Opiod Abuse – Oxycontin and Roxies

Volusia county as well as most counties in Florida has seen an amazing new trend in Drug Addiction over the last few years. In the last year of my practice at the Counseling Center of New Smyrna Beach I have seen more teens and young adults struggling with addiction than I have seen in years prior. Most of them are addicted to Alcohol, Marijuana or Pain Killer. The last being the topic I would like to discuss in this article. 

Pain Killers are typically in a class of drugs known as narcotics and are opiod type medications. These drugs are highly addictive, readily available, seen as harmless and are ripping apart families and taking lives everyday. In fact it would not surprise me if the next report I read says that oxyies and roxies have risen to the number one slot of cause of death in all classes of drugs.

In treating dependency or abuse of these or any drug it is important to have accurate information about the drug.

Drug Name: 
Oxycontin, Oxycodone, Roxicodone®, Percocet®, Percodan®, OxyIR®
(oxycodone instant release IR or oxycodone extended release ER) 

Street Name: 
OC's, OXY, OXY's, OXIES, OXYCOTTON, OXY80, PERKS, HILLBILLY HEROIN, ROXIES

Category: 
Oxycodone is an opioid analgesic medication synthesized from thebaine.

Drug Type / Action
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.

Licit Uses
Oxycodone is an effective analgesic for mild to moderate pain control, chronic pain syndromes, and for the treatment of terminal cancer pain. Oxycodone is considered to be similar to morphine, in all respects, including its abuse & dependence liabilities. 

Illicit Uses
Oxycodone is abused for its opiate-like effects. As with most opiates, the adverse effects of oxycodone abuse are dependence and tolerance development. Opiate abusers have been injecting or snorting the crushed and/or dissolved tablets.  The major source of oxycodone to the street has been through forged prescriptions, professional diversion through unscrupulous pharmacists, doctors, and dentists, "doctor-shopping", and large-scale thefts.

User Population
Every age group has been affected by the relative ease of oxycodone availability and the perceived safety of these products by professionals. Sometimes seen as a "white-collar" addiction, oxycodone abuse has increased among all ethnic and economic groups. 

DEA Status
It is a Schedule II (CII) Narcotic. 

Sources of Legal Distribution
It is available only through prescription.  Prescriptions for oxycodone cannot be refilled and can only be filled with a written prescription.

Side Effects Of Oxycodone Usage

Lightheadedness
Dizziness
Drowsiness
Sedation
Nausea
Vomiting
Stupor
Tremor
Par aesthesia
Hypoesthesia
Lethargy
Seizures
Anxiety
Mental
Impairment
Agitation
Cerebral edema
Confusion
Dizziness
Hearing loss
Tinnitus
Hypoglycemia
Hyperglycemia
Acidosis
Alkalosis
Hallucination
Somnolence
Depression
Suicide aspiration
Hypoventilation
Laryngeal edema
Erythematic

Urinary
Rash
Flushing
Proteinuria
Euphoria
Dysphoria
Constipation
Pruritus
Dehydration
Dyspepsia
Taste disturbances
Abdominal pain
Abdominal distention
Sweating increased
Diarrhea
Dry mouth
Flatulence
Gastro-intestinal disorder
Pancreatitis
Intestinal obstruction
Myalgia
Rhabdomyolysis
Miosis
Visual disturbances
Red eye
Bronchospasm
Dyspnea
Hyperpnoea
Pulmonary edema
Tachypnea
Interstitial nephritis
Papillary necrosis 

Allergic reaction
Malaise
Fatigue
Chest pain
Fever
Hypothermia
Thirst
Headache
Accidental overdose
Non-accidental overdose
Hepatitis
Hepatic failure
Jaundice
Hepatotoxicity
Hepatic disorder
Asthma
Bronchospasm
Laryngeal edema
Urticaria
Anaphylactoid reaction
Drug dependence
Drug abuse
Insomnia
Confusion anxiety
Agitation
Depressed level 
of consciousness
Nervousness
Urinary retention
Renal failure 

