John Schinnerer, Ph.D.
Guide To Self, Inc.
Handsome. Intelligent. Strong. Athletic. Popular. Addicted to OxyContin.
As a senior in high school, Steve (whose name and details have been changed to protect his identity) is captain of the football team, an elite baseball player, has a 3.8 grade point average and dates one of the hottest girls on campus. His blonde hair flows in curls down around his ears. His olive skin is darker than usual due to afternoon practices under the 100 degree California sun. He is the quintessential All-American Guy ruggedly good-looking, muscular, smart, physically gifted, admired by his peers and teachers, and revered by underclassmen.
As he sits in my office, Steve begins to tell me how he became addicted to one of the strongest prescription drugs on the planet OxyContin.
OxyContin is an opiate-based medication used to manage high intensity pain. It is an alternative to morphine for pain management. While morphine has been shown to be the most potent pain killer on the planet, OxyContin clocks in at a close second.
A 2009 WebMD report states that 12% of high school seniors have taken opioids without a doctors orders. The purpose? To relieve stress, to have a good time with friends, pain relief or simply for the high. These numbers are based on self-reports by high school students so its likely that these numbers are a conservative estimate.
OxyContin is produced by Purdue Pharma. It was introduced to the United States in 1996 after being approved by the FDA a year earlier. In five short years, OxyContin became the biggest selling brand name narcotic pain reliever in America. In 2008, retail sales of OxyContin surpassed $2.4 billion.
The generic version of OxyContin is oxycodone and comes under a variety of names including Oxycontin, Percodan-Demi, Percodan, Tylox, Percocet, OxyIR (immediate release), OxyNorm, Proladone suppositories and Roxicodone or Roxicet (both of which are immediate release). Most of these are available in varying dosages (e.g., 2.5 mg, 5 mg, 10 mg, and so on up to 80 mg).
As quarterback of the football team, Steve was expected to play regardless of physical injury. When he suffered a low back injury, he went to his doctor who prescribed him Vicodin. The Vicodin took the edge off the pain but not fully. His ability to play was still impaired due to the injury. He returned to his M.D. who upped the ante to Vicodin ES which increased the dosage from 5 mg to 7.5 mg. The Vicodin and the Vicodin ES were his first introduction to the pleasant high which results from opiate-based pain killers. Steve was prescribed 80 tabs of Vicodin ES with three refills and he was off and running.
Scripts for Pain Killers Represent a Ethical Quandary and Financial Opportunity for Some
The flip side of this difficult equation is that for some individuals, these prescriptions represent a money-making opportunity that is impossible to ignore. At $4 to $5 a pill, Steves prescription carried a street value of $1200 at the top end. For a student, that amount of cash lights up the reward centers in the brain to rival the effect of the opiates themselves.
One high school student told me that, upon bringing up the subject of his fathers recent shoulder surgery, he was asked what prescriptions his dad received. As soon as he mentioned Percodan, he was asked by a friend Hey can you get me some of those? Ill pay you for them.
Slang Terms for OxyContin
Oxycontin is known as hillbilly heroin due to the first cases of abuse occurring in rural areas like Appalachia. It also goes by the nicknames OC and oxy.
Getting Into the Body
OxyContin can be swallowed in tablet form, crushed up and snorted, crushed and smoked, injected or inserted rectally in suppository form. Oxy is a timed release pain killer so crushing it makes the high more intense and immediate. It also makes it more addictive and life-threatening.
Cranking Up the High
After a month of ramping up the number of Vicodin ES per day, the relaxed sense of well-being Steve got from the pills led to a desire for a more intense, longer-lasting buzz. A friend told him about the power of OxyContin. The friend had a few oxy that hed taken from his dads medicine cabinet. Steve and his friend both swallowed a 20 mg oxy before school. Steve had never experienced anything like it. He felt chill, relaxed and happy, yet he was able to do his school work and manage his life. Steve later recalled, all my problems seemed to recede into the background when I was taking oxy.
