Oxycodone is a strong opioid analgesic (pain killer) drug with a high potential to cause physical and psychological dependence. Oxycodone is a semi-synthetic opioid made from the alkaloid, thebaine. It is very similar to codeine in structure and actions. The agent has been around for more than 70 years in Europe but because of the addiction and abuse potential, the drug never became popular until the late 1980s.
The preparation of hydrocodone from thebaine was done to avoid the mood altering effects that were common with morphine and heroin. Oxycodone, like morphine, acts on the brain but does not show the full spectrum of mood altering effects seen with morphine or heroin, nor are the effects long lasting. However, the drug does have some euphoric effects, lessens anxiety and gives the user a pleasant experience. This plus the relatively easy availability of the drug has made it liable to abuse. Oxycodone and its derivatives have been illicitly abused in North America for the past 20-30 years.
Oxycodone is a Schedule II narcotic analgesic and is extensively used in clinical practice. In the last decade, Oxycodone has become of great concern to the DEA and numerous adverse health effect bulletins have been released. In 2004, Food and Drug Administration (FDA) approved the marketing of generic forms of controlled release Oxycodone products (e.g. oxycontin).
Recently, the DEA increased regulations over the availability of oxycodone. Persons who try and obtain repeat oxycodone prescriptions and possess it for purpose of trafficking are guilty of an indictable offence and liable to imprisonment.
In the United States, oxycodone is a Schedule II controlled drug and requires a prescription for use. Oxycodone is an excellent pain killer that can be taken orally. The drug is frequently used in clinical practice to manage pain after surgery. The drug is very effective for moderate to severe chronic pain (e.g. back pain). The drug is usually recommended for short term use not lasting more than a few weeks at a time. Generic forms like long term oxycontin are frequently administered to patients with terminal cancer.
Doses and Preparations
Oxycodone is a strong pain killer when taken orally and is prescribed in various formulations. It is often combined with aspirin (percodan, endodan, roxiprin), acetaminophen (percocet, roxicet, tylox), or ibuprofen ( combunox). Recently, a longer acting form of oxycodone, known as oxycontin, has been released.
Other long release preparations include:
All long release preparations are effective for 8-12 hours. Some of these long release preparations are also available in liquid form.
Oxycodone and all its generic formulations are available for oral, intravenous, intramuscular or intranasal use. Oral preparations are used most frequently, have a rapid onset of action and last 4-6 hours. In patients who become tolerant to the drug, higher doses of the drug are required to produce the same amount of pain relief. Unfortunately, tolerance to all side effects does not occur and there is always a risk of adverse reactions with high doses.
Like all opioids, side effects are common with oxycodone. Common side effects include:
- Mental clouding
- Blanking of emotions
In a few patients, allergic reactions may produce a skin rash. Other side effects seen after long term use include decreased levels of testosterone. This may result in impotence, which is reversible once the drug is stopped. Enlargement of the prostate has also been reported.
Acute overdose of Oxycodone can produce:
- Life threatening respiratory depression
- Skeletal muscle flaccidity
- Cold and clammy skin
- Low blood pressure and heart rate
- Respiratory arrest
Oxycodone and its derivatives should be used with great caution in inpiduals with head trauma and meningitis.
The major concern with the use of oxycodone and its derivatives is tolerance and physical dependence which can occur after several weeks to months of use. Oxycodone has almost similar effects to morphine, and thus appeals to the same community who abuse morphine and heroin. Reports of pharmacies being broken in for oxycodone are not uncommon.
Like all opioids, oxycodone use is regulated. Thus, when it is acquired illegally, the drug is expensive on the black market. Prices for black market oxycodone may range anywhere from $25 to 50 for a 50 mg tablet. With the availability of generic brands, the cost of a pill may range from $5-10.
To prevent abuse of oxycodone and its derivatives, newer formulations are being developed that will prevent excessive use and limit toxicity. Remoxy is a newer drug which is currently undergoing clinical trials.
The use of Oxycodone under the guidance of physicians is generally safe and rarely causes problems. When taken with due care for short term periods, the drug is a very effective pain killer.
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