Withdrawal Symptoms of Oxycodone Usage 

Perpetually being tired
Hot/cold sweats
Heart palpitations
Diarrhea
Rapid breathing
Crying
Runny nose
Hyperactivity
Hot and cold flashes
Aching muscles

Joints and muscles in constant pain
Vomiting
Nausea
Uncontrollable coughing
Agitation
Increased heart rate
Loss of appetite 
Abdominal Cramps

Insomnia
Watery eyes
Excessive yawning
Depression
Fever
Dilated pupils
Tremors
Watery eyes
Excessive yawning
Depression

We are finding an alarming increase in the number of adolescents using oxycodone.

OxyContin use spreads
OxyContin, when it hit the market in 1996, was touted by its maker, Purdue Pharma, as an ideal medicine for people suffering unrelenting pain, especially from cancer.  The controlled-release mechanism meant that people could keep their pain at bay for 12 hours at a time, instead of having pain return every four hours while waiting for the next dose of painkiller to take effect.   After the initial launch, Purdue Pharma, of Stamford, Conn., sought to have OxyContin® more widely prescribed for lesser pain, including the aches caused by common arthritis. 

OxyContin first turned up as a serious drug of abuse in rural areas, such as Appalachia, where it was dubbed "hillbilly heroin." It has rapidly spread to densely populated urban areas, including South Florida.  The drug is a form of oxycodone, which is sold under several brand names. Once absorbed into the system, it is impossible to tell OxyContin® from other oxycodone drugs.

Broward County Leads Nation in Amount of Rx Oxycodone
Dispensed Directly by Physicians (2/01/09)
Among the 25 physicians in the United States who received the largest quantities of the powerful narcotic pain medication, Oxycodone for direct dispensing from their offices in the first half of 2008, 18 were from Broward County. The remaining 7 physicians were from 4 other Florida counties. These 17 Broward doctors received 3.383,200 dose units (or tablets) of Oxycodone between January and June of this year. The total dose units do not include the number of dose units dispensed by pharmacies, hospital or other dispensing physicians not among the top 25 in the nation. Oxycodone is the opioid pain medication found in Percocet (with acetaminophen) or Percodan (with aspirin) or OxyContin (sustained release form).

Neighboring Palm Beach County ranked second in the nation with 852,800 dose units received by 3 of the top 25 physicians followed by Miami-Dade County with 393,900 tablets sent to 2 dispensing physicians. Hillsborough County (Tampa area) ranked 4th with 126,990 units to one physician followed by Manatee County (Bradenton area) where one physician received 116,800 dose units.

In 2007 there were 57,066,602 dose units of Oxycodone shipped to Pharmacies, Hospitals and dispensing physicians in Broward County. While many legitimate physicians may directly dispense some medications, most do not offer the highly controlled Schedule II opioids directly to patients. Rather they would write a prescription to be filled at a pharmacy. Physicians directly dispensing Schedule II narcotics are frequently associated with so called "Pain Clinics" offering "pills for pay" unlike legitimate pain management doctors. Pain Clinics have emerged, as Florida has become a key source state for pharmaceuticals diverted from appropriate medical use. Florida's failure to enact a Prescription Monitoring Program over the past 6 years makes it the largest of only a few states without such a system.

There were 119 Oxycodone-related deaths in Broward County in 2007 including 85 where the drug was considered the cause of death and 34 where the drug was detected in the deceased person. Across Florida, there were 1,253 Oxycodone-related deaths including 705 where the drug was considered the cause of death. 

United Way of Broward County Commission on Substance Abuse
From the Office of the Medical Examiner, Palm Beach County, West Palm Beach, FL

Upon reviewing the last 172 deaths involving the use of oxycodone in Palm Beach County, the Palm Beach County Medical Examiner's Office in which post mortem toxicological studies indicated the presence of oxycodone.  Benzodiazepines, detected in 96 cases, were the most common co-intoxicants in the cases of combined drug toxicity, followed by cocaine, which was found in 41. The most frequently encountered benzodiazepine was Xanax (alprazolam). This study confirms that deaths in which oxycodone is a factor are most commonly cases of combined drug toxicity.