How Long Does Oxy Take to Get Out of the Body?
Oxycontin is eliminated from the body via sweat and urine. Individuals metabolize the drug at varying rates based on age, weight, amount consumed, frequency of doses consumed, overall health, metabolism rate of the body, tolerance to the drug and the manner in which the drug was consumed (e.g., swallowed, smoked, snorted, rectally inserted or injected). The substance is detectable in urine tests for anywhere from 12 hours to 5 days from time of consumption (with an average of 3 days to leave the body). Urine tests can look specifically for OxyContin use and are quite accurate. Be aware that there are tests which do not look specifically for synthetic opioid and thus miss the presence of oxy.
How OxyContin is Made
Oxy is a byproduct of the opium plant. Liquid is drained from the opium plant and dried to create a powder form of opium. A variety of substances are derived from this powder, including morphine, codeine and oxycodone.
Climbing the Ladder
Soon after taking his first pill of oxy, Steve was swallowing 3 20 mg pills per day. He was flying on a cloud of detachment all day every day. Yet, the high started to dull after two weeks. The group of 4 friends he was hanging with spent most of their time, energy and money seeking out more and more oxy. If one of them could earn or steal $80, they would head to the town next door where a dealer would sell them 3 40 mg tabs of oxy for $80. Steve felt an intense rush of anticipation and excitement waiting in the car, unsure whether or not the dealer would deliver. Within a few weeks, Steve was crushing the pills into powder and snorting it with friends. Next, the group started crushing the pills, putting it in a pipe and smoking it to max out the euphoric high. However, the best high, according to Steve, was injecting it.
|Cost of Oxycontin
||Approximately $1 per mg
|Dosage of OxyContin
Acceleration towards Addiction
In the U.S., Oxycontin is classified as a Schedule I controlled substance by the Drug Enforcement Administration due to the high risk of addiction associated with it. As individuals use oxy, a tolerance develops over time. As tolerance builds, users frequently increase dosages to get the same effect. Some individuals try different methods of taking the drug to achieve a similar or stronger effect (e.g., snorting, smoking, injecting). As oxy is designed to be time-released and work over a 12-hour period, many abusers chew the pill, crush it and snort it, or crush it and mix with water to inject it so as to make the high more immediate and intense.A 2009 study from the National Study on Drug Use and Health reports that prescription pain relievers has risen over 400% from 1998 to 2008 in individuals over the age of 12. Pain killer abuse rose from 2.2% in 1998 to 9.8% a mere ten years later. These gains were seen across a variety of demographics including age, ethnicity, gender, socioeconomic status, educational level and geographic region. Even more startling, pain killer abuse exploded in treatment centers across the U.S. increasing from 6.8% in 1998 to 26.5% in 20008.
Prescription pain killer abuse is now the 2nd most prevalent form of illicit drug use in the nation, stated Substance Abuse and Mental Health Services Administration Administrator Pamela Hyde, J.D.
Side Effects of OxyContin
While the main effect of the drug is relief from moderate to severe pain, OxyContin provides a variety of side effects. While these side effects vary by individual, they frequently include a sense of well-being, euphoria and relaxation. One side effect reported by a client is a feeling of calm in social settings (i.e., it allowed me to chill). Many use to dull the emotions that cause them distress: anxiety, sadness, irritation and guilt.
