Oxycodone might be one of the most infamous drugs in American history. While it was originally intended to be prescribed in cases of severe and breakthrough pain, the intensive marketing campaign launched by its manufacturer, Stamford-based Purdue Pharma, and the way it was co-opted by the black market, have made the medication synonymous with the opioid epidemic that has caused thousands of overdoses across the country, many of them fatal.
Generic oxycodone remains available to be prescribed by doctors. There are still numerous instances of prescriptions and shipments being diverted by black market operators in illegal distribution operations. There are also countless troubling stories of oxycodone being cut with other, deadlier opioids (like fentanyl) and being sold to unsuspecting buyers.
Oxycodone remains a medication that is used for legitimate medical purposes, but it has become inextricably linked with the shadow of the opioid crisis.
Oxycodone is available under a number of brand names. It is often combined with another medication, such as acetaminophen, ibuprofen, or aspirin. Brand names of oxycodone and combination medications include the following:
Oxycodone is still available, but prescribing it and obtaining it (legally) looks very different. For example, before it filed for bankruptcy, Purdue Pharma stated that it would stop marketing the medication to doctors in the United States.
As much as the move was in response to the overwhelming negative publicity the company received for its role in the opioid crisis, Bloomberg pointed out that OxyContin has simply become less profitable. In 2012, the medication generated $2.8 billion in sales for Purdue Pharma. In 2017, sales were down a full $1 billion, and signs suggest that the slide will continue.
In September 2019, Purdue Pharma filed for bankruptcy in a New York court — the result of a tentative settlement with dozens of state and local governments, as well as thousands of other entities, that held the manufacturer responsible for widespread opioid-related deaths in their jurisdictions.
Purdue Pharma’s bankruptcy did not come as a surprise, but what remains controversial is that many of the attorneys general who filed suits balked at the $12 billion settlement, saying that it is not nearly enough to address the decades’ worth of damage done by the company’s aggressive and deceptive OxyContin marketing.
Purdue Pharma itself is not out of the woods. Even as the settlement is being finalized, the manufacturer is spending millions of dollars on legal costs in myriad lawsuits from across the country. Its battles will continue to range in bankruptcy court.
The Sackler family, who became one of the richest families in America through their now-relinquished ownership of the company, is facing litigation themselves. The $12 billion settlement includes $3 billion from the family, but this has not satisfied the plaintiffs, who point out that its terms spare Purdue Pharma from being held legally liable for the opioid epidemic by a judge.
The chairman of the company clarified in the bankruptcy settlement that Purdue Pharma has no intention of admitting to any culpability. Members of the Sackler family continue to reject the accusations that their company had any role in the proliferation of the spread of opioids.
In general, prescription opioids are still available, but their accessibility is a source of controversy for patients and practitioners alike. The Washington Post writes of “a sweeping change in chronic pain management,” where doctors are increasingly reluctant to prescribe opioids to patients, out of fear of seeding an addiction or being subject to malpractice lawsuits. Patients, however, object to their doses being preemptively tapered (in many cases, for no fault of their own), especially if their prescribed opioids are the only relief they have from chronic and breakthrough pain.
The tension around the availability of prescription opioids is between the members of the medical community, who are aware of 70,000 opioid-related fatalities every year (and many more near-fatal overdoses), and patients who have not only suffered greatly for years without opioids, but are now frustrated and unfairly stigmatized because opioids present the only form of pain management they can get.
As a result, prescription opioids are still available, but less readily so. A number of pain management clinics across the country have closed their doors (either because of a dearth of opioids to supply their legitimate clients or because of implications in smuggling rings, or even both). While many chronic pain patients complain that their doses are unfairly reduced, some have had their prescriptions halted entirely. These patients have had to travel long distances to find doctors who will write a prescription or to make contact with a black market seller who trades in oxycodone.
As many as 33 states have imposed legal limits on the amount of opioids doctors within their borders can prescribe to patients. Medicare Part D has similar limits for some opioid patients.
The Department of Veterans Affairs slashed the number of patients receiving opioids. And between 2016 and 2018, on directions issued by the Drug Enforcement Administration, the pharmaceutical industry at large reduced the quantity of opioids it produced by 38 percent.
Oxycodone’s powerful addictiveness is based on the fact that human beings are wired to receive pleasure, stimulation, and reward. Much of this neural wiring is activated by the opioid system in the brain and the central nervous system.
The director of the Center for Substance Abuse Research at Temple University explained that opioids act in ways similar to other drugs. Opioids bring powerfully pleasant experiences, by unlocking the dopamine transmitters in the brain that make us feel good.
