyContin tablets are a controlled-release oral formulation of oxycodone hydrochloride indicated for the management of chronic, and moderate to severe pain when a continuous around-the-clock analgesic is needed. When used properly, OxyContin can provide pain relief for up to 12 hours. OxyContin is not intended as a prn analgesic. (Not to be taken as needed.)
Usage:
While OxyContin tablets are only to be administered by swallowing the tablets whole, a number of other dangerous and potentially fatal means of administration are often employed by those seeking to increase the euphoria, by bypassing the time-release control mechanism. According to many experts, this hazardous and abusive means of ingestion creates a euphoric rush similar to heroin.
These potentially lethal ingestion practices include snorting, crushing, chewing, or injecting the dissolved product. This results in an uncontrolled delivery of the opioid and poses significant risks to the abuser that could result in overdose and death.
Effects:
Oxycodone works by stimulating certain opioid receptors located throughout the central nervous system, in the brain and along the spinal cord. When the oxycodone binds to the opioid receptors, a variety of physiologic responses can occur, including pain relief, relaxation, slowed breathing, and euphoria.
Typical side effects of opioid therapy include constipation, somnolence, nausea, vomiting, pruritus, (itching) headache, dry mouth, sweating and asthenia (weakness).
Less common but potentially hazardous effects include respiratory depression, altered mental state and postural hypotension. Elderly patients are particularly susceptible to respiratory depression, particularly when oxycodone is used in conjunction with other CNS depressant medications. Oxycodone can cause severe hypotension and is risky for individuals whose ability to maintain blood pressure has been compromised.
All effects are typical opioid side effects. Such effects are dose dependent, related to a patient's level of opioid tolerance, and specific to an individual's host factors.
Cautionary Notes:
Oxycodone should only be used with extreme caution in the following conditions: acute alcoholism; Addison's Disease; CNS depression or coma; delirium tremens; debiliated patients; kyphosocoliosis associated with respiratory depression; myxedema or hypothyroidism; prostatic hypertrophy or urethral stricture; severe impairment or hepatic, pulmonary or renal function; and toxic psychosis.
Oxycodone usage may obscure the diagnosis or clinical course in patients with acute abdominal conditions.
Oxycodone may aggravate convulsive disorders, and all opiods may induce or aggravate seizures.
The use of oxycodone with alcohol, other opioids, or illicit drugs will have an additive effect, causing central nervous system depression.
Oxycodone is abused much like other legal or illicit opioid agonists. This medication has become widely sought by drug abusers and people with a history of addiction.
Acute overdosage presents with respiratory depression, somnolence leading to stupor or coma, skeletal muscle flaccidity, cold and clammy skin, constricted pupils, bradycardia (unusually slow heart action), hypotension and death. Oxycodone overdosage requires immediate medical attention.
For patients no longer requiring oxycodone, cessation of therapy should include a gradual taper schedule to avoid acute withdrawal in the physically dependent patient.
Dependency:
When taken as directed, oxycodone will produce physical dependence in a few weeks time. However, the real danger is for users who take the drug for a euphoric rush, or by ingesting by ANY other means than swallowing the tablet whole.
According to the FDA, addiction is characterized by compulsive use, use for non-medical purposes, and continued use despite harm or risk of harm.
Sudden cessation of OxyContin after even a few weeks can cause a severe withdrawal syndrome.
OxyContin dependency is commensurate with whether an individual takes the medication as directed. For those that do, physical and emotional dependence is still a very real risk. For those ingesting the drug without medical supervision, the dependency risks are extremely high.
Tolerance to this class of drug builds quickly with again, increased risk to those taking OxyContin by chewing, snorting, or injecting for the "rush".
Withdrawal:
Hydrocodone withdrawal is often characterized by over-activity of the physiologic functions that were suppressed by the drug and/or depression of the functions that were stimulated by the drug. Opioids often cause sleepiness, calmness, and constipation, so opioid withdrawal often includes insomnia, anxiety, and diarrhea. Other withdrawal symptoms include restlessness, sweating, chills, yawning, muscle pain, teariness, and runny nose. Other symptoms include: irritability, joint pain, backache, weakness, abdominal cramps, insomnia, nausea, anorexia, vomiting, and increased blood pressure, respiratory rate, or heart rate.
