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Oxycodone HCl
WARNING
OxyContin® is an opioid agonist and a Schedule II controlled substance with an abuse liability similar to morphine.
Oxycodone can be abused in a manner similar to other opioid agonists, legal or illicit. This should be considered when prescribing or dispensing OxyContin® in situations where the physician or pharmacist is concerned about an increased risk of misuse, abuse, or diversion.
OxyContin® tablets are a controlled-release oral formulation of oxycodone hydrochloride indicated for the management of moderate to severe pain when a continuous, around-the-clock analgesic is needed for an extended period of time.
OxyContin® tablets are NOT intended for use as a prn analgesic.
OxyContin® 80 mg and 160 mg Tablets ARE FOR USE IN OPIOID TOLERANT PATIENTS ONLY. These tablet strengths may cause fatal respiratory depression when administered to patients not previously exposed to opioids.
OxyContin® (oxycodone hydrochloride controlled-release) TABLETS ARE TO BE SWALLOWED WHOLE AND ARE NOT TO BE BROKEN, CHEWED, OR CRUSHED. TAKING BROKEN, CHEWED, OR CRUSHED OxyContin® TABLETS LEADS TO RAPID RELEASE AND ABSORPTION OF A POTENTIALLY FATAL DOSE OF OXYCODONE.
OxyContin® (oxycodone hydrochloride controlled-release) tablets are an opioid analgesic supplied in 10 mg, 20 mg, 40 mg, 80 mg, and 160 mg tablet strengths for oral administration. The tablet strengths describe the amount of oxycodone per tablet as the hydrochloride salt.
Its molecular formula is C18H21NO4 · HCl. Its molecular weight is 351.83.
The chemical formula is 4, 5-epoxy-14-hydroxy-3-methoxy-17-methylmorphinan-6-one hydrochloride.
Oxycodone is a white, odorless crystalline powder derived from the opium alkaloid, thebaine. Oxycodone hydrochloride dissolves in water (1 g in 6 to 7 mL). It is slightly soluble in alcohol (octanol water partition coefficient 0.7). The tablets contain the following inactive ingredients: ammonio methacrylate copolymer, hydroxypropyl methylcellulose, lactose, magnesium stearate, povidone, red iron oxide (20 mg strength tablet only), stearyl alcohol, talc, titanium dioxide, triacetin, yellow iron oxide (40 mg strength tablet only), yellow iron oxide with FD&C blue No.2 (80 mg strength tablet only), FD&C blue No.2 (160 mg strength tablet only) and other ingredients.
INDICATIONS
OxyContin® tablets are a controlled-release oral formulation of oxycodone hydrochloride indicated for the management of moderate to severe pain when a continuous, around-the-clock analgesic is needed for an extended period of time.
OxyContin® is NOT intended for use as a prn analgesic.
Physicians should individualize treatment in every case, initiating therapy at the appropriate point along a progression from non-opioid analgesics, such as nonsteroidal anti-inflammatory drugs and acetaminophen to opioids in a plan of pain management such as outlined by the World Health Organization, the Agency for Health Research and Quality (formerly known as the Agency for Health Care Policy and Research), the Federation of State Medical Boards Model Guidelines, or the American Pain Society.
OxyContin® is not indicated for pain in the immediate post-operative period (the first 12-24 hours following surgery), or if the pain is mild, or not expected to persist for an extended period of time. OxyContin® is only indicated for post-operative use if the patient is already receiving the drug prior to surgery or if the postoperative pain is expected to be moderate to severe and persist for an extended period of time. Physicians should individualize treatment, moving from parenteral to oral analgesics as appropriate. (See American Pain Society guidelines.)
DOSAGE AND ADMINISTRATION
General Principles
OxyContin® IS AN OPIOID AGONIST AND A SCHEDULE II CONTROLLED SUBSTANCE WITH AN ABUSE LIABILITY SIMILAR TO MORPHINE.
OXYCODONE, LIKE MORPHINE AND OTHER OPIOIDS USED IN ANALGESIA, CAN BE ABUSED AND IS SUBJECT TO CRIMINAL DIVERSION.
OxyContin® (oxycodone hydrochloride controlled-release) TABLETS ARE TO BE SWALLOWED WHOLE, AND ARE NOT TO BE BROKEN, CHEWED OR CRUSHED. TAKING BROKEN, CHEWED OR CRUSHED OxyContin® TABLETS LEADS TO THE RAPID RELEASE AND ABSORPTION OF A POTENTIALLY FATAL DOSE OF OXYCODONE.
One OxyContin® 160 mg tablet is comparable to two 80 mg tablets when taken on an empty stomach. With a high fat meal, however, there is a 25% greater peak plasma concentration following one 160 mg tablet. Dietary caution should be taken when patients are initially titrated to 160 mg tablets (see Special Instructions for OxyContin® 80 mg and 160 mg Tablets).
In treating pain it is vital to assess the patient regularly and systematically. Therapy should also be regularly reviewed and adjusted based upon the patient's own reports of pain and side effects and the health professional's clinical judgment.
OxyContin® tablets are a controlled-release oral formulation of oxycodone hydrochloride indicated for the management of moderate to severe pain requiring treatment with a strong opioid for continuous, around-the-clock analgesia for an extended period of time. The controlled-release nature of the formulation allows OxyContin® to be effectively administered every 12 hours (see CLINICAL PHARMACOLOGY: PHARMACOKINETICS AND METABOLISM). While symmetric (same dose AM and PM), around-the-clock, q12h dosing is appropriate for the majority of patients, some patients may benefit from asymmetric (different dose given in AM than in PM) dosing, tailored to their pain pattern. It is usually appropriate to treat a patient with only one opioid for around-the-clock therapy.
Physicians should individualize treatment using a progressive plan of pain management such as outlined by the World Health Organization, the American Pain Society and the Federation of State Medical Boards Model Guidelines. Health care professionals should follow appropriate pain management principles of careful assessment and ongoing monitoring [See BOXED WARNING].
Initiation of Therapy
It is critical to initiate the dosing regimen for each patient individually, taking into account the patient's prior opioid and non-opioid analgesic treatment. Attention should be given to:
(1) the general condition and medical status of the patient;
(2) the daily dose, potency, and kind of the analgesic(s) the patient has been taking;
(3) the reliability of the conversion estimate used to calculate the dose of oxycodone;
(4) the patient's opioid exposure and opioid tolerance (if any);
(5) special safety issues associated with conversion to OxyContin® doses at or exceeding 160 mg q12h (see Special Instructions for OxyContin® 80 mg and 160 mg Tablets); and
(6) the balance between pain control and adverse experiences.
