What is Opana?
Opana and Opana ER (extended release) are prescription strength opioid drugs meant to treat symptoms of moderate to severe pain. With the added side effects of euphoria, stress reduction, and overall good feelings, opioid drugs are often abused and misused.
The active chemical in Opana is oxymorphone, which is a Schedule II controlled substance as designated by the Drug Enforcement Administration, or DEA. Schedule II drugs are considered to be high-risk substances for diversion, abuse, and physical dependence. On the street, Opana is called:
- Blue heaven
- Stop signs
- New blues
- Pink heaven
- Pink lady
- The O bomb
- Pink O
Opana may be swallowed in tablet form, chewed, or crushed for snorting or injection when abused. An estimated 20 percent of Americans (aged 12 and older) had abused a prescription drug one or more times in their lives by the year 2014, the National Institute on Drug Abuse (NIDA) published. In 2014, the National Survey on Drug Use and Health (NSDUH) reported that 4.3 million people in the United States were currently abusing prescription painkillers. Opioid drugs are highly addictive, and the American Society of Addiction Medicine (ASAM) reports that around 2.5 million American adults suffered from an opioid use disorder in 2014.
Who Abuses Opana?
The DEA reports that young white adults abuse Opana at the highest rates, and NSDUH supports this, showing that individuals between 18 and 25 abuse prescription pain relievers more than any other age demographic. Opana abuse may have gained popularity, particularly in rural parts of the country, with the reformulation of OxyContin (oxycodone), another prescription opioid drug, Reuters publishes. The makers of OxyContin made it more difficult to abuse by changing its chemical makeup so that it would turn into a kind of goo when crushed for snorting or injecting. As it became more difficult to get the original form of OxyContin, people dependent on opioid drugs may have turned to alternatives: Enter Opana.
The manufacturers of Opana, Endo Pharmaceuticals, answered by reformatting Opana ER in 2012 and adding a new coating to try and prevent it from being crushed, NPR reports. They even petitioned the FDA (US Food and Drug Administration) to try and block generic forms of extended-release oxymorphone drugs from being manufactured to no avail. This new formation of Opana ER may have caused more people to try and inject the drug instead of snorting it, however. Studies published in the journal Pain indicate that while the reformulation of Opana ER may have deterred non-oral abuse (e.g., snorting and injecting the drug) initially, it did not seem to deter this abuse over time.
Opana is often diverted for abuse through robberies, theft, drug trafficking organizations, and forged prescriptions, the DEA publishes. When abused, it can create an intense “high” that recreational drug users may desire. The 2013 NSDUH indicates that over half of the people who misuse prescription medications get them from a friend or relative for no charge.
Additionally, individuals with legitimate prescriptions for Opana may become dependent on the drug and wish to continue taking it after it is no longer deemed medically necessary. People may take Opana in higher doses than intended or after a prescription has run out. Individuals may make up pain symptoms to get the drug or shop around to different doctors to get it. Using a prescription drug like Opana without a necessary prescription is a form of drug abuse.
Possible Ramifications of Opana Abuse
As a potent narcotic, Opana slows respiration levels and cardiovascular functions, as the opioid suppresses the central nervous system. Opioids also impact a person’s emotional regulation, increasing levels of dopamine and other neurotransmitters in the brain, which induce feelings of pleasure. Opioids bind to opioid receptors along the central nervous system, which interferes with the way some of these natural chemical messengers are transported, produced, and reabsorbed.
When someone uses Opana to get “high,” they may seem exuberant, overly happy, relaxed, have impaired reflexes and motor control skills, and slur their speech. Opana interferes with a person’s ability to make sound decisions and lowers inhibitions. Injuries, accidents, or increased risk-taking behaviors may result. A person may engage in questionable sexual encounters or other behaviors that may seem out of character. Loss of appetite, constipation, mood swings, and mental fogginess may also be side effects of Opana use and/or abuse.
Taking Opana by method of injection increases the risks for contracting diseases like hepatitis or HIV/AIDS through the sharing of dirty needles. Collapsed veins, blood infections, and “track marks,” or scarring at the injection site, are also perils of intravenous (IV) drug use. The Centers for Disease Control and Prevention (CDC) reports on several cases of a rare and potentially fatal blood disorder called thrombotic thrombocytopenic purpura (TTP) potentially being caused by IV Opana use after the drug was reformulated.
