Oxycontin for the rich, heroin for the poor...

February 2, 2006 8:00 AM

"Well, a lot of people have said DEA is in the dark on these issues, but that is a little bit much." (.doc; long) Despite a power outage, an FDA-lead panel discusses how to manage abuse of the infamous opiod painkiller OxyContin. Purdue Pharma, its sole manufacturer, had tried to bring its more powerful successor Palladone (.pdf) to the market, before "dosage jump" issues lead to the drug being pulled by the FDA. Meanwhile, trucks loaded with $3mil dollars of "oxys" continue to get hijacked for a $15mil street turnover, despite GPS tracking and other high-tech security measures used for cigarette distribution. Doctors invariably shuffle pills sideways despite tamper-proof presciption pads (long). Purdue only stops selling more profitable and addictive double-doses of OxyContin after government pressure. On the level of the street, addicts who find themselves too tolerant to the drug find their needs more than adequately met when they can buy many more hits of heroin for the same cost. Philadelphia-based writer Jeff Deeney outlines some of these fascinating issues and more as he looks into how race, cost, manufacturing and distribution factors in OxyContin abuse invariably drive the addict to cheaper and more easily accessible heroin.
posted by Rothko (72 comments total)

Great post, Alex.
posted by klangklangston at 8:19 AM on February 2, 2006

Just remember never to smoke marijuana. It is a gateway drug.
posted by baphomet at 8:19 AM on February 2, 2006

I enjoyed seeing the "Dittoheads" tag.
posted by alumshubby at 8:23 AM on February 2, 2006

Why is this even a problem? Aside from the activeness OxyContin isn't any more dangerous then aspirin. And if you have chronic pain you're going to be taking pills indefinitely anyway.

OxyContin is probably the least-harmfull drug to be adicted too, IMO.
posted by delmoi at 8:23 AM on February 2, 2006

And yes, this is a fantastic post. This just goes to show that our society and our legal system are completely blind to the actual impact any given drug or chemical has on our society- rather than choosing which drugs to make illegal based on the social implications of its abuse, the people in charge would (predicatably) just rather play pharmeceutical follow the money.
posted by baphomet at 8:24 AM on February 2, 2006

Certanly less harmful then nicotine.
posted by delmoi at 8:24 AM on February 2, 2006

OxyContin is probably the least-harmfull drug to be adicted too, IMO.

Caffeine.
posted by baphomet at 8:25 AM on February 2, 2006

baphomet: what are you talking about? How does the post show that at all?
posted by delmoi at 8:27 AM on February 2, 2006

This is a very good post, Rothko. But why the "Dittoheads" tag? Maybe it's explained by one of the links - I haven't finished reading all of them.
posted by me & my monkey at 8:27 AM on February 2, 2006

baphomet: I meant your first post, not your second. Caffeine is not that addictive, from what I understand. It's hard to tell, though, because it's so abundant -- people have no motivation to stop taking it so it's hard to see how difficult it is to quit.

On the other hand, there are some people who have gone through caffeine withdrawal, people do become dependant on it, and it's not pleasant at all.

Anyway, what I meant was that Oxycontin is probably the least harmful highly addictive drug to be addicted too. You wouldn't want to be addicted to LSD, but that doesn't happen to vary many people (or anyone, as far as I know)
posted by delmoi at 8:30 AM on February 2, 2006

This is a very good post, Rothko. But why the "Dittoheads" tag? Maybe it's explained by one of the links - I haven't finished reading all of them.

Rush limbaugh was an oxycontin "addict" (meaning he had chronic back pain, and the government would prefer he suffer like everyone else with chronic pain, then feel comfortable)
posted by delmoi at 8:31 AM on February 2, 2006

About nine years ago, I had my wisdom teeth removed; pretty routine and uncomplicated. After the surgery, they gave me a prescription for 24 Oxycontin to manage the pain. I think I took two, and then had the rest just sitting around.

So then three years ago, my wife has some pretty invasive surgery, and is in a serious amount of pain afterwards. The doctors prescribe for her a small amount of vicodin. When she tells them that it's not really helping, and asks for something stronger, they say (I'm paraphrasing here) they used to prescribe oxycontin, but they don't anymore because people have been abusing it too much, and you'll just have to make do. I asked a physician friend of mine about this, and he said basically the same thing.

