Already more than 20 years old, there appears to be no end to the opioid epidemic. Newer and vastly powerful opioid drugs, some not even fit for human consumption, continue to fuel a drug crisis that has endured long enough to enter the third wave.
The prescription painkiller oxycodone helped launch the opioid crisis in the 1990s, widely considered the epidemic’s first wave. From 1999 to 2017, 400,000 people have died from prescription and illicit opioid overdose, according to the U.S. Centers for Disease Control and Prevention (CDC). Additionally, the number of opioid overdose deaths in 2017 was six times the amount in 1999.
After all this time, oxycodone and its brand-name formulation OxyContin remains a principal driver in this unrelenting scourge.
Oxycodone is prescribed to relieve moderate-to-severe pain.
When it enters the body, oxycodone binds to opioid receptors in the brain and spinal cord. The body already performs this process naturally to regulate pain. What’s noteworthy about oxycodone is that it stimulates those receptors to the point where the brain and nervous system are flooded with opioids — far more than the brain could ever generate on its own. This action produces feelings of pain relief and sedation.
Oxycodone also spikes levels of dopamine, the chemical often referred to as the brain’s pleasure center. When this occurs, users experience profound euphoria, which causes them to return to oxycodone again and again.
Oxycodone is available in the following forms: as a long-acting, extended-release tablet sold under the brand name OxyContin, an extended-release capsule marketed as Xtampza ER, as a solution (liquid), a concentrated solution, capsule, and tablet.
How oxycodone helped trigger the opioid epidemic can be understood through the rise of its best-known product, OxyContin.
OxyContin, approved in December 1995, was packaged as an extended release medication. Purdue Pharma, the makers of OxyContin, launched an innovative marketing campaign around the drug that was centered on this message, according to Pharmacy Times: “Delayed absorption as provided by OxyContin tablets, is believed to reduce the abuse liability of a drug.”
That campaign spurred OxyContin to become one of the most prescribed opioids in the country and convinced physicians to reverse old prescribing trends. In the process, Purdue Pharma netted $35 billion in revenue, and OxyContin became a blockbuster drug many times over.
The company funded research and paid doctors to make the case that concerns about opioid addiction were overblown and that OxyContin could safely treat an ever-wider range of maladies, states a 2017 New Yorker profile on the family that founded Purdue Pharma,
The drug effectively treated pain but ultimately got a multitude of users hooked. When opioid prescription medicines became too expensive, patients resorted to taking heroin.
The U.S. Food and Drug Administration (FDA) notified the makers of OxyContin about the lack of warning statements concerning its addictive qualities in 2003.
The FDA also issued a black box warning that OxyContin exposed users to “the risk of addiction, overdose, and death.”
In 2007, representatives of Purdue Pharma paid more than $600 million in fines as part of a guilty plea that the company initially misbranded OxyContin. A new formulation of OxyContin emerged, one that included abuse-deterrent properties, but a study showed that the switch made users turn to heroin and other opioids.
Nevertheless, a full-blown addiction epidemic would be born. An oxycodone medication contributed greatly to the jump in opioid deaths and overdoses in the 1990s and early 2000s, a period often referred to as the epidemic’s first wave. Its second and third waves have been fueled by heroin and fentanyl, yet oxycodone continues to play a prominent role.
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While not life-threatening, opioid withdrawal, in general, can produce painful and uncomfortable physical and psychological symptoms. The physical withdrawal symptoms of oxycodone include:
The psychological symptoms associated with oxycodone are:
Oxycodone withdrawal symptoms are not life-threatening. Death from oxycodone has occurred only in extreme cases where intense vomiting and diarrhea occur, leading to dehydration and eventually heart failure and death.
Still, there is not one standard timeline for oxycodone withdrawal, as it impacts each individual differently.
Withdrawal symptoms begin when the drug leaves the body. This is referred to as the substance’s half-life. The half-life and length of the drug’s activity in the bloodstream determine when withdrawal symptoms start. With oxycodone, the half-life depends on the formulation of the medication involved, whether it is of the immediate or extended-release variety.
The half-life for the immediate-release oxycodone drug is between three and four hours on average, according to this pharmacological review. For extended-release oxycodone, the half-life is about 12 hours. What this means is that the drug will process out of the body in about eight hours to 24 hours.
Withdrawal symptoms typically begin in this window of time and can last days, weeks, and even months.
Here is what a general oxycodone withdrawal timeline looks like:
8 to 24 hours: During this period, early symptoms of withdrawal begin, causing general physical and mental discomfort.
2 to 3 days: This is the window where withdrawal symptoms peak and are at their most intense levels. Also, most of the associated symptoms manifest during this time.
3 to 7 days: Acute withdrawal occurs during this period, but symptoms diminish in three to five days on average.
A few weeks to months: Mood swings, sleep disruptions, cravings, and cognitive issues can last for weeks or months, a phenomenon known as protracted withdrawal.
Attempting to quit oxycodone on your own can be fatal. The withdrawal symptoms themselves are mild compared to those associated with alcohol, benzodiazepines, and barbiturates. However, they are painful and uncomfortable enough to compel people to resume using to stop those symptoms from happening.
Opioid withdrawal is not something to try and manage at home. You are susceptible to overdosing, as your sensitivity for the drug’s effects will increase, and your tolerance to the effects will decrease. When this occurs, users put themselves at risk for taking too much oxycodone and overdosing, which can be fatal. This is especially true when people take oxycodone with other CNS depressants like alcohol.
The following are oxycodone overdose symptoms: slowed or stopped breathing, difficulty breathing, muscle weakness, excessive sleepiness, cold or clammy skin, narrowing or widening of pupils, and loss of consciousness or coma.
To avoid this risk, a medically supervised professional treatment program is recommended.
A professional recovery program begins with acute treatment, where our doctors can administer medication to ease withdrawal symptoms. What’s more, a clinical team will help you pick the best treatment option going forward.
For oxycodone addictions, treatment through clinical stabilization services is recommended. At this step, you will receive comprehensive therapy and counseling designed to help you get to the root cause of your addiction.
The services provided at this level of treatment include:
After clinical stabilization services, the next treatment step is partial care, where you can continue to receive ongoing care and counseling while attending to the obligations of your life.
Upon completion of your treatment, you can get connected to a recovery community that provides ongoing support and counseling.
Delphi Behavioral Health Group. (2019, January 11). Oxycodone Withdrawal What Timeline Should You Expect. Retrieved from https://delphihealthgroup.com/opioids/oxycodone/withdrawal-and-timelines/
Keefe, P. R., & Keefe, P. R. (2019, February 28). The Family That Built an Empire of Pain. Retrieved from https://www.newyorker.com/magazine/2017/10/30/the-family-that-built-an-empire-of-pain
Opioid Overdose. (2018, December 19). Retrieved from https://www.cdc.gov/drugoverdose/epidemic/index.html
Ordóñez, A., González, M., & Espinosa, E. (2007, May). Oxycodone: A pharmacological and clinical review. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/17525040
Oxycodone: MedlinePlus Drug Information. (n.d.). Retrieved from https://medlineplus.gov/druginfo/meds/a682132.html
Rodolico, J. (2016, January 11). Anatomy Of Addiction: How Heroin And Opioids Hijack The Brain. Retrieved from https://www.npr.org/sections/health-shots/2016/01/11/462390288/anatomy-of-addiction-how-heroin-and-opioids-hijack-the-brain