Snorting Opana can cause damage to the nasal passages and sinus cavities, resulting in a chronic runny nose or nosebleeds as well as possible lung infections. Swallowing the drug may cause higher incidence of gastrointestinal upset or potentially even an intestinal obstruction in some cases. The Drug Abuse Warning Network (DAWN) reports that in 2011, there were over 12,000 visits to emergency departments (EDs) for an adverse reaction to the nonmedical use of oxymorphone. More than 1,000 toxic exposures were reported to the American Association of Poison Control Centers that same year, the DEA publishes.
Risk and Signs of Overdose
Opana, and other opioid drugs, can significantly slow down the rate of a person’s breathing, and Endo Pharmaceuticals warns individuals of the potential for life-threatening respiratory depression when taking Opana. Recreational abuse may lead to a toxic buildup of Opana in a person’s bloodstream that can cause it to become overwhelmed, resulting in overdose. Opioid overdose fatalities are usually due to breathing issues and sometimes cardiovascular breakdown. Mixing another drug or alcohol with Opana can greatly enhance the chance for overdose and dangerous respiratory depression.
Also, if Opana ER is altered, such as by chewing, injecting, or snorting the drug, the extended-release format is bypassed. This results in sending all of the drug’s active chemicals into the bloodstream at once instead of allowing it to be slowly released over a set period of time. Oxymorphone may then overwhelm the body, and overdose may be the consequence. The CDC calls opioid overdose fatalities a serious health concern in the United States, as six out of 10 of the nearly 50,000 drug overdose deaths in 2014 involved an opioid drug.
Opioid, and Opana, overdose includes the following symptoms:
- Severe confusion
- Cold or clammy skin
- Blue tinge to lips, nails, or skin
- Nausea and/or vomiting
- Drop in levels of alertness
- Inability to wake up, extreme drowsiness, or loss of consciousness
- Weak pulse
- Shallow breathing
An overdose on Opana can be potentially life-threatening; therefore, immediate medical care should be sought. Many first responders carry naloxone, an opioid overdose reversal drug.
Opana Dependence and Withdrawal
As Opana interferes with the natural transmission, production, and absorption of some of the brain’s chemical messengers involved in mood regulation, rewards, and motivation, over time, it can actually cause changes to some of the brain’s circuitry. Shortcuts to pleasure are created by administration of the drug, and individuals may struggle to feel pleasure without Opana after an extended period of time using or abusing it. Physically, a person may become tolerant of and then dependent on Opana.
Drug tolerance refers to the necessity to take more of it to feel the same effects each time, and drug dependence means that the brain expects Opana to be present in order to function in certain ways. With physical drug dependence, withdrawal symptoms occur when the drug leaves the body. In short, opioid withdrawal syndrome is almost like the opposite of opioid intoxication. Instead of the good feelings produced by the drug, individuals will feel both physically and emotionally uncomfortable.
According to the journal Practical Pain Management, oxymorphone has a half-life of around 7-9 hours. Opana ER may stay in a person’s system longer than the immediate-release Opana, up to 12 hours. When the drug stops being active in the bloodstream, withdrawal symptoms usually start. The National Library of Medicine (NLM) reports that opioid withdrawal typically begins in about 12 hours after the last dose. Symptoms likely peak within the first day or two, tapering off within about a week. The duration and severity of withdrawal are influenced by how dependent on Opana a person is, environmental factors such as previous episodes of trauma or high levels of stress, genetic and biological factors, and any potential co-occurring disorders. A family history of addiction and drug abuse at a young age can also increase the significance of drug dependence and therefore play a role in opioid withdrawal.
Opioid withdrawal syndrome can be broken down into two main stages: early and late withdrawal. During early withdrawal, individuals may become agitated, irritable, anxious, and suffer from insomnia. Physically, muscle aches, yawning, tearing up, runny nose, and sweating may be side effects of early withdrawal. Late and acute withdrawal may include side effects like joint and back pain, abdominal cramps, nausea and vomiting, diarrhea, dizziness, dilated pupils, blurred vision, dry mouth, headache, chills and goosebumps, irregular blood pressure and heart rate, tremors, mental confusion and trouble concentrating, drug cravings, and depression. The physical symptoms likely abate within a week or so, although the emotional ramifications may continue for longer, especially without proper treatment.
When Opana Abuse and Physical Dependence Become Addiction
A person who uses Opana for medical purposes exactly as prescribed may still become physically dependent on the drug. Drug dependence is not the same thing as addiction. It is, however, a potential sign of addiction. Drug addiction is more than just physical dependence, although the changes made to the brain through chronic drug use certainly play a role in its onset and perpetuation.