So what the hell does it take to get a legitimate prescription for the stuff anymore? I mean, if doctors won't prescribe it for someone who just had surgery, then why are they still making it?
posted by Gamblor at 8:33 AM on February 2, 2006

Rush limbaugh was an oxycontin "addict" (meaning he had chronic back pain, and the government would prefer he suffer like everyone else with chronic pain, then feel comfortable)

Do you really need to take thousands of Oxys to feel "comfortable"? And, isn't one prescription enough?
posted by wakko at 8:33 AM on February 2, 2006

Delmoi, as far as the long-term physiological affects go, beyond constipation, you are mostly correct that narcotics are less harmful than other drugs.

However, in addition to overdosage by patients not tolerant to opiods, there are serious issues with non-therapeutic (ab)use, addiction and withdrawal, as well as the associated and immense social costs, which all need to be considered with narcotics.

OxyContin is pushed by Purdue's very aggressive sales force, and manufactured in dosages that suggest the drug is safer than it is. Despite its high cost, abuse levels are quite high among affluent users. Once addicts find themselves looking the next hit with an empty pocket, heroin becomes more attractive, increasing the violence and crime associated with that part of the illicit drug trade.

On another level, it is interesting to see a single company make millions of dollars of profit off of what is essentially a morphine derivative, while the FDA and DEA seem to play helpless. In these days of Abramoff and Plamegate, there is a interesting side to the story that suggests corruption at a higher level.
posted by Rothko at 8:34 AM on February 2, 2006

Oxycontin is a huge problem in Maine. And it's not a drug for the rich.
posted by selfnoise at 8:34 AM on February 2, 2006

Rush limbaugh was an oxycontin "addict" (meaning he had chronic back pain, and the government would prefer he suffer like everyone else with chronic pain, then feel comfortable)

Given quantities, it is reasonable to believe Rush Limbaugh appeared to be involved in illegal redistribution of narcotics:

According to the warrants, Limbaugh picked up 1,733 hydrocodone pills, 90 OxyContin pills, 50 Xanax tablets and 40 pills of time-release morphine during that [five month time period].
posted by Rothko at 8:39 AM on February 2, 2006

"He thought that this oxy-whatever must have helped make Rush smarter and he wanted some himself."
posted by alumshubby at 8:40 AM on February 2, 2006

And it's not a drug for the rich.

Hence the "hillbilly" in "hillbilly heroin".
posted by eddydamascene at 8:41 AM on February 2, 2006

baphomet: what are you talking about? How does the post show that at all?

My point is that OC is obviously can be a very harmful drug. People will do illicit and illegal things to obtain it. They develop a dependency on it, then a tolerance to it, then they switch to things that are much more dangerous. Look:

Meanwhile, trucks loaded with $3mil dollars of "oxys" continue to get hijacked for a $15mil street turnover

That's a huge profit turn over, even for a black market. $3 million in weed is not going to turn into $15 million once it hits the street. So criminals are obviously making a ton of money feeding this stuff to the people who are addicted to it.

Furthermore, there are plenty of drugs that could replace OC in the health care industry. They may not be quite as powerful or effective, but at the same time they aren't stolen/defrauded/abused nearly as frequently as OC is.

So lots of people could look at all this data and say, well shit, better off making this stuff illegal, because the harm it's causing society is greater than the help it can provide. And yet, there's so much goddamn money in it for all the big players involved. So you play follow the money. Follow it all the way down from the bottom and who is it going do? Purdue Pharmacy. And what are they doing with it? I wonder.

So really it doesn't matter who is getting screwed over by the stuff as long as Purdue keeps bankrolling politicians.

That was my point.
posted by baphomet at 8:46 AM on February 2, 2006

Follow it all the way down from the bottom and who is it going do? Purdue Pharmacy. And what are they doing with it? I wonder.

Wow, thanks.
posted by Rothko at 8:49 AM on February 2, 2006

No problem. It's good to know that you and I can agree despite the fact that we have some major ideological differences. By the way, did everybody see the four seperate $1000 dollar donations to Rick Santorum? Christopher Shays and Arlen Specter are both apparently popular with Purdue as well. All people who have massive popular followings on MetaFilter as I recall.
posted by baphomet at 8:54 AM on February 2, 2006

Drugs 'r bad, m'kay?
posted by oncogenesis at 8:56 AM on February 2, 2006

This is just one side of the story.

