The Addictive Powers of Opioids
Opioids (also called opiates) are prescription pain relievers that reduce the intensity of pain signals reaching the brain. They affect the areas of the brain that control emotion, which diminishes the effects of painful stimuli.1 Although prescription opioids can be used effectively for management of severe pain, they come with serious risks. All opioid-based drugs and medications have the ability to produce changes in brain chemistry that may result in physical dependence and addiction, especially in individuals who receive no medical oversight from a prescribing doctor. While opioid addiction is not synonymous with the highly dysfunctional, uncontrolled pattern of substance intake that characterizes a dependence on other drugs, it can be deadly. Opioid misuse is a common term to indicate the usage of opioids contrary to medical instructions.
Opioid Stats & Facts
- In 2014, opioid addiction resulted in 18,893 overdose deaths.2
- In 2012, healthcare providers wrote 259 million prescriptions for opioid pain medication, enough for every adult in the U.S. to have a bottle of pills.3
- More than 40 people die every day in the U.S. from prescription opioid overdoses.3
- A study published in 2015 indicates that 20% to 30% of opioids prescribed for chronic pain are being misused.4
The Centers for Disease Control and Prevention stated that the following three principles are key to improving the safe management of patients with chronic pain:
- Non-opioid therapy is preferred for chronic pain outside of active cancer, palliative and end-of-life care.
- When opioids are used, the lowest possible effective dosage should be prescribed to reduce the risks of opioid use disorder and overdose.
- Providers should always exercise caution when prescribing opioids and monitor patients closely.3
Oxycodone is a semi-synthetic prescription opioid painkiller derived from laboratory modification of thebaine, one of the opium poppy’s natural mind-altering chemicals. Doctors primarily prescribe this medication for people who have persistent pain that is moderate to severe. While most people receive oxycodone in tablet or pill form, the medication also comes in a liquid that can be injected into a vein or muscle, or under the skin.5 The drug is available alone or in combination with other pain relievers, with brand names including:
- OxyContin — oxycodone, both immediate and controlled release formulations
- OxyIR and OxyFast — oxycodone immediate release
- Percodan — oxycodone and aspirin
- Percocet — oxycodone and acetaminophen
Many people who abuse oxycodone do so by crushing the pills into a fine powder and snorting them, chewing them, or crushing and dissolving the tablets in water and injecting the solution. These methods have been used primarily with the brand OxyContin to defeat the time-release mechanism of the drug. This causes the active ingredient to take effect almost immediately after ingestion. Doing so increases the risk of overdose significantly because the drug is not intended to be used in this manner. When Purdue Pharma started distributing OxyContin in 1996, reports of illicit use and abuse began to increase.5 In an attempt to decrease epidemic levels of abuse, it reformulated OxyContin in 2010. The abuse-deterrent formula (ADF) is difficult to crush and snort, which seemingly led to a sharp drop in illicit use of the drug. However, a small study of 153 OxyContin users revealed some startling findings. Only 3.3% of the people who had abused it stopped abusing drugs completely after the ADF formula was released. About 33% continued to abuse the ADF formulation and the same percentage of people chose other drugs to abuse, with 70% turning to heroin. The remaining 30% of patients did not use OxyContin enough to make any changes regarding its usage.6
Oxycodone Stats & Facts
- In 2013, nearly 60 million prescriptions were written for oxycodone-containing drugs.7
- In 2012, 16 million people reported abusing oxycodone in their lifetimes, an increase of more than 1 million from the prior year.6
- In 2011, oxycodone was responsible for more than 150,000 ER visits.7
- According to the National Survey on Drug Use and Health, over the last 20 years, more than 7 million Americans have abused OxyContin.8
- Opioids have claimed more than 190,000 lives in the U.S. since 1999, with most experts blaming OxyContin for setting off the nation’s deadly prescription opioid epidemic.8
Research Suggests Oxycodone Is Highly Addictive
In a study published in the European Journal of Neuroscience, researchers analyzed how oxycodone and morphine affected dopamine levels in the brains of rats with no history of exposure to either substance. A chemical analysis was done to see how each medication altered the brain’s output of pleasure-producing dopamine. Both drugs triggered rapid increases in the brain’s dopamine output, but the evoked increase from morphine lasted just 60 seconds. Oxycodone triggered a dopamine increase that continued for a much longer period, leading to more extensive alteration of normal brain chemistry. The authors believe that the rapid and relatively long-lasting changes produced by oxycodone may have a substantial impact on the medication’s ability to initiate alterations to the brain and behaviors that form the basis of opioid addiction. While this was an animal-model study and further research is warranted, the findings suggest that oxycodone has a potentially higher risk of abuse/addiction than other opioid pain medications.9
- What are opioids? National Institute on Drug Abuse website. https://www.drugabuse.gov/publications/research-reports/prescription-drugs/opioids/what-are-opioids Updated Nov. 2014. Accessed June 13, 2016.
- Can the U.S. Win the War On Opioids? Drugs website. https://blog.drugs.com/2016/02/can-the-u-s-win-the-war-on-opioids/ Published Feb. 4, 2016. Accessed June 13, 2016.
- CDC Releases Guideline for Prescribing Opioids for Chronic Pain. Centers for Diseases Control and Prevention website. http://www.cdc.gov/media/releases/2016/p0315-prescribing-opioids-guidelines.html Published March 15, 2016. Accessed June 13, 2016.
- Arlotta CJ. Opioid Misuse In Chronic Pain Patients Is Around 25%, New Study Shows. Forbes. http://www.forbes.com/sites/cjarlotta/2015/04/01/opioid-misuse-in-chronic-pain-patients-is-around-25-new-study-shows/#dd48c1e80668 April 1, 2015. Accessed June 13, 2016.
- Oxycodone. Center for Substance Abuse Research website http://www.cesar.umd.edu/cesar/drugs/oxycodone.asp Updated Oct. 29, 2013. Accessed June 13, 2016.
- Lyford J. Reformulated OxyContin reduces abuse but many addicts have switched to heroin. The Pharmaceutical Journal. http://www.pharmaceutical-journal.com/news-and-analysis/news/reformulated-oxycontin-reduces-abuse-but-many-addicts-have-switched-to-heroin/20068119.article March 16, 2015. Accessed June 13, 2016.
- Oxycodone Abuse. DrugAbuse.com website. http://drugabuse.com/library/oxycodone-abuse/#statistics-on-oxycodone-abuse Accessed June 13, 2016.
- Ryan H, Girion L, Glover S. You Want a Description of Hell? OxyContin’s 12-Hour Problem. Los Angeles Times. http://static.latimes.com/oxycontin-part1/ May 5, 2016. Accessed June 13, 2016.
- Vander Weele CM, Porter-Stransky KA, Mabrouk OS, et al. Rapid dopamine transmission within the nucleus accumbens: dramatic difference between morphine and oxycodone delivery. Eur J Neurosci. 2014 Oct;40(7):3041-54. doi: 10.1111/ejn.12709. Epub 2014 Sep 11.