A recent Sun Sentinel report
Rx for Death: Patients in pain overdosing in alarming numbers
Sun-Sentinel investigation documented 393 prescription drug-related deaths over the past two years in the seven-county area stretching from Okeechobee to Miami-Dade County.  The drugs showing up most often are OxyContin®. It was present in at least 224 of the 393 deaths.  OxyContin® has become the most frequently prescribed narcotic in the country, with almost 6 million people using it, according to the federal Drug Enforcement Administration. 

Below is a statement for the Drug Enforcement Agency (DEA)
Oxycodone like morphine and hydromorphone, oxycodone is used as an analgesic. It is effective orally and is marketed alone in 10, 20, 40, 80, and 160 mg controlled-release tablets (OxyContin®), or 5 mg immediate-release capsules (OxyIR®), or in combination products with aspirin (Percodan®) or acetaminophen (Percocet®) for the relief of pain. All oxycodone products are in Schedule II. Oxycodone is abused orally, or the tablets are crushed and sniffed or dissolved in water and injected.

Historically, oxycodone products have been popular drugs of abuse among the narcotic abusing population. In recent years, concern has grown among federal, state, and local officials about the dramatic increase in the illicit availability and abuse of OxyContin® products. These products contain large amounts of oxycodone (10 to 160 mg) in a formulation intended for slow release over about a 12-hour period.

Abusers have learned that this slow-release mechanism can be easily circumvented by crushing the tablet and swallowing, smoking, snorting, or injecting the drug product for a more rapid and intense high. The criminal activity associated with illicitly obtaining and distributing this drug, as well as serious consequences of illicit use, including addiction and fatal overdose deaths, is of epidemic proportions in some areas of the United States. 

FACT:
There is significant research that reveals the fact the medical detoxification without a rigorous program of recovery that includes Psychotherapy and Substance Abuse Group Therapy, may have little lasting effect. The rate of recidivism (relapse) is extremely high with those that choose to forego therapy in conjunction with medical detoxification. At the Counseling Center of New Smyrna Beach we have several specialist who treat addiction issues, if we can be of help please feel free to contact us for an appointment. 

The following is a link to the United States Substance Abuse and Mental Health Service Administration. 

http://www.samhsa.gov

Link to an article I wrote on Addiciton. click here...

Addictions: Why Don’t They Just Quit?

By Shane Porter

One of the most frustrating issues surrounding addictions is, understanding addictions. Most people just go thru life assuming that we have the power to stop. But do we? Addiction is everywhere. It is said that one out of five adults has an immediate relative who has struggled with addiction to drugs or alcohol. One fifth of the population. So does one fifth of the population have a weak personality? Are they weak of mind or character? Or is there more to the story? Such as the Dopamine pathway?

There are four primary misperceptions about addiction that I would like to take a moment to address. 

The first is that addicts cannot or should not be treated with medications. The truth is studies have shown that medications reduce the chance of relapse and enhance the effectiveness of psychotherapy. 

The second is that if addicts simply go to a 12 step meeting you will stop. The truth is 12 step meeting while proven to be very effective are not a cure for everyone. Even if they really want to stop. 

The third is that addicts are bad people. If this is true we should be leery of 1/5 of the people we know. The truth is addicts have a brain disease that needs treatment. Do drugs alter behaviors? The obvious answer is yes, however that does not mean the person is evil.

Then the fourth and most important, that Addiction is a will power problem. This is a very old belief that gets perpetuated by movies, media, 12 step meetings and worse of all therapists just like me who supposedly specialize in treatment of addictions. Be very careful of professionals who do not talk to you about the brains neuropathways. There is an area of the brain called the mesocorticolimbic dopamine system that is activated by addictions that is not under conscious control. 

What exactly is Addiction?

To be honest it is a very generic word that describes very little. Most use it liberally and it becomes a matter of opinion. Scary isn’t it that the opinion of one can become a fact of another. Addiction is a word that is used to indicate there is a problem that seems to be an uncontrollable urge. People can be addicted to many things including: drugs, alcohol, food, sex, pornography, nicotine, gambling.