But what sets opioids like oxycodone apart is how they target the amygdala, the region of the brain from where the electrochemical signals of emotions and motivation are born. This is what makes the craving for oxycodone so deep.
Chronic oxycodone use leads to changes in the brain’s structure, removing special connections between neurons and forcing the brain to rely on the opioid compounds to do the work of thought, emotion, and critical thinking.
As the addiction progresses, the reward system is replaced by irresistible cravings, which in turn influence behavior. The smallest triggers can jumpstart the need for more opioids. The biggest triggers make the desire for opioids unbearable.
The final piece of the puzzle that makes oxycodone so addictive is that after long-term exposure, the brain cannot function without it. Therefore, taking oxycodone away results in excruciating withdrawal symptoms that make a person even more dependent on the medication just to feel normal.
One of the significant health concerns of the abuse of oxycodone is that the brain eventually gets used to the constant presence of its chemical compounds in the central nervous system.
Whether the oxycodone use was for legitimate medical reasons that got out of hand or for recreational purposes, the body becomes increasingly dependent on oxycodone for feelings of pain management and comfort, eventually losing the ability to function properly without it. This is a state known as tolerance, defined as the process by which a patient requires higher and higher amounts of a drug to get the original degree of the desired effect.
As the need for oxycodone continues, the health effects also pile up. Taking oxycodone beyond prescribed parameters will often lead to:
Any signs like these are grounds for concerns that the use of oxycodone has crossed the line into abuse.
If a person refuses to seek help for their oxycodone addiction, it may be necessary to stage an intervention. This is a properly planned and carried out group meeting, between the patient, their close friends and family, and a trained moderator or professional interventionist, to convince the patient that they have a problem with oxycodone abuse, and they need to enroll in a treatment program immediately.
The people in the intervention will present their reasons why their loved one needs help. This will usually entail listing the damage and changes caused by oxycodone abuse. The intervention is not meant to shame the person, but to provide an opportunity for them to take action by starting the recovery process.
However, the intervention should also make clear that if the person refuses help, they will be subject to consequences, such as divorce/separation, eviction, or termination of custody or financial support. These consequences should not be made lightly, and they should be the result of weeks’ worth of work with the trained moderator to be taken seriously.
When done properly and successfully, the person accepts the need for help for their oxycodone problem. They then begin working with the moderator and their friends and family on how to immediately connect with a treatment center.
Interventions can be very emotional and contentious experiences. They should never be conducted without the presence and supervision of trained, licensed moderator.
The first step of treatment at a facility will be detox, which is where the patient is weaned off their physical need for opioids. This can be a complex, painful, and potentially dangerous process, and it should never be attempted without medical oversight.
Especially in cases of chronic oxycodone addiction, simply terminating oxycodone consumption can be extremely distressing (physically and psychologically), and it can lead to numerous health complications. As a result, do not attempt to stop taking opioids cold turkey on your own. Consult a medical professional before stopping use.
During medical detox, medical staff at a treatment facility will administer medications to ease the process. Sometimes, mild, slow-acting opioids are given to the patient, as a way of providing a buffer against the painful withdrawal symptoms that come with discontinuation while still giving the central nervous system the opioids it needs to stay comfortable (albeit at a lower dose). This is known as medication-assisted treatment. Methadone or buprenorphine are usually used.
Without MAT, it takes a little more than a week for the physical dependence of opioids to be broken. The exact timeline depends on the nature of the oxycodone abuse, as well as if the patient has been taking other drugs, their past history of substance abuse, and if there are any other prevailing health issues.
Once detox is complete, the next step of treatment is psychological counseling. This will address the mental health damage caused by the oxycodone abuse, as well as teach the patient how they can mentally cope and function without the powerful (and constant) presence of opioids.
Part of this work is to connect with other people in recovery, to learn from their experiences and to embark on the road to recovery together. Doing this group work, and making family and friends part of the process, helps patients understand that they are not alone, and that they have support they can turn to when sober life becomes challenging.
In the long term, this can entail joining a group like Narcotics Anonymous, or one of the dozens of groups based on the 12-step model, that helps patients navigate the complications of being in recovery and being unable to use oxycodone for pain management or for recreational purposes. This form of aftercare can be lifelong, always providing the patient with a core group of advocates and friends who can be there in times of struggle and loneliness. This offering of strength and solidarity can go a long way in helping patients enjoy a full and rich life in recovery.
People struggling with opioid abuse benefit from a comprehensive rehab program that transitions them through each level of care. This kind of continuous supportive care reduces the risk of relapse.