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Oxycontin as viewed from several perspectives...
OxyContin (Oxycodone hydrochloride controlled-release) is an opioid analgesic in time-release form. Which means a small amount of the drug is absorbed over a 12 hour period.
The active ingredient in Oxycontin is Oxycodone which is the main ingredient in Percocet, Percodan, Tylox, Roxicet, Oxycocet, OxyIR, Endodan, Endocet and probably a few more names not mentioned. Oxycodone has been around for years and is used for moderate to severe pain. It is a Schedule II controlled substance. It works by inhibiting ascending pain pathways in the Central Nervous System, increases the pain threshold, and alters pain perception.
The problem with Oxycodone is after using it for a while the body develops a natural tolerance to the medication, as it does with all opiates. In order to get the same affect the person needs to increase the dose. This does not mean the person is addicted. There is a difference between tolerance and addiction.
The problem that chronic pain sufferers have with opiates is the need to increase the dose to get the same affect. Before Oxycontin came along the patient would increase there dose as tolerance developed and this increased the risk of side effects of the other ingredient in the medication. For example: Percocet contains Oxycodone 5mg with Acetaminophen 325mg. Increasing the dose of this medication also increases the dose of Acetaminophen that the person gets.
Another downfall of fast acting medications is that you get a peak affect in 2 hours and then a sudden drop of the medication. So the patient was unable to keep a steady level of the drug in their system.
In the past in order to get adequate pain relief, the patient would have to switch to another medication and found it did not work as well as the Oxycodone.
In 1996 the Purdue Pharmaceutical company came out with the Oxycontin, the first oxycodone pain medication that is time released (MSContin is also made by Purdue and is a time released form of Morphine). These are the only two opiate pain relievers available in a sustained released formula.
With Oxycontin the patient can get Oxycodone (A very effective medication for pain) in a sustained released formula without the adverse affects of acetaminophen or aspirin that is in many of the fast acting formulas. It releases small amounts of Oxycodone over 12 hours, keeping the therapeutic levels of this drug in the blood stream. This was a Godsend for pain patients. For the first time they could get adequate pain control in a sustained released product. This gave many patients a new outlook on life. For many this was the first time they were able to get through their day Painfree! Because it is sustained released it does not cause an elevation in medication blood levels like the fast acting drugs do. It keeps a steady, constant level of Oxycodone in the bloodstream, resulting in adequate pain relief.
Contrary to popular belief you do not need to be a Cancer patient to take Oxycontin. It works very effectively for patients suffering with chronic pain. Most of these patients try hundreds of other medications before finally deciding to go on Opiate treatment. Contrary to popular belief, patients who take Oxycontin are not junkies, drug seekers, drug addicts or poor. They are normal people who suffer with a condition that causes excruciating daily pain and have tried everything to try and control this pain. They are your mothers, children, neighbors and friends. All they want is to be able to live their lives without pain.
OxyContin is supplied in 10 mg, 20 mg, 40 mg, 80 mg, and 160 mg tablet strengths. The tablet strengths describe the amount of Oxycodone per tablet. The medication is sustained released and lasts for 12 hours. The pills are given every 12 hours in order to keep a constant level of the drug in the system.
Oxycontin should not be used for
quick pain relief. It should be used by those patients who suffer with chronic
daily pain that is moderate to severe. It is not for mild pain or for temporary
pain, such as after dental or surgical procedures.
Each patient has to be dosed individually. What works for one patient may not work for another. This is true for all the opiates. Physicians start out with the lowest dose and gradually increase that dose until they reach the point of pain relief.
There are different criteria for different people. It depends on age, weight, type of pain, history of taking opiate's in the past.
In a person who has never taken opiates they start them on the absolute lowest dose. In a person who has been on opiates in the past the starting dose will be higher.
Oxycontin was produced to provide a time release of the active ingredient - oxycodone. The pills should not be broken in half, crushed, snorted, or injected. Doing this could cause a fatal dose of the medication to be released suddenly.
OxyContin is an opioid agonist. Opioid agonists are substances that act by attaching to specific proteins called opioid receptors, which are found in the brain, spinal cord, and gastrointestinal tract. When these drugs attach to certain opioid receptors in the brain and spinal cord they can effectively block the transmission of pain messages to the brain.
CNS: Drowsiness, dizziness, confusion, headache, sedation, euphoria
GI: Nausea, vomiting, anorexia, constipation, cramps.