The four basic components of any addiction are pleasure, loss of control, compulsion and denial. 

Then there is what is called simple addiction versus complex addiction.

Simple addiction has a superficial physical dependence; it involves physical cravings and withdrawal when the addictive substance is removed. Simple addictions can be treated or influenced by spiritual, economic, social and moral incentives. I.e.- someone may not drink again because they are afraid that they may lose their job, or that their standing in the community may be compromised. 

Complex addictions are different in that they are self protecting, there is an attempt to use the substance as a way of altering the individuals psychological mood, the person is seen as out of control, and willpower or self talk do not work so well. Individuals with complex addictions usually require intensive, long-term treatment, and they must emphasize abstinence.

So what is the role of dopamine in addiction and how is it helpful or harmful?

According to a study in the Journal of Psychosocial Nursing the mesocorticolimbic dopamine system is the site of the rewarding effects of all the major classes of addictive drugs.

Addictive substances affect different structures of the brain, primarily the brain’s limbic system. The limbic system, also commonly referred to as the brains reward system responds to a pleasurable experience by releasing the neurotransmitter dopamine. Addicts experience extremely intense feelings of pleasure and satisfaction because dopamine is flooding the limbic system.

Two other parts of the brain that are important in understanding addiction and neurotransmission are the Nucleus Accumbens and the Ventral Tagmental Area. 

The Nucleus Accumbens also known as the ventral tagmentum is a complex structure of the basal forebrain that is closely associated with the limbic system. It plays a role in reward, pleasure, and addiction. Live studies show that most addictive drugs elevate dopamine levels in this area of the brain.

The Ventral Tagmental Area is a part of the midbrain that plays a role in mediating reward, pleasure, and addiction. This area is a part of the mesocorticolimbic dopamine system.

According to Nora Volkow a leading medical specialist in addictions, the human brain is a complex and fine-tuned communications network containing billions of specialized cells called neurons that give origin to our thoughts, emotions, perceptions and drives. 

Usually a drug is taken the first time by choice to feel pleasure or to relieve stress or depression. But the choice is short-lived. Because repeated drug use alters the well-balanced systems in the brain, eventually replacing a person’s normal needs and desires with a one-track mission to seek and use drugs. At this point, normal desires and motives will have a hard time competing with the desire to take a drug.

How Does the Brain Become Addicted?

Typically, a person takes a drug of abuse, be it marijuana or cocaine or even alcohol, activating the same brain circuits as do behaviors linked to survival, such as eating, bonding and sex. The drug causes a surge in levels of a brain chemical called dopamine, which results in feelings of pleasure. The brain remembers this pleasure and wants it repeated.

Just as food is linked to survival in day-to-day living, drugs begin to take on the same significance for the addict. The need to obtain and take drugs becomes more important than any other need, including truly vital behaviors like eating. The addict no longer seeks the drug for pleasure, but for relieving distress.

Eventually, the drive to seek and use the drug is all that matters, despite devastating consequences.

Finally, control and choice and everything that once held value in a person’s life, such as family, job and community, are lost to the disease of addiction.

What brain changes are responsible for such a dramatic shift?

Research on addiction is helping us find out just how drugs change the way the brain works. These changes include the following:

Reduced dopamine activity. We depend on our brain’s ability to release dopamine in order to experience pleasure and to motivate our responses to the natural rewards of everyday life, such as the sight or smell of food. Drugs produce very large and rapid dopamine surges and the brain responds by reducing normal dopamine activity. Eventually, the disrupted dopamine system renders the addict incapable of feeling any pleasure even from the drugs they seek to feed their addiction.

Altered brain regions that control decision making and judgment. Drugs of abuse affect the regions of the brain that help us control our desires and emotions. The resulting lack of control leads addicted people to compulsively pursue drugs, even when the drugs have lost their power to reward.

The disease of addiction can develop in people despite their best intentions or strength of character. Drug addiction is insidious because it affects the very brain areas that people need to “think straight,” apply good judgment and make good decisions for their lives. 