Drug addiction is when a person can no longer control the amount of drugs they take or the length of time they take them. They may make many attempts to stop taking Opana and not be successful in doing so.
Physically, weight fluctuations, malnutrition, a decline in personal hygiene and appearance, and signs of IV drug use or insufflation (snorting) may be present. Drug paraphernalia like rubber tubing, shoelaces, syringes, tubes or rolled dollar bills, razorblades, mirrors, and powder residue may be apparent.
Pill bottles may be evident in the trash or in easy-to-access places in a person’s room. People may become increasingly secretive and distant.
Individuals who battle addiction to Opana will likely stop engaging in activities they used to like before; social circles may change; and they may become withdrawn. Relationships and finances may suffer. Increased risk-taking behaviors and a lack of concern over potential consequences of the drug abuse may be common. Mood swings and a total personality shift may occur in someone who suffers from Opana addiction. Sleep schedules may become erratic; a person may eat and sleep at odd times and for longer or shorter than normal.
Medical Detox for Opana Withdrawal
Opana and Opana ER are not to be stopped suddenly even when used as directed, Endo Pharmaceuticals warns. Opioid withdrawal syndrome can be best managed through medical detox, which includes the use of both supportive and pharmacological tools. Highly trained professionals can monitor vital signs and provide a calm, safe, and secure environment for individuals around the clock during detox. Typically, detox lasts between 5-7 days, depending on the needs of the individual and their level of dependence.
Medical detox often uses medications to reduce and minimize withdrawal symptoms. Long-acting opioid agonists like methadone and buprenorphine can fill opioid receptors longer than Opana, thus keeping withdrawal symptoms to a minimum. Individuals can take less of these drugs less often and then slowly reduce the dosage over time through a tapering off schedule until they are drug-free. This should only be done under direct medical supervision.
Buprenorphine is a partial opioid agonist, meaning that it doesn’t activate the receptors in the same way as a full opioid agonist like Opana does; therefore, it shouldn’t produce the same euphoric effects either. Naloxone is regularly added to buprenorphine to create combination products like Zubsolv, Suboxone, and Bunavail for use in treating opioid dependence, the Substance Abuse and Mental Health Services Administration (SAMHSA) reports. Naloxone is an opioid antagonist, which means it blocks the opioid receptors from receiving more of the drugs and thus being activated. The naloxone component in these combination products only becomes active if a person tries to abuse and inject it, or takes another opioid drug at the same time. In this sense, these drugs can act as tools to help prevent relapse and encourage treatment compliance.
Other medications like sleep aids, antidepressants, and gastrointestinal medications may be useful during detox also to target specific symptoms of Opana withdrawal. In medical detox, substance abuse, medical, and mental health professionals all work together to help individuals reach a level of healthy physical balance before continuing on with a drug abuse treatment program.
Treatment for Opana Addiction
Detox is often a necessary first step in treating Opana addiction, as it can help a person become physically stable. It should be followed with either a residential (inpatient) or outpatient treatment program. A full assessment and evaluation can be helpful in determining exactly what the right level of care for each individual may be. Someone who needs flexibility with scheduling due to familial, occupational, or school obligations may desire an outpatient treatment program, for example. Outpatient programs may be best suited to individuals with lower levels of dependency and who have a strong support system surrounding them. Inpatient substance abuse treatment programs usually provide the highest level of care and various amenities and options for services. In an inpatient treatment model, individuals allow their brains time to heal and recover while providing themselves with a respite from everyday life and its potential stressors.
Counseling and behavioral therapy sessions help individuals to work through psychological distress and learn new life skills, anger management techniques, how to better regulate moods, and cope with stress. Cognitive Behavioral Therapy (CBT) is a form of therapy that helps individuals to recognize why they may have started abusing a drug like Opana and how to prevent a return to drug use and other self-destructive behaviors in the future. Self-reliance, communication skills, and self-confidence are enhanced through group, individual, and family therapy sessions.
An inpatient substance abuse program can help individuals to stick to a structured schedule, ensuring that they get enough sleep and eat healthy and balanced meals. Fitness programs and creative therapy outlets may be beneficial in occupying the mind and providing a healthy outlet for stress and other emotions.
Complementary medical techniques may be combined with traditional methods for a full and comprehensive treatment plan that helps to improve a person’s connection to mind, body, and soul, thus enhancing their overall wellbeing and sense of self. Any co-occurring disorders can be managed through integrated care. Brain chemistry can be reset, balance restored, and new healthy habits formed with a complete and individualized substance abuse treatment program.