Care should be taken to use low initial doses of OxyContin® in patients who are not already opioid-tolerant, especially those who are receiving concurrent treatment with muscle relaxants, sedatives, or other CNS active medications (see DRUG INTERACTIONS).
For initiation of OxyContin® therapy for patients previously taking opioids, the conversion ratios from Foley, KM. [NEJM, 1985; 313:84-95], found below, are a reasonable starting point, although not verified in well-controlled, multiple-dose trials.
Experience indicates a reasonable starting dose of OxyContin® for patients who are taking non-opioid analgesics and require continuous around-the-clock therapy for an extended period of time is 10 mg q12h. If a non-opioid analgesic is being provided, it may be continued. OxyContin® should be individually titrated to a dose that provides adequate analgesia and minimizes side effects.
1. Using standard conversion ratio estimates (see Table 4 below), multiply the mg/day of the previous opioids by the appropriate multiplication factors to obtain the equivalent total daily dose of oral oxycodone.
2. When converting from oxycodone, divide the 24-hour oxycodone dose in half to obtain the twice a day (q12h) dose of OxyContin®.
3. Round down to a dose which is appropriate for the tablet strengths available (10 mg, 20 mg, 40 mg, 80 mg, and 160 mg tablets).
4. Discontinue all other around-the-clock opioid drugs when OxyContin® therapy is initiated.
5. No fixed conversion ratio is likely to be satisfactory in all patients, especially patients receiving large opioid doses. The recommended doses shown in Table 4 are only a starting point, and close observation and frequent titration are indicated until patients are stable on the new therapy.
Table 4
Multiplication Factors for Converting the Daily Dose of
Prior Opioids to the Daily Dose of Oral Oxycodone*
(Mg/Day Prior Opioid x Factor = Mg/Day Oral Oxycodone)
Oral Prior Opioid Parenteral Prior Opioid
Oxycodone 1
Codeine 0.15
Hydrocodone 0.9
Hydromorphone 4 20
Levorphanol 7.5 15
Meperidine 0.1 0.4
Methadone 1.5 3
Morphine 0.5 3
To be used only for conversion to oral oxycodone. For patients receiving high-dose parenteral opioids, a more conservative conversion is warranted. For example, for high-dose parenteral morphine, use 1.5 instead of 3 as a multiplication factor.
In all cases, supplemental analgesia (see below) should be made available in the form of a suitable short-acting analgesic.
OxyContin® can be safely used concomitantly with usual doses of non-opioid analgesics and analgesic adjuvants, provided care is taken to select a proper initial dose (see PRECAUTIONS).
Conversion from Transdermal Fentanyl to OxyContin®
Eighteen hours following the removal of the transdermal fentanyl patch, OxyContin® treatment can be initiated. Although there has been no systematic assessment of such conversion, a conservative oxycodone dose, approximately 10 mg q12h of OxyContin®, should be initially substituted for each 25 µg/hr fentanyl transdermal patch. The patient should be followed closely for early titration, as there is very limited clinical experience with this conversion.
Managing Expected Opioid Adverse Experiences
Most patients receiving opioids, especially those who are opioid-naive, will experience side effects. Frequently the side effects from OxyContin® are transient, but may require evaluation and management. Adverse events such as constipation should be anticipated and treated aggressively and prophylactically with a stimulant laxative and/or stool softener. Patients do not usually become tolerant to the constipating effects of opioids.
Other opioid-related side effects such as sedation and nausea are usually self-limited and often do not persist beyond the first few days. If nausea persists and is unacceptable to the patient, treatment with anti-emetics or other modalities may relieve these symptoms and should be considered.
Patients receiving OxyContin® may pass an intact matrix "ghost" in the stool or via colostomy. These ghosts contain little or no residual oxycodone and are of no clinical consequence.
Individualization of Dosage
Once therapy is initiated, pain relief and other opioid effects should be frequently assessed. Patients should be titrated to adequate effect (generally mild or no pain with the regular use of no more than two doses of supplemental analgesia per 24 hours). Patients who experience breakthrough pain may require dosage adjustment or rescue medication. Because steady-state plasma concentrations are approximated within 24 to 36 hours, dosage adjustment may be carried out every 1 to 2 days. It is most appropriate to increase the q12h dose, not the dosing frequency. There is no clinical information on dosing intervals shorter than q12h. As a guideline, except for the increase from 10 mg to 20 mg q12h, the total daily oxycodone dose usually can be increased by 25% to 50% of the current dose at each increase.
If signs of excessive opioid-related adverse experiences are observed, the next dose may be reduced. If this adjustment leads to inadequate analgesia, a supplemental dose of immediate-release oxycodone may be given. Alternatively, non-opioid analgesic adjuvants may be employed. Dose adjustments should be made to obtain an appropriate balance between pain relief and opioid-related adverse experiences.
If significant adverse events occur before the therapeutic goal of mild or no pain is achieved, the events should be treated aggressively. Once adverse events are under control, upward titration should continue to an acceptable level of pain control.
During periods of changing analgesic requirements, including initial titration, frequent contact is recommended between physician, other members of the healthcare team, the patient and the caregiver/family.
Special Instructions for OxyContin® 80 mg and 160 mg Tablets (For use in opioid-tolerant patients only)
OxyContin® 80 mg and 160 mg Tablets are for use only in opioid-tolerant patients requiring daily oxycodone equivalent dosages of 160 mg or more for the 80 mg tablet and 320 mg or more for the 160 mg tablet. Care should be taken in the prescribing of these tablet strengths. Patients should be instructed against use by individuals other than the patient for whom it was prescribed, as such inappropriate use may have severe medical consequences, including death.
One OxyContin® 160 mg tablet is comparable to two 80 mg tablets when taken on an empty stomach. With a high fat meal, however, there is a 25% greater peak plasma concentration following one 160 mg tablet. Dietary caution should be taken when patients are initially titrated to 160 mg tablets.
Supplemental Analgesia
Most patients given around-the-clock therapy with controlled-release opioids may need to have immediate-release medication available for exacerbations of pain or to prevent pain that occurs predictably during certain patient activities (incident pain).
Maintenance of Therapy
The intent of the titration period is to establish a patient-specific q12h dose that will maintain adequate analgesia with acceptable side effects for as long as pain relief is necessary. Should pain recur then the dose can be incrementally increased to re-establish pain control. The method of therapy adjustment outlined above should be employed to re-establish pain control.
During chronic therapy, especially for non-cancer pain syndromes, the continued need for around-the-clock opioid therapy should be reassessed periodically (e.g., every 6 to 12 months) as appropriate.
Cessation of Therapy
When the patient no longer requires therapy with OxyContin® tablets, doses should be tapered gradually to prevent signs and symptoms of withdrawal in the physically dependent patient.