OD and OC The Downside
As a mental health professional, few things are as scarier to me than OxyContin and the possibility of overdose (OD). People begin taking oxy for the happy and pleasant high. Within 2 to 3 weeks, they use oxy simply to function and feel normal. Within 2 to 3 weeks, they are addicted. Within 2 to 3 weeks, they are forced into a terrible choice – use or suffer intense withdrawal effects. Some users combine alcohol with oxy to create a deadly effect. The FDA reports that combining OxyContin with alcohol, barbiturates, antihistamines, or benzodiazepines (e.g., Valium) may result in death. The exact number of deaths due to OxyContin is difficult to determine, but Miami-Dade County reported 11 deaths likely due to oxy use in 2001. The true numbers are likely far higher. According to the U.S. Drug Enforcement Agency, the vast majority of (oxycodone-related) deaths have been associated with oral consumption of the drug. More people have died taking oxy orally than smoking, snorting or shooting it. Also, the majority of deaths related to oxycodone involve more than one drug (e.g, OxyContin and Valium). The CDC stated that deaths from opioids have exploded by 300% from 1999 to 2006. In 1999, there were 4,000 known opioid-related deaths. In 2006, that number ballooned to 13,800.One report found oxy use to be a gateway to heroin use. Given the addictive strength of the high associated with oxy, when money gets tight, users may look for a cheaper fix. Many overcome their aversion to needles, start with oxy and move on to heroin. While the life-shattering effects of heroin and oxy are similar, there is one massive difference: heroin is illegal; oxy is legal when used under doctors orders. While the battle currently rages on over the legalization of marijuana (with its own set of issues), one of fastest-growing drugs in the world has the FDAs stamp of approval and is easy to rationalize in the mind of users. One of my oxy-using clients told me that he would never take Vicodin because it has too much acetaminophen in it and it can ruin your liver. As soon as he uttered this statement, we both laughed aloud at the absurd nature of the statement. However, this is exactly what users tell themselves in their minds when they are in the midst of using. This is the power of rationalization.
Withdrawal Effects of OxyContin
When oxy is stopped, the symptoms can include nausea, vomiting (in some cases for multiple days), muscle aches and pains, twitching (also known as crazy arms and legs), insomnia, intense irritability, depression, diarrhea, extreme fatigue (e.g., sleeping for 12 16 hours), runny nose, perspiration, and possible auditory and visual hallucinations. Clients have anecdotally reported the withdrawal symptoms are ten times worse than a bad flu.
What to Look For as a Parent or Loved One
How do you spot someone who is abusing oxy? By the time Steves parents were aware of the abuse, needle tracks littered his arms. Yet, he was still managing a 3.4 GPA (dropping a bit from when he was sober), playing one high school sport, had a girlfriend, and was popular among peers. Steve was pulled over by local police 20 times over an 8 month stretch and ticketed only twice (for speeding). He was high on oxy every single time. He had liquor in the car with him nearly every time. No one picked up the fact that he was high on oxy. Why didnt the police pick it up? Because its that difficult to detect. There is no smell as in alcohol or marijuana use. There are no slurred words. The eyes are vaguely glassy but not necessarily bloodshot. Balance is intact. Whats more, the feeling of relaxation that comes from oxy, lulls others into thinking the user is sober because they dont get overly anxious in pressure-packed situations. So what are some of the signs of oxy abuse?The easiest signs to pick up are also the most concrete such as used syringes wrapped up and thrown away, pens which have been disassembled with powdery residue inside the hollow shaft (used for snorting crushed oxy), aluminum foil thrown away in garbage cans outside the kitchen (used to contain the oxy when heating it), lighters, pipes, needle tracks on arms and cut straws. You can also spot oxy use by dramatic changes in sleep behavior (e.g., up all night most nights, sleeping for 12+ hours after coming down) and sudden weight loss (e.g., 5% of body weight in a 2 to 3 month period).