The other, is that thousands of people with serious pain issues are being denied adequate treatment due to the scaremongering that has gone on over Oxycontin, and many, doctors have been wrongfully barred from practice, and even imprisoned for engaging what would be regarded as legitimate medical practice everywhere else besides the USA.

See these for the other side of the story:

http://www.reason.com/0304/fe.ma.the.shtml
http://www.sallysatelmd.com/html/a-nytimes13.html
http://www.immunesupport.com/library/showarticle.cfm/ID/4073/e/1/T/CFIDS_FM/
http://www.painreliefnetwork.org/the_accidental_addict___mar_24__2004.html
posted by PeterMcDermott at 9:08 AM on February 2, 2006

Uh, you guys realizing that people abusing Oxy aren't taking it as prescribed, right? Because a lot of these comments just plain don't make sense otherwise.


OxyContin is probably the least-harmfull drug to be adicted too, IMO.

Please defend this statement. When abused (crushed up and snorted), Oxy is incredibly addictive.
posted by bobot at 9:11 AM on February 2, 2006

Oops. That should have been:

Link 1
Link 2
Link 3
Link 4

In fact, everything on the Pain Relief Network's website is a real eye-opener.
posted by PeterMcDermott at 9:13 AM on February 2, 2006

So lots of people could look at all this data and say, well shit, better off making this stuff illegal, because the harm it's causing society is greater than the help it can provide. And yet, there's so much goddamn money in it for all the big players involved.

If it wasn't illegal or otherwise restricted there would be negligible amounts of money involved. That goes for prescription sales as well.

Given quantities, it is reasonable to believe Rush Limbaugh appeared to be involved in illegal redistribution of narcotics

Very unlikely. These drugs are tolerance forming. It is not at all uncommon for a chronic pain patient (or addict for that matter) to use enormous amounts of opiods. At least on the chronic pain side this is an accepted part of treatment. Does it really make sense for a person who makes as much as he does to be selling pills on the side?
posted by hupp at 9:14 AM on February 2, 2006

OxyContin is probably the least-harmfull drug to be adicted too, IMO.

I have a friend who died of an Oxy-Contin overdose. He was in his mid-thirties, not otherwise a drug or alcohol abuser, otherwise in healthy physical condition. Additionally he left behind two small children.

Where are you getting your "facts" delmoi?
posted by Pollomacho at 9:15 AM on February 2, 2006

Please defend this statement

Presumably, what the original poster was trying to get at is that the only major side-effect of opioid dependence is slight constipation. Provided that you have a legal supply of the drug, you can take it indefinitely in enormous quantities with no adverse effects whatsoever -- provided you can live with the existential problem of physical dependence.
posted by PeterMcDermott at 9:16 AM on February 2, 2006

Does it really make sense for a person who makes as much as he does to be selling pills on the side?

Presumably redistribution of unused drugs by someone less likely to be targeted by law enforcement due to his political views assures a constant supply.
posted by Rothko at 9:17 AM on February 2, 2006

PeterMcDermott, that's exactly the situation I was describing above. My wife was denied the pain medication she needed for short-term recovery from surgery because, I suspect, the doctors didn't want the scrutiny. Incredibly frustrating.
posted by Gamblor at 9:19 AM on February 2, 2006

Palladone, Palladone, where do you roam?
posted by IndigoJones at 9:23 AM on February 2, 2006

I suspect, the doctors didn't want the scrutiny

That's why I think that the Pain Relief Network is so important. Imagine how it must be to have a real problem with chronic pain, pain that lasts for years and years and years, only to be denied adequate treatment simply because your doctor is frightened of coming to the DEA's attention just for prescribing this stuff.

And it's just not true for Rothko to say that the DEA have been doing nothing. If the Pain Relief Network are to be believed, then DEA agents have been going around the USA, targetting doctors that they feel prescribe more than some arbitrary but unspecified level of this drug, using tools like bribery, entrapment and fear to do so.