Conversion from OxyContin® to Parenteral Opioids
To avoid overdose, conservative dose conversion ratios should be followed.
SAFETY AND HANDLING
OxyContin® (oxycodone HCl controlled-release) tablets are solid dosage forms that contain oxycodone which is a controlled substance. Like morphine, oxycodone is controlled under Schedule II of the Controlled Substances Act. OxyContin® has been targeted for theft and diversion by criminals. Healthcare professionals should contact their State Professional Licensing Board or State Controlled Substances Authority for information on how to prevent and detect abuse or diversion of this product.
HOW SUPPLIED
OxyContin® (oxycodone hydrochloride controlled-release) 10 mg tablets are round, unscored, white-colored, convex tablets bearing the symbol OC on one side and 10 on the other. They are supplied as follows:
NDC 59011-100-10: child-resistant closure, opaque plastic bottles of 100
NDC 59011-100-25: unit dose packaging with 25 individually numbered tablets per card; one card per glue end carton
OxyContin® (oxycodone hydrochloride controlled-release) 20 mg tablets are round, unscored, pink-colored, convex tablets bearing the symbol OC on one side and 20 on the other. They are supplied as follows:
NDC 59011-103-10: child-resistant closure, opaque plastic bottles of 100
NDC 59011-103-25: unit dose packaging with 25 individually numbered tablets per card; one card per glue end carton
OxyContin® (oxycodone hydrochloride controlled-release) 40 mg tablets are round, unscored, yellow-colored, convex tablets bearing the symbol OC on one side and 40 on the other. They are supplied as follows:
NDC 59011-105-10: child-resistant closure, opaque plastic bottles of 100
NDC 59011-105-25: unit dose packaging with 25 individually numbered tablets per card; one card per glue end carton
OxyContin® (oxycodone hydrochloride controlled-release) 80 mg tablets are round, unscored, green-colored, convex tablets bearing the symbol OC on one side and 80 on the other. They are supplied as follows:
NDC 59011-107-10: child-resistant closure, opaque plastic bottles of 100
NDC 59011-107-25: unit dose packaging with 25 individually numbered tablets per card; one card per glue end carton
OxyContin® (oxycodone hydrochloride controlled-release) 160 mg tablets are caplet-shaped, unscored, blue-colored, convex tablets bearing the symbol OC on one side and 160 on the other. They are supplied as follows:
NDC 59011-109-10: child-resistant closure, opaque plastic bottles of 100
NDC 59011-109-25: unit dose packaging with 25 individually numbered tablets per card; one card per glue end carton
Store at 25°C (77 F); excursions permitted between 15°-30°C (59°-86°F).
Dispense in tight, light-resistant container.
Healthcare professionals can telephone Purdue Pharmas Medical Services Department (1-888-726-7535) for information on this product.
PATIENT INFORMATION
If clinically advisable, patients receiving OxyContin® (oxycodone hydrochloride controlled-release) tablets or their caregivers should be given the following information by the physician, nurse, pharmacist, or caregiver:
1. Patients should be aware that OxyContin® tablets contain oxycodone, which is a morphine-like substance.
2. Patients should be advised that OxyContin® tablets were designed to work properly only if swallowed whole. OxyContin® tablets will release all their contents at once if broken, chewed, or crushed, resulting in a risk of fatal overdose.
3. Patients should be advised to report episodes of breakthrough pain and adverse experiences occurring during therapy. Individualization of dosage is essential to make optimal use of this medication.
4. Patients should be advised not to adjust the dose of OxyContin® without consulting the prescribing professional.
5. Patients should be advised that OxyContin® may impair mental and/or physical ability required for the performance of potentially hazardous tasks (e.g., driving, operating heavy machinery).
6. Patients should not combine OxyContin® with alcohol or other central nervous system depressants (sleep aids, tranquilizers) except by the orders of the prescribing physician, because dangerous additive effects may occur, resulting in serious injury or death.
7. Women of childbearing potential who become, or are planning to become, pregnant should be advised to consult their physician regarding the effects of analgesics and other drug use during pregnancy on themselves and their unborn child.
8. Patients should be advised that OxyContin® is a potential drug of abuse. They should protect it from theft, and it should never be given to anyone other than the individual for whom it was prescribed.
9. Patients should be advised that they may pass empty matrix "ghosts" (tablets) via colostomy or in the stool, and that this is of no concern since the active medication has already been absorbed.
10. Patients should be advised that if they have been receiving treatment with OxyContin® for more than a few weeks and cessation of therapy is indicated, it may be appropriate to taper the OxyContin® dose, rather than abruptly discontinue it, due to the risk of precipitating withdrawal symptoms. Their physician can provide a dose schedule to accomplish a gradual discontinuation of the medication.
11. Patients should be instructed to keep OxyContin® in a secure place out of the reach of children. When OxyContin® is no longer needed, the unused tablets should be destroyed by flushing down the toilet.
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OxyContin: Questions and Answers
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Questions and Answers about OxyContin
What kind of medicine is OxyContin?
What kind of pain is appropriate to treat with OxyContin?
How do I know if I have the right kind of pain to use OxyContin?
Are there any activities that I should not perform while using OxyContin for pain relief?
What should I do if I still have pain after I take the OxyContin?
Can I take other medicines while I am using OxyContin for pain relief?
Can I drink an alcoholic beverage while I am using OxyContin for pain relief?
Will I become addicted to OxyContin if I take it every day?
What should I do when I no longer need the OxyContin for pain relief?
Haven't there been press reports about the misuse of OxyContin?
Can I take OxyContin if I am pregnant, planning to become pregnant, or planning to nurse my baby?
Are there any other special precautions I should take with my OxyContin?
1. What kind of medicine is OxyContin?
OxyContin contains oxycodone, a very strong narcotic pain reliever similar to morphine. OxyContin is designed so that the oxycodone is slowly released over time, allowing it to be used twice daily. You should never break, chew, or crush the OxyContin tablet since this causes a large amount of oxycodone to be released from the tablet all at once, potentially resulting in a dangerous or fatal drug overdose.
2. What kind of pain is appropriate to treat with OxyContin?
OxyContin is intended to help relieve pain that is moderate to severe in intensity, when that pain is present all the time, and expected to continue for a long time. This level of pain severity may be caused by a variety of different medical conditions.
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3. How do I know if I have the right kind of pain to use OxyContin?
Only a physician can determine if OxyContin is a good choice to manage a your pain. If you have pain every day that lasts for a large part of the day, and the pain is moderate or severe in intensity, depending upon other factors in your medical history, OxyContin may be a good choice for you. Speak with your physician.
