Opana is a brand name of oxymorphone, an opiate analgesic drug used to manage chronic pain. This drug is typically prescribed to people with severe chronic pain who require continuous pain medication and cannot take other medications. Because this drug is formulated as an extended-release tablet and is a very potent analgesic, Opana is recommended only when other methods of pain management are insufficient. Oxymorphone can be highly addictive. The drug works by affecting the central nervous system, so fewer pain signals are received.
An article published by Reuters reported that prescription drug abuse now leads to more deaths per year than heroin and cocaine combined. Prescription drug abuse is a growing problem that has become especially prominent in rural areas. Much of the rise in the abuse of oxymorphone has been attributed to changes made to oxycodone that made it more difficult to abuse. Many people addicted to oxycodone began to use oxymorphone after oxycodone was no longer a feasible option. Oxymorphone is more potent per milligram than oxycodone, which makes overdose more likely.
In addition to the negative health effects caused by abuse of Opana, prescriptions drug addiction and abuse can have other negative effects that result from the methods used to abuse the drug. For example, health officials have linked the abuse of Opana with a recent outbreak of HIV in southern Indiana.
Many people who misuse prescription painkillers crush the tablets and then inject the drug intravenously. Injecting drugs and sharing needles can significantly increase an individual’s risks for contracting transmittable diseases like HIV.
Effects of Oxymorphone
Effects on the Mind
Oxymorphone is an opioid drug. This type of drug works by attaching to opioid receptors within the central nervous system. This prevents the brain from receiving pain signals, making opioid drugs very effective in pain management. However, this has the added effect of creating a euphoric feeling, or “high,” that some people seek when they use this type of medication. NIDA warns that individuals who become addicted to oxymorphone may begin to use the drug in ways other than it was intended, such as crushing the tablets to snort or inject, in order to intensify the euphoric feeling.
The use of oxymorphone, both legitimate and illicit, can have an impact on the mind and mental functioning. The U.S. National Library of Medicine lists the following mental effects:
- Difficulty sleeping
A recent study found that the neuropsychological effects of opioid drugs can be extensive and may be long-lasting among those who use the drug frequently. Effects included lowered performance in attention, memory, concentration, psychomotor functioning, and spatial reasoning. Long-term effects were more serious and included poorer reasoning skills and less impulse control.
Oxymorphone is a highly addictive substance. NIDA defines addiction as compulsively seeking and using a substance despite negative consequences to the individual’s life. Addiction often includes physical dependence on the substance, meaning individuals experience withdrawal symptoms when they attempt to stop using the drug. This chronic disease can have devastating effects on the chemistry and physical structure of the brain, which typically require long-term treatment by medical professionals and mental health professionals.
One of the neuropsychological effects of oxymorphone that is commonly experienced is increased tolerance to the drug. Over time, the central nervous system becomes accustomed to the presence of opioids and does not respond the same way as it once did. This can make opioids less effective at treating pain, and decreases the “high” felt by the individual. Higher doses of the drug must be administered to achieve the desired results. Tolerance can decrease quickly if an individual stops using oxymorphone for a period of time. Because of this, risk of overdose can increase after treatment for opioid addiction, since a large dose that was once well-tolerated may now be too much for the body to handle.
Effects on the Body
Oxymorphone can have various effects on the body. The U.S. National Library of Medicine lists the following side effects of oxymorphone use:
- Nausea and vomiting
- Loss of appetite
- Dry mouth
- Stomach pain
More serious physical effects of oxymorphone include difficulty breathing, increased heart rate and fainting. Overdose of oxymorphone is very dangerous and can be life-threatening. Symptoms of overdose include:
- Slowed or stopped breathing
- Blue skin, lips, or fingernails
- Cold, clammy skin
- Extreme sleepiness or loss of consciousness
If overdose is suspected, call 911 immediately.
