By Anthony McDaniel, M.D.
Oxycodone is an opioid analgesic medication synthesized from opium-derived thebaine. It was developed in 1916 in Germany, as one of several new semi-synthetic opioids in an attempt to improve on the existing opioids: morphine, diacetylmorphine (heroin), and codeine. Oxycodone oral medications are generally prescribed for the relief of moderate to severe pain. Low dosages have also been prescribed for temporary relief of diarrhea. Currently it is formulated as single ingredient products or compounded products. Some common examples of compounding are oxycodone with acetaminophen/paracetamol or NSAIDs such as ibuprofen. The formulations are available as generics but are also made under various brand names. OxyContin is Purdue Pharma's brand for time-release single-ingredient oxycodone oral medication. The manufacturing rights to time-released generic oxycodone are under dispute.
The most commonly reported effects include euphoria, memory loss, constipation, fatigue, dizziness, nausea, lightheadedness, headache, dry mouth, anxiety, pruritus, and diaphoresis. It has also been claimed to cause dimness in vision due to miosis. Some patients have also experienced loss of appetite, nervousness, abdominal pain, diarrhea, ischuria, dyspnea, and hiccups, although these symptoms appear in less than 5% of patients taking oxycodone. Rarely, the drug can cause impotence, enlarged prostate gland, and decreased testosterone secretion. Compared to morphine, oxycodone causes less respiratory depression, sedation, pruritus, nausea, and euphoria. As a result, it is generally better tolerated than morphine. In high doses, overdoses, or in patients not tolerant to opiates, oxycodone can cause shallow breathing, bradycardia, cold, clammy skin, apnea, hypotension, miosis (pupil constriction), circulatory collapse, respiratory arrest, and death.
There is a high risk of experiencing severe withdrawal symptoms if a patient discontinues oxycodone abruptly. Therefore therapy should be gradually discontinued rather than abruptly discontinued. People who use oxycodone in a hazardous or harmful fashion are at even higher risk of severe withdrawal symptoms as they tend to use higher than prescribed doses. The symptoms of oxycodone withdrawal are the same as for other opiate based painkillers and may include "anxiety, nausea, insomnia, muscle pain, muscle weakness, fevers, and other flu like symptoms." Withdrawal symptoms have also been reported in newborns whose mothers had been either injecting or orally taking oxycodone during pregnancy. Instances of recreational use and diversion of OxyContin have increased in the U.S. beginning in the late 1990s. The slang term hillbilly heroin for OxyContin refers to the occurrence of the "earliest reported cases of Oxycontin abuse" in the U.S. in rural areas such as Appalachia. Diversion of OxyContin in the U.S. may occur through "fraudulent prescriptions, doctor shopping, over-prescribing, and pharmacy theft. One investigation in Boston found that OxyContin was a "gateway" drug for heroin, which addicts turned to as cheaper alternative.
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