Personally, I think the situation is barbaric.
posted by PeterMcDermott at 9:29 AM on February 2, 2006

Explains how Rush lost the weight.
posted by Smedleyman at 9:36 AM on February 2, 2006

Prisoner Of Pain
posted by homunculus at 9:42 AM on February 2, 2006

An excellent post. The cycle between pharma-doctors-addicts-DEA is nuts. There are all kinds of costs to drug addiction, a study here in Baltimore estimates the yearly cost of each heroin addict, of which we have a plethora, as rouns 500k, when everything from lost wages to ER healthcare to theft to police salaries are factored in. There's no reason that OC should be any different. delmoi's assertion about safety is specious in the American context where there is no legal use of opiods except for pain management. OC may not harm your body, per se, but the other harms are so great as to make it very pernicious indeed.

It's been true for a long time, even pre-OC scare, that pain is not managed well in the US precisely because the DEA threatens doctors who follow what is elsewhere considered accepted medical practice. It's more than a shame, it's a tragedy.
posted by OmieWise at 9:43 AM on February 2, 2006

Presumably redistribution of unused drugs by someone less likely to be targeted by law enforcement due to his political views assures a constant supply.

If your motivation was to obtain a constant supply doesn't it seem counterproductive to sell the same drugs you were using? It's not like they reproduce and multiply when spread around.
posted by hupp at 9:46 AM on February 2, 2006

That's a huge profit turn over, even for a black market. $3 million in weed is not going to turn into $15 million once it hits the street.

That doesn't seem right to me. Consider plants raised in the Sequoia National Forest by Mexican drug cartels. Street value is estimated at $3000/plant. Production costs are pretty much limited to pesticides, fertilizers, plastic hoses -- upper bound at market cost for a dozen ears of corn. Paying two armed guards a living wage costs about $1/plant. Transportation costs are close to negligable. You could have 10% yield and let distributors take a 90% cut, and you still get 5x profit.
posted by eddydamascene at 9:47 AM on February 2, 2006

I rather think that you're falling into the trap of pharmacological determinism though, OmieWise. In my experience, it isn't drugs that make addicts so much as those with addictive traits who seek out addictive drugs.

Take away the Oxycontin and there's no shortage of other opioids for those people to gorge themselves upon, and quite frankly, I'd much rather they were using safe, legal doses of opioids than most of the other serious drugs of dependence such as alcohol, crack cocaine, etc. etc.
posted by PeterMcDermott at 9:52 AM on February 2, 2006

In my experience, it isn't drugs that make addicts so much as those with addictive traits who seek out addictive drugs.

Well, yes and no. People make bad choices about drug use, and about a lot of other things. Some might be attributable to addictive traits. One problem I see with OC is that it is more easily viewed as safer and less problematic than heroin. When it comes all pretty looking, like a pill from a bottle, rather than a pill from a glassene baggy, it is easier to convince yourself it isn't so bad to take it. In other words, I do see OC as a gateway drug. Most addicts, by far, are not born addicted to their drug of choice.

I don't mean to be determinist, just to point out that you can only call OC less harmful if its divorced from its context. It may be relatively healthy for a Park Avenue user, but it comes with heavy costs to anyone who cannot afford to spend unlimited money to procure it. And don't forget that part of that context is also the throttling of doctors who prescribe pain pills.
posted by OmieWise at 10:04 AM on February 2, 2006

Having been on OxyContin for 3 years now, I totally understand the frustration Gamblor feels...regular doctors *are* afraid to prescribe it, which is why you need to goto a doctor specializing in Pain Management. Even then, a lot of them (who have never experienced serious/chronic pain themselves) are loath to prescribe OC for fear of DEA retribution.

Without OC, I would not be able to be sitting here typing right now...I would be stuck in bed unable to move at all (even the slightest bit). I have been prescribed every pain medication there is, and nothing is as effective as OC combined with Instant Release opioids (percoset) for breakthrough pain.

One alternative I see mentioned in a lot of these articles is MSContin, that is, Morphine Sulphate, something thats been around for *hundreds* of years...this is a *terrible* drug, since the sulphate breakdown products can cause severe allergic reactions (like it did for me) and for someone not allergic is still unhealthy. This is why OC was such a breakthrough in pain medication, it is a pure opiate with a very kind binding/time release agent.