GU Increased urinary output, dysuria, urinary retention
INTEG: Rash, urticaria, bruising, flushing, diaphoresis (Sweating), pruritus (itching)
EENT: Tinnitus, blurred vision, miosis, diplopia
CV: Palpitations, bradycardia, change in BP
RESP: Respiratory depression
Hypersensitivity, addiction (narcotic)
Addictive personality, pregnancy (B), lactation, increased intracranial pressure, MI (Acute), severe heart disease, respiratory depression, hepatic disease, renal disease, child <18.
Detoxified by the liver, excreted in the urine, crosses placenta, excreted in breast milk.
Increased effects with other CNS depressants: Alcohol, narcotics, sedative/hypnotics, antipsychotics, skeletal muscle relaxants.
Signs and Symptoms: Serious overdose of oxycodone HCl is characterized by respiratory depression (a decrease in respiratory rate and/or tidal volume, Cheyne-Stokes respiration, cyanosis), extreme somnolence, progressing to stupor or coma skeletal muscle flaccidity, cold and clammy skin, and sometimes bradycardia and hypotension. In serious overdosage, apnea, circulatory collapse, cardiac arrest, and death may occur.
Treatment: Primary attention should be given to the reestablishment of adequate respiratory exchange through provision of a patent airway and the institution of assisted or controlled ventilation. The narcotic antagonist naloxone is a specific antidote against respiratory depression which may result from overdose or unusual sensitivity to narcotics, including oxycodone. Therefore, an appropriate dose: 0.4 mg should be administered, preferably by the IV route, simultaneously with efforts at respiration resuscitation. Since the duration of action of oxycodone may exceed that of the antagonist, the patient should be kept under continued surveillance and repeated doses of the antagonist should be administered as needed to maintain adequate respiration.
An antagonist should not be administered in the absence of clinically significant respiratory or cardiovascular depression.
Oxygen, IV fluids, vasopressors and other supportive measures should be employed as indicated. Gastric emptying may be useful in removing unabsorbed drug.
Package Insert for Oxycontin *Must have Adobe Acrobat Reader to view this page.
Purdue letter to healthcare professionals In PDF format - must have Adobe Acrobat Reader to view this page.
I'm sure every American has read at least one story in their local newspaper or seen at least one news report on the illegal use of Oxycontin. Oxycontin was made to provide patients with Chronic pain a way to get their medication in a time released form and does work when used correctly. When it becomes a problem is when the tablets are crushed, broken, snorted, injected or the higher dose tablets are taken by someone who has never taken opiates before. This is dangerous and could lead to death! Their was a tragic story on the news about 2 sixteen year old girls who took one of the higher dose tablets, went to bed, and never woke up.
PLEASE educate your children on the dangers of this medication if used improperly. Even if taken whole - the doses can be too high for someone who has never taken opiates before in their life. When these tablets are crushed it is even more detrimental. Percocet contains 5mg of Oxycodone - One 80 Mg Oxycontin contains the equivalent of 16 Percocet. When crushed it is like taking 16 Percocet at one time. One 160mg tablet is equivalent to 32 Percocet. So when used illegally and crushed it is like taking a whole bottle of Percocet at once. I don't think anyone in their right mind would do this. This is how dangerous this can be! For pain patients it is a life saver. For people using it illegally it can cause death.
The drug has become a life saver for many and has given many people their lives back.
OxyContin Diversion and Abuse
As seen by the National Drug Intelligence Center
National Drug Intelligence Center
What is Oxycontin?
OxyContin is a trade name product for the generic narcotic oxycodone hydrochloride, an opiate agonist. Opiate agonists provide pain relief by acting on opioid receptors in the spinal cord, brain, and possibly in the tissues directly. Opioids, natural or synthetic classes of drugs that act like morphine, are the most effective pain relievers available. Oxycodone is manufactured by modifying thebaine, an alkaloid found in opium. Oxycodone has a high abuse potential and is prescribed for moderate to high pain relief associated with injuries, bursitis, dislocation, fractures, neuralgia, arthritis, and lower back and cancer pain. It is also used postoperatively and for pain relief after childbirth. Percocet, Percodan, and Tylox are other trade name oxycodone products.