If you feel you only need to take a pain reliever occasionally and this adequately treats your pain, OxyContin is NOT the right drug for you. If you only need a pain reliever for a few days, for example following a dental or surgical procedure, OxyContin is not the right drug for you.
4. Are there any activities that I should not perform while using OxyContin for pain relief?
OxyContin may interfere with your ability to do certain things that require your full attention. You should not drive a car, operate heavy machinery, or do other possibly dangerous activities while taking OxyContin.
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5. What should I do if I still have pain after I take the OxyContin?
Because OxyContin is a very strong medication, you should not adjust the dose without first speaking with your physician.
6. Can I take other medicines while I am using OxyContin for pain relief?
Combining OxyContin with some other types of medication such as sleeping pills, tranquilizers, and other pain medications may be dangerous due to the risk of interactions of these medications that can result in injury or death. You should speak with your physician before taking any other medicines with OxyContin. You should also tell your physician about all prescription drugs, over-the-counter drugs, and dietary supplements/herbal remedies that you are taking before starting OxyContin.
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7. Can I drink an alcoholic beverage while I am using OxyContin for pain relief?
You should not drink any beverage that contains alcohol while you are taking OxyContin. This includes beer, wine, and all distilled liquors. OxyContin and alcoholic beverages may have dangerous interactions that can result in serious injury or death.
8. Will I become addicted to OxyContin if I take it every day?
OxyContin is only intended for moderate to severe pain that is present on a daily basis and that requires a very strong pain reliever. Patients with this type of severe pain condition require daily pain treatment. Taking OxyContin daily can result in physical dependence, a condition in which the body shows signs of narcotic withdrawal if the OxyContin is stopped suddenly. This is not the same thing as addiction, which represents a situation in which people obtain and take narcotics because of a psychological need, and not just to treat a legitimate painful condition. Physical dependence can be treated by slowly under the advice of a physician by slowing decreasing the OxyContin dose when it is no longer needed for the treatment of pain. Concerns of addiction should not prevent patients with appropriate pain conditions from using OxyContin or other narcotics for pain relief.
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9. What should I do when I no longer need the OxyContin for pain relief?
When you no longer need OxyContin, the dose should be gradually reduced so that you do not feel sick with withdrawal symptoms. You should ask your physician for a plan on how to gradually decrease the dose and when to stop the OxyContin.
10. Haven't there been press reports about the misuse of OxyContin?
OxyContin is a safe and effective pain medication when properly prescribed and used as directed. OxyContin has also been used as a drug of abuse. You should protect your prescription and your medication from theft and never give OxyContin to anyone else. You should destroy any left over OxyContin tablets that you may have once your physician instructs you to stop taking the medication.
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11. Can I take OxyContin if I am pregnant, planning to become pregnant, or planning to nurse my baby?
Your should speak to your physician about the effects of drugs like OxyContin on an unborn or newborn child.
12. Are there any other special precautions I should take with my OxyContin?
Because there is a large dose of medication in each OxyContin tablet, you must be very careful to keep OxyContin stored in a secure location, out of the reach of children. When you no longer need OxyContin for pain relief, you should flush the unused tablets down the toilet.
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FDA STRENGTHENS WARNINGS FOR OXYCONTIN
FDA has strengthened the warnings and precautions sections in the labeling of OxyContin (oxycodone HCl controlled-release) Tablets, a narcotic drug approved for the treatment of moderate to severe pain, because of continuing reports of abuse and diversion.
OxyContin contains oxycodone HCL, an opioid agonist with an addiction potential similar to that of morphine. Opioid agonists are substances that act by attaching to specific proteins called opioid receptors, which are found in the brain, spinal cord, and gastrointestinal tract. When these drugs attach to certain opioid receptors in the brain and spinal cord they can effectively block the transmission of pain messages to the brain.
OxyContin is a controlled substance in Schedule II of the Controlled Substances Act (CSA), which is administered by the Drug Enforcement Administration (DEA). Schedule II provides the maximum amount of control possible under the CSA for approved drug products.
In recent months, there have been numerous reports of OxyContin diversion and abuse in several states. Some of these reported cases have been associated with serious consequences including death. In an effort to educate health care providers about these risks, Purdue Pharmaceuticals, manufacturer of the product, has issued a warning in the form of a "Dear Healthcare Professional" letter. The "Dear Healthcare Professional" letter will be distributed widely to physicians, pharmacists, and other healthcare professionals. The letter explains the changes to the labeling including proper prescribing information and highlights the problems associated with the abuse and diversion of OxyContin.
OxyContin, like morphine, has a high potential for abuse. It is supplied in a controlled-release dosage form and is intended to provide up to 12 hours of relief from moderate to severe pain. The tablet must be taken whole and only by mouth. When the tablet is crushed and its contents are injected intravenously or snorted into the nostrils, the controlled release mechanism is defeated and a potentially lethal dose of oxycodone is released immediately.
FDA has worked with Purdue to make specific changes to the OxyContin labeling. The new labeling is intended to change prescription practices as well as increase the physicians' focus on the potential for abuse, misuse, and diversion.
Changes include a "black box warning", the strongest type of warning for an FDA-approved drug. The new warnings are intended to lessen the chance that OxyContin will be prescribed inappropriately for pain of lesser severity than the approved use or for other disorders or conditions inappropriate for a Schedule II narcotic.
The FDA-approved indication for OxyContin is for the treatment of patients with moderate to severe pain who are expected to need continuous opioids for an extended time. An important factor that must be considered in prescribing OxyContin is the severity of the pain that is being treated, not simply the disease causing the painful symptoms.
FDA continues to recommend that appropriate pain control be provided to patients who are living with severe pain. Although abuse, misuse, and diversion are potential problems for all opioids, including OxyContin, opioids are a very important part of the medical armamentarium for the management of pain when used appropriately under the careful supervision of a physician.
Because of the ongoing problem of OxyContin abuse and diversion, FDA has met with DEA, the Substance Abuse and Mental Health Service Agency, the National Institute on Drug Abuse, Purdue, Inc., and others. FDA will continue to monitor reports of abuse, misuse, and diversion of OxyContin and other opioids and will work with other federal agencies and drug manufacturers to help ensure that these important drugs remain available to appropriate patients.
Since all opioids are subject to abuse, misuse, and diversion, FDA is encouraging all manufacturers of opioids sold in the U.S. to review voluntarily, and revise as necessary, their product's labeling to provide adequate warnings and precautions regarding these risks and to promote responsible prescribing practices.
For more information, patients and healthcare providers can call Purdue Pharmaceuticals at 1-888-726-7535, or go to FDA's website at www.fda.gov/cder/drug/infopage/oxycontin/.