Its a real shame that OC has gotten such a bad rap...again as many have pointed out, there are very few people that die solely on OxyContin...they have usually not taken it properly (swallow whole, do not crush/snort/chew) and have taken other drugs with it. If OC were taken off the market, I would have to be hospitalized to get the proper medication to allow me to not be passing out from pain every 15 minutes.
posted by gren at 10:05 AM on February 2, 2006 [1 favorite]

It's been true for a long time, even pre-OC scare, that pain is not managed well in the US precisely because the DEA threatens doctors who follow what is elsewhere considered accepted medical practice. It's more than a shame, it's a tragedy.

I agree, it's messed up on several levels. Agencies like the DEA benefit from the illegality of this drug, from increased government funding, to increased jurisdiction over legitimate commercial trade, to property seizures. Congressmen receive payoffs from Purdue for allowing its continued sale. Dealers benefit from the higher revenue it generates. The FDA seems incapable of addressing pain management as a medical issue. It's a very multilayered and complex issue.
posted by Rothko at 10:11 AM on February 2, 2006

One quick note: a lot of people here don't realize that an OxyContin pill on its own is NOT something an addict or experimentor would take. OxyContin is a 12 hour time release medication.

For people to get high off of OC, it must be non-generic (I'll tell you why later) and it must be ground into a fine powder, which can be snorted or swallowed. Then you will get the full dose all at once, rather than its intended 12 hour style.

Many generic forms of OxyContin have come up with ways to stop people from crushing it...some use silicon as a binder so they are rock hard and shatter, not turning into powder. Others have mixed in a compound that turns to gel on contact with water, again defeating any abuse attempts. Some have mixed Naloxone in with the binding agent...so if the pill is crushed, the Naloxone blocks the opiate receptors, thus defeating the purpose of crushing it in the first place.

Percoset is an Instant Release form of the same drug in OxyContin, Oxycodone, and is far easier to abuse (Cold Water Seperation will remove all the APAP) and more widely available than OxyContin, yet you don't hear about the problems it causes...
posted by gren at 10:18 AM on February 2, 2006 [1 favorite]

Paging Ikkyu2.
posted by moonbird at 10:25 AM on February 2, 2006

OK, all very fair points OmieWise. I withdraw my allegation of Pharmacological Determinism.
posted by PeterMcDermott at 10:32 AM on February 2, 2006

"...OxyContin isn't any more dangerous then aspirin. And if you have chronic pain you're going to be taking pills indefinitely anyway."

Indefinitely, perhaps. But which meds are appropriate to take long term is a vital question due to the long term effects (stomach bleeding, just one among the many) of many meds.

It irks me to see so many (including the dentist who gave my 11 year old a RX for Vicodin in quantities large enough to get Rush-does he have any liver left-Limbaugh high) accepting that drugs like this, and the very, very commonly prescribed Demerol, can be taken in great quantities (I was given 80 of them after abdominal surgery, even though my pain was manageable with Tylenol) and are no more harmful than aspirin. Next time your dentist gives your Demerol, because it's cheap so people often prefer it (and it gets you really stoned), Google Normeperedine Toxicity (twitch for life!), something the pharmacist rarely mentions or even seems to know about (I had to ask 3). Nearly all RX meds, including Tylenol, Aspirin, etc. can have possible harmful effects, many can accumulate in your system, and different folks process and flush out these drugs at different rates. It shocks me that so many believe that these sort of drugs are "no more harmful than aspirin."
posted by onegreeneye at 10:32 AM on February 2, 2006

Correction: It should say above, nearly all meds, not nearly all RX meds.

Also, good grief to those touting Oxycontin as harmless. Google Oxycontin and "Live Damage."

Great med for pain, but not without dangers by any means.
posted by onegreeneye at 10:43 AM on February 2, 2006

"LIVER damage." I'll quit now while the typo demon has me in its grasp.
posted by onegreeneye at 10:45 AM on February 2, 2006

One quick note: a lot of people here don't realize that an OxyContin pill on its own is NOT something an addict or experimentor would take. OxyContin is a 12 hour time release medication. For people to get high off of OC, it must be non-generic (I'll tell you why later) and it must be ground into a fine powder, which can be snorted or swallowed. Then you will get the full dose all at once, rather than its intended 12 hour style.