Oxycodone is a central nervous system depressant. Oxycodone's action appears to work through stimulating the opioid receptors found in the central nervous system that activate responses ranging from analgesia to respiratory depression to euphoria. People who take the drug repeatedly can develop a tolerance or resistance to the drug's effects. Thus, a cancer patient can take a dose of oxycodone on a regular basis that would be fatal in a person never exposed to oxycodone or another opioid. Most individuals who abuse oxycodone seek to gain the euphoric effects, mitigate pain, and avoid withdrawal symptoms associated with oxycodone or heroin abstinence.
OxyContin is an oral, controlled-release oxycodone that acts for 12 hours, making it the longest lasting oxycodone on the market. Patients taking shorter acting oxycodone products, such as Percocet, may need to take the product every 4 to 6 hours. While drug doses vary by individual, the typical OxyContin dose prescribed by physicians ranges from two to four tablets per day. OxyContin was developed and patented in 1996 by Purdue Pharma L.P. and was originally available in 10 milligram (mg), 20 mg, 40 mg, and 80 mg tablets. A 160 mg tablet became available in July 2000. By comparison, Percocet and Tylox contain 5 mg of oxycodone and Percodan-Demi contains just 2.25 mg. The strength, duration, and known dosage of OxyContin are the primary reasons the drug is attractive to both abusers and legitimate users.
How is it Abused?
The abuse of oxycodone products in general has increased in recent years. In April 2000, The Journal of the American Medical Association (JAMA) published a study, which examined two data collection sources. The DEA Automation of Reports and Consolidated Orders System (ARCOS) data tracks the distribution of oxycodone and other opioid analgesics and the Drug Abuse Warning Network (DAWN) Medical Examiner (ME) and Emergency Department (ED) data ascertained the health consequences associated with its abuse from 1990 to 1996. The JAMA study found a 23 percent increase in the medical use of oxycodone with no corresponding increase in the illicit abuse of the drug. However, 1998 DAWN ME data reported a 93 percent increase in oxycodone mentions between 1997 and 1998 and the number of oxycodone-related DAWN ED mentions increased 32.4 percent from 1997 (4,857) to 1999 (6,429).
Several deaths have resulted specifically from the abuse of OxyContin in Kentucky, Ohio, Virginia, and West Virginia. The Pike County, Kentucky, Coroner reported 19 OxyContin-related deaths during calendar year 2000. In December 2000, seven OxyContin overdose deaths were reported in Southeastern Kentucky by two Kentucky State Police posts. The Logan Daily News reported in October 2000 that four Hocking County, Ohio, residents overdosed on OxyContin over an 18-day period. Two of the four died. There have been at least four OxyContin overdose deaths in Pulaski, Virginia, since 1998. In July 2000, The Williamson Daily reported five OxyContin-related overdose deaths in southwestern West Virginia since May 2001
OxyContin is designed to be swallowed whole; however, abusers ingest the drug in a variety of ways. OxyContin abusers often chew the tablets or crush the tablets and snort the powder. Because oxycodone is water soluble, crushed tablets can be dissolved in water and the solution injected. The latter two methods lead to the rapid release and absorption of oxycodone. The alcohol and drug treatment staff at the Mountain Comprehensive Care Center, Prestonsburg, Kentucky, reports individuals who have never injected drugs are using OxyContin intravenously and they have never seen a drug "proliferate like OxyContin has since May 2000." The staff at this center has over 90 cumulative years' experience conducting drug evaluations.
OxyContin and heroin have similar effects; therefore, both drugs are attractive to the same abuser population. OxyContin is sometimes referred to as "poor man's heroin," despite the high price it commands at the street level. A 40 mg tablet of OxyContin by prescription costs approximately $4 or $400 for a 100-tablet bottle in a retail pharmacy. Street prices vary depending on geographic location, but generally OxyContin sells for between 50 cents and $1 per milligram. Thus, the same 100-tablet bottle purchased for $400 at a retail pharmacy can sell for $2,000 to $4,000 illegally.
OxyContin is, however, relatively inexpensive for those covered by health insurance, since the insurance provider covers most costs associated with doctor visits and the prescription. Unfortunately, many OxyContin abusers whose health insurance will no longer pay for prescriptions and who cannot afford the high street-level prices are attracted to heroin. For example, in West Virginia the availability of lower cost heroin is attracting many OxyContin abusers who have never used heroin.