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OxyContin Diversion and Abuse
Overview
Diversion and abuse of the prescription pain reliever OxyContin is a major problem, particularly in the eastern United States. The Drug Enforcement Administration (DEA) reports that, in the United States, oxycodone products, including OxyContin, are frequently abused pharmaceuticals. The pharmacological effects of OxyContin make it a suitable substitute for heroin; therefore, it is attractive to the same abuser population. Law enforcement reports indicate heroin abusers are obtaining OxyContin because the pharmaceutical drug offers reliable strength and dosage levels. In addition, if the abusers' health insurance covers an illness that the drug treats, the insurance provider may cover the cost of the drug. Conversely, OxyContin abusers who have never used heroin may be attracted to the lower priced heroin when their health insurance no longer pays for OxyContin prescriptions or when they cannot afford the high street-level price of OxyContin. For example the West Virginia, Hancock-Brooke-Weirton Drug Task Force reports that a local couple, recently sentenced for conspiracy to sell heroin, turned to heroin after their doctor refused to continue prescribing OxyContin and they could not afford the street price of the pharmaceutical. OxyContin abusers sometimes commit theft, armed robbery, and fraud to sustain their habits.
The illegal diversion, distribution, and abuse of oxycodone products, particularly OxyContin, appear to be concentrated most heavily in the East, according to respondents to the National Drug Intelligence Center (NDIC) National Drug Threat Survey 2000 and DEA reporting. OxyContin Tablet, commonly referred to as OxyContin, has become the oxycodone product of choice in Maine, Ohio, and West Virginia, and in portions of eastern Kentucky, Maryland, western Pennsylvania, and rural southwestern Virginia.
Background
OxyContin is a trade name product for the generic narcotic oxycodone hydrochloride, an opiate agonist. Opiate agonists provide pain relief by acting on opioid receptors in the spinal cord, brain, and possibly in the tissues directly. Opioids, natural or synthetic classes of drugs that act like morphine, are the most effective pain relievers available. Oxycodone is manufactured by modifying thebaine, an alkaloid found in opium. Oxycodone has a high abuse potential and is prescribed for moderate to high pain relief associated with injuries, bursitis, dislocation, fractures, neuralgia, arthritis, and lower back and cancer pain. It is also used postoperatively and for pain relief after childbirth. Percocet, Percodan, and Tylox are other trade name oxycodone products.
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. People who take the drug repeatedly can develop a tolerance or resistance to the drug's effects. Thus, a cancer patient can take a dose of oxycodone on a regular basis that would be fatal in a person never exposed to oxycodone or another opioid. Most individuals who abuse oxycodone seek to gain the euphoric effects, mitigate pain, and avoid withdrawal symptoms associated with oxycodone or heroin abstinence.
OxyContin is an oral, controlled-release oxycodone that acts for 12 hours, making it the longest lasting oxycodone on the market. Patients taking shorter acting oxycodone products, such as Percocet, may need to take the product every 4 to 6 hours. While drug doses vary by individual, the typical OxyContin dose prescribed by physicians ranges from two to four tablets per day. OxyContin was developed and patented in 1996 by Purdue Pharma L.P. and was originally available in 10 milligram (mg), 20 mg, 40 mg, and 80 mg tablets. A 160 mg tablet became available in July 2000. By comparison, Percocet and Tylox contain 5 mg of oxycodone and Percodan-Demi contains just 2.25 mg. The strength, duration, and known dosage of OxyContin are the primary reasons the drug is attractive to both abusers and legitimate users.
Abuse
The abuse of oxycodone products in general has increased in recent years. In April 2000, The Journal of the American Medical Association (JAMA) published a study, which examined two data collection sources. The DEA Automation of Reports and Consolidated Orders System (ARCOS) data tracks the distribution of oxycodone and other opioid analgesics and the Drug Abuse Warning Network (DAWN) Medical Examiner (ME) and Emergency Department (ED) data ascertained the health consequences associated with its abuse from 1990 to 1996. The JAMA study found a 23 percent increase in the medical use of oxycodone with no corresponding increase in the illicit abuse of the drug. However, 1998 DAWN ME data reported a 93 percent increase in oxycodone mentions between 1997 and 1998 and the number of oxycodone-related DAWN ED mentions increased 32.4 percent from 1997 (4,857) to 1999 (6,429).
Opioids, Pain, and Addiction
Addiction to opioids used for legitimate medical purposes under a qualified physician's care is rare. According to the National Institute on Drug Abuse, however, many physicians limit prescribing powerful opioid pain medications because they believe patients may become addicted to the drugs. Recent evidence suggests that, unlike opioid abusers, most healthy, nondrug-abusing patients do not report euphoria after being administered opioids, possibly because their level of pain may reduce some of the opioid's euphoric effects making patients less likely to become abusers. (Source: NIDA INFOFAX Pain Medications)
Several deaths have resulted specifically from the abuse of OxyContin in Kentucky, Ohio, Virginia, and West Virginia. The Pike County, Kentucky, Coroner reported 19 OxyContin-related deaths during calendar year 2000. In December 2000, seven OxyContin overdose deaths were reported in Southeastern Kentucky by two Kentucky State Police posts. The Logan Daily News reported in October 2000 that four Hocking County, Ohio, residents overdosed on OxyContin over an 18-day period. Two of the four died. There have been at least four OxyContin overdose deaths in Pulaski, Virginia, since 1998. In July 2000, The Williamson Daily reported five OxyContin-related overdose deaths in southwestern West Virginia since May 2000
Related Criminal Activity
and Diversion
OxyContin abuse has led to an increased number of pharmacy robberies, thefts, shoplifting incidents, and health care fraud incidents, as illustrated by the following:
Maine-In June 2000, the Bangor Daily News reported the arrest of an individual charged with selling approximately $8,000 worth of OxyContin weekly. The OxyContin was prescribed to the individual's wife to control cancer-related pain. The husband illegally diverted some of the pills, which allegedly were paid for by Medicaid, for a substantial profit.
Maine-In August 2000, the Portland Press Herald reported that law enforcement authorities dismantled a drug ring accused of obtaining OxyContin by forging prescriptions, having them filled at pharmacies in southern Maine and New Hampshire, and covering the costs with their Medicaid cards.
Ohio-A heroin addict who learned about OxyContin at a methadone clinic committed at least seven aggravated robberies in early 2000 attempting to finance his 800-mg-a-day OxyContin habit.
Pennsylvania-The Cambria County Drug Task Force views prescription fraud as the fastest growing crime in Cambria County; an increase in the number of pharmacy burglaries in the county is directly related to OxyContin abuse. For example, on January 1, 2001, a robber stole more than $1,000 worth of OxyContin from a local pharmacy.
Pennsylvania-In December 2000, the Pennsylvania State Police reported an attempted armed robbery at a pharmacy in Clearfield County, where the suspect sought OxyContin.