You're obviously never scraped resin out of your bowl.

You can get nice and high by tripling the dose. Washing it down with a half bottle of Jack Daniels works nicely too.
posted by three blind mice at 10:50 AM on February 2, 2006

Oh, and outstanding post Rothko.
posted by three blind mice at 10:51 AM on February 2, 2006

LIVER damage.

Yeah, from the asprin -- not the opioid.
posted by PeterMcDermott at 10:52 AM on February 2, 2006

Also, good grief to those touting Oxycontin as harmless. Google Oxycontin and "Liver Damage."

I'm not finding any sources that say Oxycontin causes liver damage. Have a source?
posted by Sirius at 11:26 AM on February 2, 2006

There is nothing at the FDA website linked to by Rothko that indicates that OC has any component (like the Tylenonl in Vicodin) that would damage the liver.
posted by OmieWise at 11:33 AM on February 2, 2006

this is a fascinating discussion - there's a lot to Oxycontin that I didn't know about. Great post!
posted by rks404 at 12:02 PM on February 2, 2006

"Oxycontin is a huge problem in Maine. And it's not a drug for the rich."

I'll vouch for that. I went to high school there (way Downeast), many years ago, and my youngest siblings went to the same school recently. Apparently a very large number of their classmates were grinding up Oxys and snorting them. One of my former classmates is an RN at the local hospital, and she told me about dozens of people from the town (not just kids) having bad reactions, overdosing, needing rehab; they had to build a new rehab wing just to handle it. This is a town of only about 2,000 people, with about 200 kids in the high school, which handles several surrounding (much smaller) towns as well.

And to follow the heroin angle of the story, my former stepdad (my sib's father) is now in state prison for possessing a very large amount of heroin with intent to distribute in that same little town. Obviously the Oxy addicts did the switch.

What a mess.
posted by zoogleplex at 12:11 PM on February 2, 2006

You can get nice and high by tripling the dose. Washing it down with a half bottle of Jack Daniels works nicely too.

Forgive my ignorance, but I always thought mixing opioids and alcohol to that level led to so much relaxation that you can forget to breath and your heart can stop beating. It happened (fatally) to the brother of an acquaintance of mine on the methadone program, I don't know how much alcohol was involved but I heard not fantastic amounts. Is this only particular opioids or is it generally the case?
posted by Sparx at 12:53 PM on February 2, 2006

Drugs are good for me. I don't know what's wrong with the rest of you.
posted by zerolives at 12:53 PM on February 2, 2006

Sparx, all opiods are CNS depressants and they all will reduce respiration rates. Combining opiates with alcohol (another CNS depressant) produces a synergistic effect that can cause death with surprisingly small quantities. Bottom line, do what feels good but don't mix opiates with alcohol!
posted by krash2fast at 1:23 PM on February 2, 2006

Thanks, krash2fest. I suspected as much.
posted by Sparx at 1:33 PM on February 2, 2006

*krash2fest = krash2fast. Sorry 'bout that, cheif.
posted by Sparx at 1:36 PM on February 2, 2006

*cheif = chi...of fuggedaboutit
posted by Sparx at 1:37 PM on February 2, 2006

three blind mice writes "You can get nice and high by tripling the dose. Washing it down with a half bottle of Jack Daniels works nicely too.
Sparx writes "Forgive my ignorance, but I always thought mixing opioids and alcohol to that level led to so much relaxation that you can forget to breath and your heart can stop beating. It happened (fatally) to the brother of an acquaintance of mine on the methadone program, I don't know how much alcohol was involved but I heard not fantastic amounts. Is this only particular opioids or is it generally the case?"
An overdose on opioids alone kills you by that method...that is, you don't forget to breath, your muscles are just so relaxed to the point where involuntary bodily functions stop (if someone that hasn't taken opiates before took my daily dose, they would die without immeadiate medical attention). Adding another depressant like alcohol will serve to speed up that process...like 90some% of all OxyContin overdoses, there is something other than OC involved.