Related Criminal Activity
doctors, & enforcement
Sat, 23 Mar 2002
DOCTOR GETS OVER 60 YEARS IN FOUR
MILTON, Fla. -- A doctor convicted of manslaughter in the deaths of four patients who overdosed on the painkiller OxyContin was sentenced yesterday to nearly 63 years in prison.
Dr. James Graves, 55, was the nation's first doctor to be found guilty of manslaughter or murder in an OxyContin death. Graves remained defiant, telling the prosecutor that one day both of them would have to "stand before God."
Prosecutors said Graves ran a "pill mill" that dispensed the powerful painkiller to addicts and dealers. A jury found Graves guilty last month of manslaughter, unlawful delivery of a controlled substance and racketeering.
Wed. Feb 22. 2002
PANHANDLE DOCTOR'S OXYCONTIN CONVICTION TO
A doctor's manslaughter convictions for overdose deaths from the painkiller OxyContin should make physicians more cautious about their prescribing practices, a federal drug official said Wednesday.
The prosecution of Dr. James Graves, convicted Tuesday in the deaths of four patients, was part of a national crackdown on the abuse of prescription drugs. He was convicted in state court in nearby Milton.
"It's going to send a very strong message to the medical community that they treat these very potent drugs _ to include OxyContin but there are others _ with respect," said Laura Nagel, head of diversion control for the Drug Enforcement Administration.
Graves, 55, of Pace, was the first doctor in the nation convicted of manslaughter or murder for deaths from OxyContin. He is facing a maximum of 15 years in prison on each of four counts of manslaughter and five counts of unlawful delivery of controlled substance. He also faces 30 years for racketeering.
At least two other doctors are facing charges of causing the deaths of patients who took OxyContin. Dr. Frank Fisher is set for trial next week in Redding, Calif., on three manslaughter counts, and Dr. Denis Deonarine of West Palm Beach, Fla., could face a death sentence if convicted of first-degree murder in an overdose death. No trial date has been set for Deonarine.
Dr. Theodore Parran, a specialist in internal and addictive medicine who testified against Graves, expects more manslaughter prosecutions.
"My impression is that prosecutors have generally felt unwilling to push the manslaughter side of this because of not really having a game plan on how to make a manslaughter charge stick," he said.
The Graves case gives them a "roadmap," said Parran, who is on the medical school faculty at Case Western Reserve University in Cleveland.
In most cases doctors accused of overprescribing have been charged with crimes such as insurance fraud or illegal distribution.
The DEA, working with state law enforcement agencies, in recent years has focused more attention on prescription drugs partly because of OxyContin. The agency blames OxyContin alone for 117 deaths in the past two years and suspects it is the likely cause in 179 others.
"It cannot be ignored," Nagel said. "People are dying."
Nagel said most physicians have nothing to worry about.
"Doctors that are operating and doing everything appropriately, they'll never see us," she said.
Parran agreed, saying "This isn't going to have a chilling effect on anybody except for felons." He characterized Graves as a rare "dishonest doc" out to make money from addicted or dependent patients by keeping them coming back for more prescriptions.
Dr. William Hurwitz, a pain management physician in McLean, Va., has a different view and is worried that legitimate doctors also have reason to worry because of the verdict.
"There's almost a standard of strict liability for any mistakes that are made or deviations in proper behavior by patients," Hurwitz said. "That has a chilling effect and should have a chilling effect on primary care physicians to sort of venture tentatively into managing pain."
Graves, a Kentucky native, was a general practitioner but began specializing in pain management a couple years before he was arrested in 2000.
Hurwitz said pain management doctors should protect themselves by keeping meticulous records and closely monitoring patients. Some may avoid young and lower-class patients because they are more prone to being drug abusers, he said.
Timothy Bannon, a spokesman for Purdue Pharma, which makes OxyContin, declined comment on the Graves case but said the Stamford, Conn.-based company, is vigorously defending itself against lawsuits prompted by overdoses and deaths.
"We believe them to be baseless and motivated in many cases by money," Bannon said. "We also feel that these cases can threaten the appropriate care given to patients by their physicians."
The company has cited the voluntary withdrawal of three suits in Mississippi, Maine and North Carolina over the past couple months.
Bannon said Purdue Pharma also is committed to spending $100 million by the end of the year on developing an abuse-resistant alternative to OxyContin.
Addicts defeat OxyContin's 12-hour time release mechanism and get a heroin-like high by chewing the tablets or crushing them and then snorting or injecting the drug.
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