Virginia-The Police Chief in Pulaski reported in October 2000 that approximately 90 percent of all thefts, burglaries, and shoplifting incidents in the area were linked to the OxyContin trade.
Virginia-Prosecutors in Tazewell County reported in October 2000 that more than 150 people have been charged with felonies associated with OxyContin abuse. Since February 1999, thieves reportedly demanded only OxyContin in at least 10 pharmacy robberies. The high number of robberies prompted some pharmacies in Tazewell County to discontinue selling OxyContin and post signs stating they no longer would carry the drug.
Sentencing and Legislation
Oxycodone, including OxyContin, are Schedule II drugs under the Federal Comprehensive Drug Abuse Prevention and Control Act. Federal sentencing guidelines for diverted Schedule II pharmaceuticals are determined by the total weight of the tablets, not strength. Similar drugs of lower strength like Percocet and Tylox may weigh more than OxyContin, thus distributing the same quantities may result in stiffer penalties than for distributing OxyContin.
Authorities in Maine, in conjunction with the U.S. Government, launched a new initiative in 2000 regarding OxyContin abuse. The Maine Attorney General's Office has proposed legislation seeking to make possession of a large number of OxyContin tablets a felony; such possession is currently a misdemeanor.
Outlook
Continued increases in the diversion and abuse of OxyContin are likely. Reliable strength, potential prescription cost coverage, and significant profit potential make OxyContin attractive to both illicit distributors and abusers. Authorities have recognized the increasing problems associated with diversion of the drug. Law enforcement officials, physicians, pharmacists, and representatives of Purdue Pharma L.P. are working together to find methods to limit diversion and abuse. Legislative initiatives are also being drafted to make OxyContin distribution less appealing by creating more stringent penalties.
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zazen
Stranger
Reged: 01/24/04
Posts: 6
Loc: SF Bay Area
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just for the record, oxycontin should not be confused with the medication called PERCOCET which is (like norco and vicodine) a compound of two pain medications.
percocet is made of oxycodone and acetaminophen and comes in tablets of 5/325, 10/325, etc.
i've used it for long-term back pain and have had no problems with it. like any strong pain meds, you have to counter the possability of constipation appropriately.
personally, i would like to see some of our OP's offer it.
for more information, see www.endo.com which is a major producer of the generic tablets called endocet.
~zazen~
Edited by zazen (05/10/04 10:01 PM)
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SuseCue
Member
Reged: 04/25/04
Posts: 169
Loc: Tampa, FL
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Isn't Percocet Schedule ll? In all doses?
Cami
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LumbarSpasm
Silent Chaos
Reged: 05/07/02
Posts: 1539
Loc: USA
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Yes.
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LumbarSpasm
Or just a pain in the butt?!
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Luv714
Banned for posting "PM me for good source" which our rules we equal making offers
Reged: 02/16/02
Posts: 184
Loc: NorthEast USA
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What is UP w/that oxycontin-oxycodone website??? I mean, really ... they contradict themselves several times in their own information... is it for real?? Has anyone used it?? I am a lung cancer patient, and just today got 'fentanyl'[patches] from my primary doc... but she said she'd consider oxy for me.. but $$ would be outrageous.... and that maybe I should investigate other sources (op's).. is that site a scam or what?? does anyone know?
Thanx,
Luv714
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SuseCue
Member
Reged: 04/25/04
Posts: 169
Loc: Tampa, FL
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I was taking Oxycotin for a little over a year. At first I liked it. I did get very good pain relief for about 6 to 8 hour intervals The one thing I did not like about it is that my tollerance built very quickly to it. I started at 20mgs twice a day and in six months I was up to 40mgs three times a day. My doctor was going to put me on 80mg twice a day when I asked to try something else instead. I was just increasing too quickly. This may not be the case for anyone else. I am now taking Avinza. I highly recommened it. Granted, I have only been taking it for almost two weeks, but what I really like about it is that it is one pill a day and there are no ups and downs, mood swings, or euphoria. It just keeps me on an even keel and I really like that. Good Luck if you try the Oxy.
btw, I have been on the Patches as well and I had a very hard time keeping them on. I live in Florida so I had to deal with heat and humidity so the patches were just not ideal for me.
Cami
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oldnavy170
Board Addict
Reged: 05/12/03
Posts: 357
Loc: New York
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I am just curious.....whats in Avinza? Is it another form of Oxy or something else all together?
Thanks.
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southstar
Newbie
Reged: 03/16/04
Posts: 29
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its time released morphin. it worked great for me to. i was buliding a tolurace to the oxy to fast as well.
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Administrator
Administrator
Reged: 11/19/01
Posts: 1554
Loc: DrugBuyers.Com
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Deav Diversion - Drugs of concern - Oxicodone
Quote:
Oxycodone
(Trade Names: Tylox, Percodan, Oxycontin)
Introduction
Oxycodone abuse has been a continuing problem in the United States since the early 1960's. In passing the Controlled Substances Act of 1970, Congress placed oxycodone in Schedule II (CII). In spite of its CII status, oxycodone continued to be abused. The abuse of a new sustained-release formulation of oxycodone, known as Oxycontin7, has escalated over the last year. Drug abuse treatment centers, law enforcement personnel, and health care professionals have reported a dramatic increase in the abuse of these sustained release products in Maine, Virginia, West Virginia, Ohio, Kentucky and Maryland. Recently, abuse has spread to other states such as Pennsylvania and Florida. The estimated number of emergency department (ED) episodes involving oxycodone were stable from 1990 through 1996. However, the number of ED episodes more than trippled from 1996 to 2000: 3,190 episodes in 1996 to 10,825 in 2000.
Licit Uses
Oxycodone is an effective analgesic for mild to moderate pain control, chronic pain syndromes, and for the treatment of terminal cancer pain. Five mg of oxycodone is equivalent to 30 mg of codeine when administered orally. Oxycodone and morphine are equipotent for pain control in the normal population; 10 mg of orally-administered oxycodone is equivalent to 10 mg of subcutaneously administered morphine. Oxycodone is considered to be similar to morphine, in all respects, including its abuse & dependence liabilties. Oxycodone in dosages of 5 to 10 mg in combination with acetaminophen or aspirin are abused orally. High dose single entity sustained release formulations containing 10 to 80 mg of oxycodone are abused by crushing or chewing the tablet and then swallowing, snorting or injecting the drug.