To three blind mice; Even if you triple the dose of OC, taking it in the normal manner of swallowing uncrushed pills, you will still not get a buzz if you are a daily opiate user...adding alcohol will of course get you high, but there are plenty of other safer ways of getting a buzz on. Beyond which, people like me that take OC daily are *very* strict in our dosages...taking more means you will run out, which is a very bad thing. If you are getting legit OC scrips, they are not the only pills you get...you will get pills for Breakthrough Pain, among other things depending on your condition (like all the skeletal muscle relaxers I get for the spasms in my back). Personally, I also get Percoset, Valium, Phenergan, naproxen and Soma. If I wanted to get a buzz going, I would dip into those (less the naproxen) for extra rather than the OC. Even then, with the level of pain I live with, it would take far more pills than I have available to get high...pain is a very effective blocker of the 'high' qualities these medications can give to normal people.
posted by gren at 1:47 PM on February 2, 2006

It's incredibly hard to overdose on opioids, gren has it right on. Where the lethal overdose of alcohol is something like twice the amount it takes to get you wasted, it takes five to six times the amount for a non-addict to go from recreational use to being dead.

And yes, T3, Vicodin and Percocet (Percoset?) all have a better recreational buzz and higher prescription numbers. In fact I believe Percocet has Oxycodone with APAP as oppose to just plain oxycodone HCl in Oxycontin. So it's the same drug in extended release form. It's just a much less socially-acceptable way of getting high (snorting, injecting) than just popping a pill.

And gren's medicine cabinet has a street value of several grand apparently.
posted by geoff. at 1:56 PM on February 2, 2006

Also, good grief to those touting Oxycontin as harmless. Google Oxycontin and "Liver Damage."

Abusing percocet causes liver damage, not oxycontin. This is because of acetominophen toxicity. If you take your own advice, this seems abundandly clear.

The lack of chronic pain treatment, and general insensitivity to chronic pain in the US is scandalous. In Britain, where the regulations are written by doctors instead of ignorant cops, paracetamol can't be sold except in small size blister packs, due to its hepatatoxicity, and diamorphine is actually given to the terminally ill and those in severe chronic pain. Does this mean that those people are are addicted to heroin, well, yes. Does it mean they are in any way comperable to Renton, Sick Boy, et al? Of course not.

The context in which a drug is used has as much relevance as the drug itself. This is indisputable medical fact when it comes to opioids. The body metabolises these drugs differently when you are in pain. You are still addicted and develop a huge tolerance, but it is not the stupifying euphoric the junkies enjoy. It enables lucidity, rather than preventing it. These drugs give people who are dying or in chronic pain dignity and the ability to live their lives. Demonizing these drugs carries the

I suspect a lot of the moral panic over OxyContin and opioids in general in the US stems from the old barbarism that "pain is weakness leaving the body". I regularly hear people express the opinion that chemical pain control is a form of moral weakness. It disgusts me.
posted by [expletive deleted] at 2:11 PM on February 2, 2006

Beyond which, people like me that take OC daily are *very* strict in our dosages...taking more means you will run out, which is a very bad thing. If you are getting legit OC scrips, they are not the only pills you get..

Of course gren. You're not a junkie, probably never have been, and probably never will be.

Abuse and use are two different worlds. Quaaludes were widely perscribed in the 70s. The Zoloft of its time. Lots of people benefitted, but even more abused the hell out of them. Lovely biscuits those 714's. Then the DEA made Rorer and Lemmon pull them.
posted by three blind mice at 2:14 PM on February 2, 2006

Oh, and am I the only person who thinks that putting acetaminophen in percocet to dissuade abuse is like putting a little bit of arsenic in alcohol to deter excessive drinking?
posted by [expletive deleted] at 2:18 PM on February 2, 2006

"all opioids may induce or aggravate seizures in some clinical settings." Yikes.

And "Once absorbed, oxycodone is distributed to skeletal muscle, liver, intestinal tract, lungs, spleen, and brain."

http://www.fda.gov/cder/foi/label/2001/20553s022lbl.htm

I stand corrected, it doesn't say that once in the liver it can accummulate and damage the organ function, as with Normeperedine Toxicity. It'd be interesting to know what the info is on that if any.