No one wants to grow up to be a drug addict, after all.

Which is why there is the following percentage of addiction after first use. 

Tobacco – 32%

Alcohol – 15% 

Heroin – 23%

Cocaine – 16%

In simple terms because of the role of elevated dopamine levels in the brain, our brains perceive the substance or addiction as wonderfully pleasurable. Over time the brain actually changes it’s structure and how it works.

In 2005 there was a national survey done by the Substance Abuse and Mental Health Service Administration on individuals ages 12 and up. The following numbers were given as to individual Americans who suffer from a specific area of addiction.

Alcohol – 18,658,000

Marijuana – 4,090,000

Cocaine – 1,549,000

Pain Relievers – 1,546,000

Tranquilizers – 419,000

Stimulants – 409,000

Hallucinogens – 371,000

Heroin – 227,000

Inhalants – 221,000

Sedatives – 97,000

But addiction is not limited to just drugs. The same principles apply to other addictions. Research continues to suggest that dopamine plays a role in the formation and maintenance of addictive behaviors such as gambling, pornography, sex and even eating. So the same chemical and physiological changes that we see in substance abuse exist in all forms of addiction.

Did you know that 60% of all website visits are sexual in nature. That 20% of men and 13% of women admit to viewing porn at work. 10% of adults admit to having internet sexual addiction.

According to the National Council on Addiction Compulsivity 8% or 24 million Americans are sex addicts. 

It is also estimated that 2 million American adults are compulsive gamblers at some point in their life. In any given year 4.8 million Americans are considered problem gamblers.

So do you have an addiction problem?

The best way to get an answer to this question is to seek a professional assessment.

Below is a quick list to determine if you do have a problem. Remember these are not just specific to drugs or alcohol they are true of any addiction.

The difference between abuse and dependence is not always clear to the general public, but therapist use a set of criteria to distinguish between these two categories of problem use.

The essential feature of abuse is a pattern of substance use that causes someone to experience harmful consequences. Therapist diagnose substance abuse if, in a twelve-month period, a person is in one or more of the following situations related to drug use:

Failure to meet obligations, such as missing work or school

Engaging in reckless activities, such as driving while intoxicated

Encountering legal troubles, such as getting arrested

Continuing to use despite personal problems, such as a fight with a partner

Dependence is more severe. Therapist will look for three or more criteria from a set that includes two physiological factors and five behavioral patterns, again, over a twelve-month period. Tolerance and withdrawal alone are not enough to indicate dependence. And not all behavioral signs occur with every substance.

The physiological factors are:

Tolerance, in which a person needs more of a drug to achieve intoxication

Withdrawal, in which they experience mental or physical symptoms after stopping drug use

The behavioral patterns are:

Being unable to stop once using starts

Exceeding self-imposed limits

Curtailing time spent on other activities

Spending excessive time using or getting drugs

Taking a drug despite deteriorating health

So why doesn’t everyone get help?

Recent studies have shown that the primary reasons people don’t get help is:

44.4% - cost or insurance barriers. 

21.2% - Not ready to stop using

21.1% - other barriers to access treatment

18.5% - Stigma

9.4% - Lack of knowledge or don’t know where to go

3.8% - Did not have the time

0.4% - thought treatment would not work

Treatment does work when it is properly given. The combination of professional treatment, and support groups has a signifigant chance of success. 

Most people want to find a qualified therapist like those found at the Counseling center of New Smyrna Beach, and a support group like AA, NA, SA, Celebrate Recovery or Rational Recovery. 

If needed your therapist can refer you to a medical program or detox program for the use of medications to help with the addiction, to help reset some of the dopamine pathways that may have been altered during addiction.

There is hope, don’t let previous failures or relapses discourage you from getting the most current and beneficial help available.

We hope that this handout has been helpful to you. At the Counseling Center of New Smyrna Beach we have several therapist who can assist you in getting the treatment you need. If we can be of help please call 386.423.9161 today. Start living your legacy!