Chemistry/Pharmacology
Oxycodone [4,5a-epoxy-14-hydroxy-3-methoxy-17-methylmorphinan-6-one, dihydrohydroxycodeinone] is a semisynthetic opioid structurally related to codeine and is approximately equipotent to morphine in producing opiate-like effects. The first report that oxycodone, sold under the brand name Eukodal, produced a "striking euphoria" and habituation symptoms was published in Germany in the 1920's. While oxycodone is metabolized by the liver to oxymorphone, the physiological and behavioral effects are not related to, nor dependent on, the formation of this metabolic by-product.
Oxycodone will test positive for an opiate in the available field test kits.
Illicit Uses
Oxycodone is abused for its opiate-like effects. In addition to its equipotency to morphine in analgesic effects, it is also equipotent to morphine in relieving abstinence symptoms from chronic opiate (heroin, morphine) administration.For this reason, it is often used to alleviate or prevent the onset of opiate withdrawal by street users of heroin and methadone. In early studies by the Addiction Research Center in Lexington, Kentucky in the 1960's, it was discovered that the subjective and physiological effects of oxycodone were greater than an equivalent dose of morphine in opiate substance abusers. Many dosage forms are available. Oxycodones behavioral effects can last up to 5 hours. The drug is most often administered orally. The sustained-release formula has a longer duration of action (8-12 hours). A recent study comparing controlled released products containing oxycodone (Oxycontin) and morphine (MS Contin) reported that Oxycontin was twice as potent as MS Contin.
As with most opiates, the adverse effects of oxycodone abuse are dependence and tolerance development. Oxycodones co-formulation with acetaminophen has also increased the likelihood of acetaminophen-induced hepatic necrosis with chronic dosing. Its availability in sustained release formulations has increased the dosage forms from 10 to 160 mg per tablet making it more attractive than oxycodone to opiate abusers and doctor-shoppers. The original idea of polymer-formulations of oxycodone was to reduce the likelihood of misuse with high dose formulations. Opiate abusers quickly learned the ease of extraction of the molecule from the polymer formula and have been injecting or snorting the crushed and/or dissolved tablets because of its higher dosage formulations.
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.
Illicit Distribution
Oxycodone-containing products are in tablet, capsule and liquid forms. A variety of colors, markings, and packaging are available.
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. Oxycontin7 sells for $0.50 to $1.00 per milligram. A 40 mg tablet is sold for $25-$40, and the 80 mg tablets are being sold for $65-$80. The manufacturer has recently discontinued marketing the 160 mg tablets.
Control Status
Oxycodone products are in Schedule II of the Controlled Substances Act of 1970.
Comments and additional information are welcomed by the Drug and Chemical Evaluation Section, FAX 202-307-8570 or telephone 202-307-7183.
August, 2001
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trixxie
Member
Reged: 05/23/03
Posts: 194
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Curious, should a person NOT drive at all when taking oxycontin?
Thats what the info says. I mean I would have to take the bus to work. I am not on a high dose, and function totally normal, except with some break through pain.
What are the legalalities???
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The truth shall set you free!
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Anonymous
Unregistered
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Avinza is a polimer coated morphine, time released, its the first step in coating narcotics with a substance that will destroy the morphine if the capsules are crushed, not unlike norcane, so people who chrush up there oxycotin to get a rush will no longer be able to do that they haven't perfected it yet but there working on it. Avinza taken as directed to someone with a high tolorance to narcotics will get little relief from this drug, PS it's also VERY expensive something like 220.00 for 30 60mg caps at the drug store, Tim
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Billyl
Board Addict
Reged: 06/15/02
Posts: 389
Loc: NorthEast
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Quote: personally, i would like to see some of our OP's offer it.
Don't ever count on it. It is a schedule 2, no refills. No US OP in their right mind would prescribe it. They would be shut down.
Quote: just for the record, oxycontin should not be confused with the medication called PERCOCET which is (like norco and vicodine) a compound of two pain medications.
Just for the record there is little diiference between the two medications both contain Oxycodone. The main ingrediant is essentially identical. One is a slow release formulation the other short with some APAP mixed in for good measure. Chemically it isn't like Hydrocodone.
Just wanted to clear up some mis-information.
Take care. Billylll
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drewsmerdel
Pooh-Bah
Reged: 12/14/01
Posts: 1137
Loc: Nap Town
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Percocet and Percodan are the same drug in my opion, the active ingedient in each is the same. The real diffrence is that Oxy is time released and can be "cooked" up, and percocet ot percodan are not time released and cannot be "cooked" up. Purdue was supposed to change the structure of the drug(oxycontin) so that it could not be injected, they are past their deadline for that(Wonder why????).
Drew
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Are you hungry?
Are you sick?
Are you begging for a break?
Are you sweet?
Are you fresh?
Are you strung up by the wrists?
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SuseCue
Member
Reged: 04/25/04
Posts: 169
Loc: Tampa, FL
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I have been on the Avinza 120mgs for a month now and so far so good. The best part about it is the even keel it keeps you on all day. No ups and downs like with the oxycotin. I really hated that about the oxycotin.
The pain relief is moderate but with my situation, my doctor has drilled it into my head that no amount of medication will get me pain free. So, I have come to accept that. I have the Percocet10mgs (I take two at a time)for breakthrough when needed and I have probably cut down 50% on them since switching to the Avinza. My doc also gave me Axert for Migraines, so far no effect at all, and Lidoderm Patches. I really like the Lidoderm Patches. They just numb the tissue and some of the muscle in my knee. They certainly are not enough pain relief for use by them selves but they are nice to put on after physical therapy while watching television.
BTW..I have MS, Brittle Bone Disease, deg everything..etc..I have had a knee replacement and a hip replacement, among other orthopedic junk. My knee replacement was a mess. I developed Celulitis soon after and it just never healed. So a lot of my pain is mechanical, which my doc says can not be relieved with pain killers. I need to have the knee done over, as well as the other knee replaced. I am an orthopedic mess.
So I am very happy with the Avinza so far. Like I said, taking only 4 percocet a day instead of 8, and only 2 on a few days. And Only one Avinza instead of 3 oxycotins. So overall, it has been a good experience.
I will keep ya'll updated. (My very first southern experssion!..LOL Moved from NJ to FL right after knee replacement to be with family for assistance).
Thanks to everyone for listening and offering advice..I really like this board. Everyone is so knowledgable.
Luv,
Cami
PS> Everyone have a Happy and Safe Memorial Day weekend!
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Fighting for peace is like screwing for virginity.
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djfrvr
Stranger
Reged: 07/10/04
Posts: 5
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Oxy is hell, IMHO. Once you get used to it, it's almost impossible to break up with it for good,
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daddyj
Board Addict
Reged: 02/06/03
Posts: 384
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Quote:
What is UP w/that oxycontin-oxycodone website??? I mean, really ... they contradict themselves several times in their own information... is it for real?? Has anyone used it?? I am a lung cancer patient, and just today got 'fentanyl'[patches] from my primary doc... but she said she'd consider oxy for me.. but $$ would be outrageous.... and that maybe I should investigate other sources (op's).. is that site a scam or what?? does anyone know?