I certainly wasn't implying that pain shouldn't be managed. My mother shocks the crap out of herself with a TENS unit, burning herself trying to get pain relief now that morphine doesn't work well for her anymore. I meant only that it's a rare medication that is completely harmless, carrying no risk of ill effects from prolonged use or accumulation in the body.

I found pain managed in a much more sane manner in the UK and France, however, the folks I knew there spent months waiting to see a doc to get going on that management. Even in London. Ugh.
posted by onegreeneye at 2:36 PM on February 2, 2006

Onegreeneye, meperidine is a synthetic opioid, and oxycodone is a true opiate. While they are both powerful mu-opioid agonists, they are structurally dissimilar. Compare the structure of meperidine and oxycodone. They are vastly different molecules and will have completely different metabolites. This is why normeperidine causes liver toxicity, yet oxycodone metabolites don't.
posted by [expletive deleted] at 3:14 PM on February 2, 2006

[expletive deleted] Thanks for that. Meperidine seems to be (at least where I live) doled out like mad, and folks (nursing staff and pharmacists alike) seem, surprisingly, to have to really do their homework to learn about the possible and easy to achieve toxicity.

This is an interesting thread - some of the links state that women metabolize these substances more slowly than men. Again, I'd be interested to know what effect that has when you get into higher and higher doses of oxycodone, and how the gender issue is accounted for in prescribing. Interesting stuff.
posted by onegreeneye at 5:14 PM on February 2, 2006

[expletive deleted] writes "Oh, and am I the only person who thinks that putting acetaminophen in percocet to dissuade abuse is like putting a little bit of arsenic in alcohol to deter excessive drinking?"

No, I think it is criminal as well...DEA horse poo and human stupidity 'if we mix APAP in the pills, people that abuse it will die early from liver failure/tylenol poisoning'...go go War on Drugs :|
posted by gren at 8:37 PM on February 2, 2006

The body metabolises these drugs differently when you are in pain. You are still addicted and develop a huge tolerance, but it is not the stupifying euphoric the junkies enjoy.

Nitpick:

It's misleading to describe this state as addiction. You may be physically dependent in the sense that you'll develop a tolerance to the drug, and may experience physical withdrawal on cessation (though if I recall correctly, the research shows that very few genuine pain patients actually experience withdrawal.)

Most of the definitions of addiction (DSM IV, WHO, etc.) include things drug seeking behaviour, obsessive concern with the drug, negative consequences, etc. and these are rarely present in pain patients being prescribed opiates -- even long term and on high doses.

It enables lucidity, rather than preventing it.

Hard as it may seem to believe, I've known many 'proper' heroin addicts on long-term maintenance scripts (for methadone, heroin or other opioids) who say the exactly same thing about their own opioid use.
posted by PeterMcDermott at 12:27 AM on February 3, 2006

PeterMcDermott : "Most of the definitions of addiction (DSM IV, WHO, etc.) include things drug seeking behaviour, obsessive concern with the drug, negative consequences, etc. and these are rarely present in pain patients being prescribed opiates -- even long term and on high doses. "

That definition is bullshit and self-serving since if you're getting the drug legally, there's not much reason to be worried about seeking drugs or the risk of arrest or purity/ODs. I think the key test is would they exhibit these symptoms if, one day *poof*, access and price was as hard as for the street addicts? If so, then yes. After all, the way one realizes about addiction is by withholding the object of addiction.
posted by Gyan at 4:06 AM on February 3, 2006

Though if I recall correctly, the research shows that very few genuine pain patients actually experience withdrawal.

Really? Is there a link for research on that? My mom has chronic pain (using a TENS unit now) and when she decided she'd had enough of the cost of morphine, and went off it cold turkey, we had to call an ambulance for what the 911 folks thought were signs of all sorts of things. Turned out it was drug withdrawl. Coworker with FM, same thing. Neither was getting high, or even relief any more, from being on the meds so long (hence the desire to stop paying for them) but did indeed have withdrawls - which in old people can be seriously scary: Sweating, chills, severe twitching and muscle spasms that produce weird kicking motions, cramps, vomiting, diarrhea, big drop in blood pressure, heart rate changes, etc.
posted by onegreeneye at 11:14 AM on February 3, 2006