The Hype of Hillbilly Heroin: The Truth About OxyContin Pt. 1
In 1995 the pharmaceutical giant Purdue Pharma created a new pain medication that for 5 years was a godsend to those in chronic pain without making waves in the media-sphere. OxyContin is different than other narcotic pain medications (medications that are derived from or synthetic versions of components of opium) because unlike most that wear off after 4-6 hours, it lasts for 8-12. OxyContin contains oxycodone, a derivative of thebaine and is structurally related to codeine and vicodin. Like codeine and vicodin, oxycodone has been available for decades in preparations containing acetaminophen (tylenol) or acetylsalicylic acid (aspirin). You may have heard of these medications: percocet containing tylenol and percodan containing aspirin.
OxyContin is different from percocet or percodan because it doesn’t have tylenol or aspirin in it so much higher doses can be consumed without compromising your liver or stomach and it contains a suspended dose of the medication which is released over 12 hours for most people although some people say the effects wear off in 8 (I have found that it is much closer to 12 and I take 2 per day although my pain increases starting roughly 2 hours before the next dose).
If you are unfamiliar with the media stories in the last 7 years about oxycontin, its high potential for abuse lies in the ability of the consumer to crush the pills releasing the 12 hour suspended dose at once for a more powerful high. Chronic pain varies considerably from patient to patient and some require doses that could potentially kill another person if the pill is crushed. OxyContin was available in up to 160mg doses (from doses that start as low as 5mg) until recently and now the maximum is 80mg with a few exceptions. If you have ever taken regular vicodin or tylenol 3, an 80mg oxycontin is like taking 8 pills 3 times in a day or as much as 24 pills at once if the medication is crushed! (http://www.globalrph.com/narcotic.htm) Only 8 regular strength Vicodin can be taken in a day before you risk liver damage from acetaminophen so obviously the abuse potential and subsequent addiction potential are much higher in OxyContin as one pill can be consumed by addicts instead of a handful of another narcotic where you risk liver or stomach problems.
People in chronic pain however seek relief from their agony and not just an escape or high. In fact, many pain patients naively avoid these medications because of fear of addiction yet study after study show that very few people who are prescribed these medications for pain and take them as directed become addicted and personally I feel those concerned enough to avoid them are probably not the ones that would abuse them. The people that are addicted to these medications are not typically unwitting patients in pain but people with histories of substance abuse that seek out these medications on the black market or deceive doctors to acquire them (http://www.csdp.org/research/CatoXLibbyXAnalysis.pdf, page 8).
Many people hold the dangerous myth that if you take enough of these pills for long enough, even if you need them, that you will become addicted. Physical tolerance to a medication you need is not the same thing as addiction which is largely psychological. Physical dependence and tolerance occur with many types of medications and that does not mean the patient is addicted to them.
The war on drugs as well as the media’s falling in line with such are making a very difficult situation for many that are in chronic pain, including myself. Oxycodone is a very effective pain medication which for me personally, was exponentially more tolerable than morphine which sedated and nauseated me without the analgesia that oxycodone provides. Denying patients medication or adequate dosages because of another group of people abusing them is illogical and cruel.
The government should worry about actual criminals and doctors should worry about their patients and until then, the suffering will suffer more.
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Part 2 of this piece will cover the media spin on OxyContin use/abuse and its effects.
My grandmother had two major surgeries in one week–one to remove her left breast because of breast cancer and the other to remove part of a blockage in her bowels due to her previous bout with ovarian cancer–and Oxy was one of the only things that kept her from being in serious pain. Her body had went through so much, she couldn’t use morphine because it made her sick and dizzy. Oxy made her feel good again.
The nurses and doctors warned her that when she went off her high dosage, that she may go through withdrawl and that she needed to slowly ween herself off the medication. One nurse even explained that her daughter had dropped her medication completely one day and ended up in the hospital the next week because her withdrawl was so bad.
My grandmother was lucky. She used it for months and she managed to ween herself in less than a week. No withdrawls, nothing. If only people that abused this wonderful medication could have the willpower and strength that she does.
“… she couldn’t use morphine because it made her sick and dizzy. Oxy made her feel good again …”
myth no 1. codeine … oxy … it all becomes the same chemical once the body begins to metabolize it. the symptoms ’sick and dizzy’ do not mean intolerance, or allergy, as the world at large likes to think, they mean that the patient has received a dose which is too high … and the dizziness/sick feeling is the way the body interprets the vaso-diliatory action that narcotics have on our circulatory system. vasodilation means the cerebrum has less perfusion than it would like, and so the nausea centre of the brain interprets this as a sick feeling.
as a matter of record, my 7 years as a cancer/bowel surgery/respiratory nurse have taught me that oxy sucks as an analgesic and no post operative patient of mine has ever received it … interestingly enough. morphine, fentanyl, dilaudid … these are the popular post operative pain relievers. also demerol is popular with the surgeons, because its not as ‘paralytic’ to the bowel as morphine derivatives. but … it sucks as a pain reliever ~ half life too short.
back to the comment/post ~ the answer in many cases is not another drug … its receiving treatment from someone who understands pharmacology and narcotics ~ most practising clincians have no clue and most patients have even fewer clues.
regarding the problem of breaking up the long acting capsules ~ this happens with LA morphine also. not much we can do, except someone, somewhere is obviously selling it, ain’t they?
myth no 2. tolerance and addiction …
this is so widely misunderstood ~ these are entirely different concepts. and i am so glad you mentioned this here.
tolerance means your body has adapted, as its designed to do. addiction denotes a behaviour in which a person will pursue something (usually harmful) at any and all cost. pain is subjective. that means nurses/docs must believe self reports of pain and stop judging what they think the patients pain response should be. still addicts feel pain … genuinely feel pain. and they are a sickly bunch ~ oft-over-represented among the hospital admissions. and so … how do we treat their pain? tough one. some think we should not … i think pain is pain … regardless of who’s reporting it.so … a narcotic-tolerant person is not an addict.
in my nursing practice i have seen people suffer unnecessarily b/c they believed all this bulls!t out there about narcotics, blah blah. pain will kill if unattended. also … any patients who happen to be undermedicated at the hands of a doc, or nurse who doesn’t have a clue … these patients have a right to be pain free. families have sued nurses and docs and won … in cases where they felt their dying relative did not receive adequate pain control.
sorry to ramble … this topic is near and dear to my heart …. (i’m a former RN).
Thank you so much for the comments and professional information! This discussion needs to be had and move beyond the blogs into the mainstream press where the majority can truly understand the plight of people in chronic pain and their necessity, absolute necessity for relief.
I turn 21 in about 15 minutes and I can’t fully enjoy my birthday like my peers. I have to worry about respiratory depression and other effects if I drink too much.
At the end of the day I feel like there are so many things that I used to be able to do that I can’t now. I can’t be a 21 year old. I can’t be a student. I can’t work jobs I want and when I was on proper medications and dosages, I could. This is what frustrates me and hopefully one of the dozens of doctors I am bounced between will get this someday.