Oxycontin Is Still A Prescribed Medication

with good reason

“OxyContin, the highly addictive painkiller opioid, is still available in the United States with a prescription. Purdue Pharma. How is it possible?”

It’s possible because the substance itself- oxycodone- is not the problem, per se. The hazard of Oxycontin is the high dosage amounts. This situation is going to require some explanation, and there’s no way around it. I’ll try to be as brief as possible.

First, it needs to be understood that opioids are among the most commonly prescribed pharmaceutical drugs, all over the world. Because nothing else works better for severe pain relief. Medical prescription of opioids will continue to be common and widespread until something that’s equally effective is invented that’s safer and less habit-forming. Every few years someone claims to invent an effective substitute. But, no, not yet. Maybe some day.

The Oxycontin problem got out of hand because an opioid substance, oxycodone, that was already well-known under the trade names of Percodan and Percocet, was made available in dosages that far exceeded the usual amounts of 5mg or 10mg. Oxycontin was most commonly prescribed in 40mg and 80mg amounts.

Oxycodone- Percodan, Percocet, percs- was already a well-known pharma compound, with a public reputation as a mild opioid. But oxycodone is only slightly less powerful than morphine, and what made the effect mild was the low dose amount. Used as directed, 5mg or 10mg of oxycodone will provide pain relief for a moderate-to-borderline severe pain, like a wisdom tooth extraction, without getting to the level of effect that is experienced as an opioid “high.” But once the dose level gets past 15mg, it can feel a little mind-altering, and at 20mg, most users get the first hint of that cheery carefree weightless feeling that makes opioids such an attractive drug effect. And at 40mg, the effect is undeniable for almost any first-time user. Some people don’t like it; some like it more than other people. Most people who use an amount like that have to admit that it feels really relaxing and euphoric. 40mg is also much more than anyone needs for a mild pain condition.

Mild opioid pills are also traditionally formulated along with some type of NSAID pain med, like aspirin or acetaminophen (tylenol.) Usually around 325mg, along with 5mg or 10mg of opioid. There’s a funny tradeoff in the FDA policy that mandates this: the NSAID is supposedly included to help the effect of the opioid, so less is required for pain relief. But the large amount of NSAID also seems to be intended to discourage users from taking more than the prescribed dose, because anyone who takes more than, say, three of the pills is going to be ingesting around 1 gram of aspirin or tylenol, and most people get pretty bad stomach upset from an amount any greater than that. So the logic is that the NSAID ingredient will keep users from trying to get high with the pills. This kinda-sorta works to discourage such experiments, especially for the normal clientele. But confirmed opioid lovers and addicts often don’t care, and will swallow handfuls and put up with the stomach upset and side effect in order to get the high they’re looking for. What the FDA doesn’t seem to view as a serious problem is the fact that someone who uses large amounts of opioid-NSAID pills eventually destroys their liver and their kidneys. If the amount of NSAID is really large, one overdose of NSAIDs can leave someone on a dialysis machine. That’s the tradeoff.

The chicanery of what Purdue and other opioid merchants were doing was in how they justified packing those high doses into one pill, while also avoiding any requirement to add NSAIDs. Doses like 20mg, 40mg, 80mg, and even 160mg were marketed as “time-release formulations” offering “12-hour pain relief.” However, getting an “instant release” was as easy as chewing the pills. And also, the “12-hour relief” turned out to be a bit of an exaggeration, especially for the supposed target patient clientele of people with severe chronic pain.

But what was really bad is that the Purdue/Sackler people took one- 1- medical paper contending that people prescribed opioids for paint relief would not experience addiction from the effects; any side effects--like euphoria--would not be experienced that strongly, and that in the event that they did show up, they’d be easily disregarded and use of Oxycontin would be easily discontinued.

This is actually an accurate conclusion- but only up to a point. I first read much the same contention in a book published much earlier than the study, in 1961- Drugs And The Mind, by Robert S. DeRopp. DeRopp noted that patients hospitalized with severe pain conditions- say, from burns or injuries that required some weeks to heal- were able to tolerate large doses of strong opioids while simply experiencing their effect as pain-relieving rather than euphoric, and even if they had been receiving opioids for many weeks they did not succumb to a craving for opioids. The euphoria property wasn’t anything that they felt particularly attuned to. The crucial difference between people laid up with protracted pain and opioid addicts is that the attention of the hospital patients was directed at healing physically as completely as possible.

Similarly, there are literally millions of Americans with legal prescriptions for opioids prescribed for daily use for their chronic pain conditions. Most of them don’t abuse their medications--they take care to keep their use at threshold, and don’t enjoy the loss of control that comes from overuse. Most Americans who used opioids in the era when they were legal for sale over the counter used them the same way. They used them the way I did when I was prescribed 10mg doses of hydrocodone for excruciating shingles pain; taking enough for pain relief, and no more, in order to maintain the stamina required to function normally, and then discontinuing without issue once the pain was gone.

But the Purdue people took that finding--that people using opioids for pain were able to use them without becoming addicted, even when used for extended periods of time- ramped it up out of context, and used it for a sales pitch, telling doctors that everyone with a twisted ankle or a back sprain could tolerate a 21-day regime of 40mg Oxycontin. to help them “heal completely.” 40mg of Oxycontin packs a serious wallop. And a three week supply is enough to share with friends. And that’s how the trouble started.

I’ve read the book Dopesick, by the way. Read it all in one seven-hour stretch, in fact. And when I finished the book at around 3 am, I stared at the ceiling until daybreak. That book broke my heart. Bad enough that I have no interest in watching the streaming series.

It’s also important to comprehend that the author of the book, Beth Macy, made it plain that User Criminalization only makes these problems worse. I’m not talking about the “drug decriminalization” that was rolled back in Oregon, for a population of addicts up to their ears in a criminal lifestyle, committing so many other offenses against the public order--and themselves--that they’re already too far gone for mere “drug possession decriminalization” to do any good. All of those street addicts were at least partly pushed into that situation by a User Criminalization pariah status that was put on them from the outset. The girl from south Virginia featured as the main character in Dopesick ended up in a dumpster in Las Vegas, beat to death. Have a look at the photo of that girl with her dog, that’s included in the book. Maybe a year before she was first stamped a criminal and thrown away by her own community, because she was “dirty”, and wouldn’t get “clean” fast enough to suit the dictates of the law.