Thanx,
Luv714
I'm not sure which website you're talking about, but oxycontin is quite expensive. However, companies have recently introduced generic oxycontin because of some mistake that Purdue made in patenting the drug, so it should be quite a bit cheaper. The way I read several articles on the subject, Teva and Endo already had everything in place to get FDA approval to manufacture and market generic oxycontin in case the judge ruled against Purdue, which he did.
The Teva brand of generic OC seems to be just as potent as brand-name.
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Misty morning, clouds in the sky
Without warning, the wizard walks by
Casting his shadow, weaving his spell
Funny clothes, tinkling bell
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MkivTT
Stranger
Reged: 07/16/04
Posts: 17
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hmmm, keep us posted
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SuseCue
Member
Reged: 04/25/04
Posts: 169
Loc: Tampa, FL
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Do you know if these new generics will be made so that you cannot mess with the time release? I know that Perdue was supposed to be working on this.
This would take a lot of the pressure off of the doctors to prescribe it more freely.
Susie**
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Fighting for peace is like screwing for virginity.
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IMSUSCOT1
Threadhead
Reged: 10/23/02
Posts: 946
Loc: usa
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I tried the teva and found it terrible! I actually took my bottle back to walgreens the next day & made them chang it for brand name...guess it just depends on chemistry, but I find Oxycontin works well for me, with few if any side effects, other than occasional nausea with some of my other meds. But I didn't like the generic at all.
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Opie_Yates
Veteran
Reged: 08/11/03
Posts: 550
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Quote:
Oxy is hell, IMHO. Once you get used to it, it's almost impossible to break up with it for good,
LOL...reminds you of one of those bad marriages that ends up lasting 50 years! 
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********YES! DEFINITELY VOTE IN '08!********
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daddyj
Board Addict
Reged: 02/06/03
Posts: 384
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The Teva Generic doesn't have any such measure.
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Misty morning, clouds in the sky
Without warning, the wizard walks by
Casting his shadow, weaving his spell
Funny clothes, tinkling bell
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curiousdee
Member
Reged: 05/29/04
Posts: 193
Loc: Southeast U.S.
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Hey Luv14 sorry to hear about your diagnosis. My father had lung cancer too. I wish you only great things and will pray for you.
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SuseCue
Member
Reged: 04/25/04
Posts: 169
Loc: Tampa, FL
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Remember that this forum is not to discuss suppliers. We have other forums for that.
Thank you
Edited by Melody (07/12/05 03:47 PM)
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trixxie
Member
Reged: 05/23/03
Posts: 194
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My two cents worth?? I think oxycontin is a godsend. I was on the duragesic, and I started having strange mental ups and downs. When I went from 50mcg to nothing, I had minimal w/d's. When I don't need LA pain meds, I look forward to that day, that means that I will be healed!
Until then..I will rely on the medication to live my life to the best I can. I can work, be a mom, wife, and an active participant in life. Under my circumstances, I don't think I could ask for much more.
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The truth shall set you free!
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Luv714
Banned for posting "PM me for good source" which our rules we equal making offers
Reged: 02/16/02
Posts: 184
Loc: NorthEast USA
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Hey CuriousDee,
Thanx much for that info... truly appreciate
Luv714
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treezat
Journeyman
Reged: 05/22/04
Posts: 50
Loc: southeast US
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hey gang 
oxycontin and morphine are chemical structures that are so similar to your brains very own DOPAMINE endorphins, that the receptor areas in your body will glady accept the opiate immitators.
the down side is that the most powerful opitates (pure tar from an Afghani poppa-reaver, per say, opium, pure synthesized chemically pefect morphine, etc.) are still FAR FAR less powerful then your brains very own DOPAMINE! it only makes sense for the natural endorphin to be more powerful.
The problem is that for dopamine to work right you have to be very, very healthy. Preferrably physically active, strong root chakra, excellent diet, etc. Pretty much every person on a opiate is not in a state of body or mind where they can undertake physical activity, and the opiate therapy can have an effect on your diet and digestion process. And if you live in the united states there is a 80% chance you arent getting the essential fatty acids and ameeno acids your body needs for dopamine production. fast food and tv dinners and cruddy diets leads to instant intolerance of pain and people due to lack of endorphins. in addition your body becomes slack when it sees it neither has the fuel nor the need for the dopamine endorphin, because something else is agonising the receptors (oxy/morphine/opiate) it decides to save the much needed energy for other natural processes.
so until you can become regularly physically active, or drmatically change a regularly monitor your diet, my personal and non professional opinion and advice to you is this :
check out an online or otherwise herbal supplement store (my personal favorite is iherb.com because they also have links to an online encyclopedia of health conditions and proposed herbal/mineral/ameeno/suplment remedies and they are usually quie honest about effects and trials ) and get yourself some of this :
L-tyrosine (dopamine/norepinephrine synthesis)
SAMe (clinically proven anti depressant, liver detox)
GABA (bodys natural CNS depressant, blocks larger pain messages)
your body will thank you and with regular supplement intake your body will be able to resume natural processes and become less dependant on the chemical substitues and agitators because of the presence of the readily available and more powerful natural endorphins.
you are still going to need to carefully maintain intake of medicines and supplements, and if you see a health professional who is worth anything discuss this with them first. many health professionals are unaware of herbal remidies and treatments but they know what ameeno acids do if they paid attention while attaining their degree.
just a suggestion for those of you who are sick and tired of getting ripped off and fighting doctors for stronger pain medicines and really just tired of living in pain and suffering, all the while being persecuted as a schedule 2 narcotics user and looked down upon for your contion. You have tried chemical replacement and agitation to no avail, why not try using your bodys natural abilities to heal and maintain itself given proper fuels?
may you be well.
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rockystuart
Enthusiast
Reged: 03/11/04
Posts: 237
Loc: San Fran Bay Area, Calif
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YEs reading up on how the various dopamine receptors (primaririly mu(u) and kappa(k1) plus 12 others are BLOCKED by pain killers like oxy and morphine makes for good reading. the main difference between oxy and morph is that oxy is not rendered 70-80% into inert or ineffective substances like morphine is , when taken orally.
and i AM ABSOLUTELY SURE THAT NO AMOUNT OF SUPPLIMENT/CLEAN LIVING WILL PUT CARTALIGE BACK INBETWEEN MY VERTEBREA.
lOOK UP "pRINCIPLES OF DRUG ACTION 2, fALL 2000" BY jACK dErUITER. Sorry caps. I found if from a link on the DB last week
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