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According to the CDC, 44 people in the United States die each day from the misuse of prescription painkillers. Rates of addiction are high. In 2012, 2.1 million people met the criteria for substance use disorders related to prescription opioid drugs in the US alone, as reported by NIDA. In 2014, a survey showed that 22.1 percent of individuals addicted to opioid drugs were originally prescribed the medication for legitimate use, and 50.5 percent originally got the drug from a friend or relative.
USA Today has reported that the exponential increase in oxymorphone abuse has overwhelmed officials, particularly in suburbs and rural areas. Prescriptions for the drug have increased, as well as the street value per pill. A large percentage of those who seek help for drug addiction are now presenting with oxymorphone addiction, as opposed to addiction to drugs like oxycodone or heroin. In response, Opana is being reformulated to make crushing and injecting the drug more difficult. The new formula was recently approved by the FDA.
Effects of Addiction
Addiction to opioid drugs like oxymorphone can have many effects on an individual’s mental and physical health, behavior, and daily functioning. Addiction is a pervasive disease that involves compulsively seeking out and using the addictive substance. Some of the effects of addiction can be observed by the friends and loved ones of the addicted individual.
Mayo Clinic lists the following behavioral effects of prescription drug addiction:
- Stealing or forging prescriptions
- Taking higher doses or using the drug in other ways than how it was prescribed
- Seeing more than one doctor to receive multiple prescriptions
- Trouble sleeping or sleeping more than usual
- Hostile or unpredictable behavior
- Poor decision-making or lack of impulse control
CBS News listed the following warning signs of addiction:
- Chronic drowsiness or lack of energy
- Withdrawing from, or changing, friend groups
- Lack of participation in activities previously enjoyed
- Increased secrecy and lying
Choosing a Treatment Program
The most effective treatment for addiction to prescription painkillers is tailored to the needs of the individual. Many social and familial factors impact the development of, and recovery from, addiction, and these factors must be incorporated into the treatment plan. Treatment typically involved both behavioral therapy and medication, which research has shown is more effective than using either therapy or medication alone.
Behavioral therapy treats addiction by addressing unhealthy behavior and negative thoughts that might be contributing to the pattern of drug use. The goal with this treatment approach is to provide life skills that will allow the individual to better resist urges to use drugs in the future. Family relationships and other life circumstances, such as work or friendships, should also be addressed. Medication prescribed throughout the treatment process may include drugs intended to aid withdrawal or to maintain sobriety.
Withdrawal and the Detox Process
Physical dependence on a substance occurs when the body becomes accustomed to the presence of the drug and relies on the substance to maintain normal functioning. Withdrawal is the process the body goes through to reestablish normal functioning without the drug. While withdrawal from opiates can be painful and unpleasant, it is not usually dangerous or life-threatening. Symptoms of withdrawal can include:
- Anxiety and agitation
- Muscle aches
- Watery eyes and runny nose
- Trouble sleeping
- Abdominal cramps
- Dilated pupils
- Nausea and vomiting
The initial period of treatment for oxymorphone addiction is detox. This is the period of time when the body rids itself of the addictive substance. Withdrawal is a component of detox, and medications may be offered during this period to ease withdrawal symptoms. Alcohol Health and Research World reports that approximately 10 percent of people in detox need inpatient care. Most people can detox as an outpatient, which is less expensive and time-consuming; however, medical detox is always recommended for opiate addiction, which means medical supervision is always required even if one detoxes on an outpatient basis. For those with co-occurring mental health or physical conditions, or those dealing with long-term or severe addictions, medical detox is always needed.
An important component of oxymorphone addiction treatment is behavioral therapy. Therapy is usually provided individually, as well as in a group setting. The Substance Abuse and Mental Health Services Administration (SAMHSA) lists the following types of therapy as being most common in the treatment of substance abuse:
- Cognitive Behavioral Therapy: In this model, the individual learns to recognize unhelpful or damaging patterns of behavior or thoughts. Learning to recognize choices that perpetuate drug abuse allows the individual to modify behavior in the future. New patterns are established so the person in treatment can better handle triggers and stress.