Less obvious signs of abuse come from careful, mindful attention to patterns of behavior. Patterns to watch for include:
· Concern for the abuser expressed by friends and peers
· Text messages or emails referencing deals, needles, OC, oxies, roxies or O
· Wearing long sleeves all the time regardless of outside temperature (to cover up needle tracks)
· Intense impatience and jitteriness (e.g., cannot stand to stay at home, always in a hurry, a 10 on a 10 point scale)
· Out all day long (e.g., leaving for school early to use, staying out late to use)
· Riding dirty ( as one parent termed it) where a group of 3 to 5 friends drive around for hours with no real plans
· Extreme fatigue (e.g., user will crash hard and sleep for 12-15 hours upon coming down off high)
· Profuse perspiration
· Angry and indignant when approached about discipline or use (again, think of a 9 or 10 in intensity on a 10 point scale)
· Intensely emotional denial of black and white truths such as the existence of texts referring to hooking up with some OC or needle references or a positive drug test result
· High frequency of lying
· Low engagement with family
· Most of free time is spent shut in bedroom or out with friends
· Missing money among family members (frequent theft of cash, perhaps $80-100 per week or more)
· Excuses for more cash that are socially acceptable but are untrue (e.g., Mom, I want to go to tutoring for help with calculus. Can you give me $80 to pay for a tutoring course at school?)
Reformulation of OxyContin OxyContin Version 2.0
A newly reformulated version of oxy is more difficult to abuse as is resistant to cutting, chewing and breaking. Attempts to melt or dissolve the new oxy creates a gooey substance that individuals cannot pull into a syringe. While version 2.0 of oxy reduces the possibility of abuse, it does not eliminate it.
A Happy Ending?
After a massive collective effort by his parents, psychiatrist, friends, family, counselor and himself, Steve has been clean and sober for over three months. However, everyone is well aware that a relapse is only a bad day away. The motto used by everyone involved is trust and verify as a reminder to mindfully work to rebuild the trust thats been disintegrated and to ensure the factual accuracy of every story Steve shares. His grades are back up to a 3.8. His relationship with his girlfriend is solid. And perhaps, most importantly, his relationship with his parents is on the mend. The indignance and conflict that were daily occurrences at home have been replaced with greater happiness and emotional equanimity.
A Guide to the Safe Use of Pain Medicine. (2009-02-29). Federal Drug Administration. http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm095673.htm.
Misuse of Prescription Pain Relievers: All Graphics and Other Media. (2009-12-16). Federal Drug Administration. http://www.fda.gov/Drugs/ResourcesForYou/ucm080368.htm.
Prescribed Opioids: Overdoses Not Uncommon. (2010-01-19). WebMD. http://www.webmd.com/pain-management/news/20100119/prescribed-opioids-overdoses-not-uncommon.
Substance Abuse and Mental Health Services Administration. (2009). Results from the 2008 National Survey on Drug Use and Health: National Findings (Office of Applied Studies, NSDUH Series H-36, HHS Publication No. SMA 09-4434) Rockville, MD.
Summary of Medical Examiner Reports on Oxycodone-related Deaths. Drug Enforcement Agency. http://www.deadiversion.usdoj.gov/drugs_concern/oxycodone/oxycontin7.htm.
Tough P (2001-07-29). “The alchemy of OxyContin”. New York Times. http://www.nytimes.com/2001/07/29/magazine/the-alchemy-of-oxycontin.html.
About the Author John Schinnerer, Ph.D. is in private practice teaching clients the latest ways to turn down the volume on negative emotions such as anger, anxiety and stress. He also helps individuals discover successful, more meaningful lives. His offices are in Danville, California 94526. He graduated from U.C. Berkeley with a Ph.D. in educational psychology. He has been an executive, speaker and coach for over 14 years. John is Founder of Guide To Self, a company that coaches men to happiness and success using the latest in positive psychology. He hosted over 200 episodes of Guide To Self Radio, a daily prime time radio show, in the SF Bay Area. His areas of expertise range from positive psychology, to emotional awareness, to anger management. He wrote the award-winning, Guide To Self: The Beginners Guide To Managing Emotion and Thought, which is available for FREE right now at http://www.GuideToSelf.com. His blog, Shrunken Mind, was recently recognized as one of the top 3 in positive psychology on the web (http://drjohnblog.guidetoself.com ). His new video blog teaches people concrete steps towards managing anger and irritability. (http://drjohnsblog.wordpress.com ).