- Motivational Enhancement Therapy: This model is typically used in the early stages of treatment. The purpose of this therapy is to encourage the individual to engage in the treatment process and commit to recovery from drug abuse.
- Contingency Management: Treatment following this model uses positive reinforcement to encourage participation in treatment and maintenance of sobriety. Rewards are given for specific behaviors, creating positive associations with treatment and encouraging the individual to continue those healthy behaviors in the future.
Behavioral therapy is offered in residential programs, intensive outpatient programs, and standard outpatient treatment programs. Each level of treatment offers a different level of care and number of hours spent in therapy. Most treatment plans involve an initial period of more intense treatment, and then transition to involve fewer hours in treatment as recovery progresses.
Inpatient treatment may be long- or short-term. Long-term programs may last several months, and they offer the most intensive form of addiction treatment available. Short-term programs offer much of the same treatment as long-term programs, but typically last weeks or months. These programs offer 24-hour supervision and care in a highly structured environment. One of the most common methods of treatment practiced within residential programs is the therapeutic community, a model that views addiction within the context of an individual’s environment. Treatment within this model encourages personal responsibility and awareness, and uses the structured environment and the presence of other people in recovery to assist in the therapeutic process.
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Outpatient treatment for oxymorphone addiction is available at varying levels of intensity, ranging from intensive outpatient programs, also called partial hospitalization, to day programs involving fewer hours in treatment per day. Intensive outpatient programs offer many of the same treatment components as residential programs, but the individual continues to live at home while spending a certain number of hours in treatment.
In addition to individual therapy, group counseling is frequently employed in the treatment of addiction. Group therapy can provide a support system that may be missing from an individual’s life, which is an important component of recovery from addiction. According to NIDA, participation in group counseling can significantly increase the likelihood of positive outcomes from addiction treatment.
Outpatient programs are typically a much less expensive option than residential programs. The Health Research and Educational Trust found that outpatient programs are much more cost-effective in treating drug addiction than their inpatient counterparts. However, inpatient programs greatly reduce the risk of relapse. The U.S. National Library of Medicine reports that participants in residential drug treatment programs are four times less likely to relapse into drug use.
Medications for Treatment of Opioid Addiction
Medications are often prescribed during recovery from opioid addiction. Different medications can be used to treat withdrawal symptoms or to reduce cravings. The three medications most commonly used in the treatment of opioid addiction are naltrexone, methadone, and buprenorphine.
Methadone is one of the most common medications used in the treatment of opioid dependence, and it has been used for this purpose for several decades. Methadone works by mimicking the effects of opioids like oxymorphone, thereby lessening symptoms of withdrawal and reducing cravings for the illicit drug. Because methadone mimics the effects of illicit drugs, it is a carefully controlled substance and only available within certain treatment programs. Methadone is not available on an outpatient basis.
Naltrexone works by blocking the effects of opiates within the body. This prevents the abuse of oxymorphone by lessening the effects of the drug felt by the individual. Naltrexone is used to treat both addiction and overdose of opioids. Effects of this drug can last for several weeks, so it is most often used for those who lack consistent access to medical care.
Buprenorphine is a more recent addition to opioid addiction treatment. Use of buprenorphine to treat addiction to opioid drugs is still considered off-label use, but the FDA is reviewing studies showing evidence that it is effective in the treatment of addiction. This drug is better tolerated than naltrexone, and it has less potential for abuse than methadone. Buprenorphine treats withdrawal symptoms and reduces cravings for opioids like oxymorphone. It can be prescribed in an office setting, so people in outpatient treatment for addiction have easier access to this medication than other options, such as methadone. The use of buprenorphine in the treatment of oxymorphone and other opioid addiction has become more common in recent years and continues to increase in popularity.