Did you know that Opana (Oxymorphone) belongs to one of the many opioid drugs that are involved in the opioid epidemic that has taken over the US due to which Food and Drug Administration (FDA) asked to take this drug down from the market in 2017? There has been an upsurge in the cases of people especially from the age group of 18-25 years, using prescription medications such as Opana, for recreational purposes and while this trend is upsetting, there have been certain rules and regulations that have come to practice to counter this rise.

Let’s bring the fact into light about how Opana became one of the most abused prescription drugs. Back in 2010, Oxycontin (Oxycodone), an opioid medication, was reformulated into a substance that was difficult to crush, snort, and inject making it hard to consume for people who were using it to get ‘high’. Nonetheless, people shifted to Opana as an alternate realizing that it promises the same ecstatic effect as Oxycontin, and very soon Opana was topping the charts as the most frequently abused prescription medicine.

White pills with a green background.

Oxymorphone is the generic name for Opana which is a drug that belongs to the Opioid class of medicine. Opana is a semi-synthetic opioid. Opioids are substances that act on opioid receptors in the body and produce a morphine-like effect by alleviating moderate to severe pain. Opioids are referred to as narcotics which means the drugs that produce pain relief (analgesia), stupor, and sleep (narcosis), and cause addiction. Opioids are prescribed when other pain medications have failed.

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Drug Enforcement Administration (DEA) has categorized Opana as a Schedule II drug. Schedule II drugs, substances, and chemicals are compounds with a high potential for abuse, leading to physical and psychological dependence with increased use of the drug. Consequently, these drugs are very hazardous to health if used in excess or abused. 

Oxymorphone comes in two forms:

  • Immediate-release formulation- 5mg and 10mg tablets
  • Extended-Release (ER) formulation- 5mg, 7.5mg, 10mg, 15g, 20mg, 30mg, and 40mg tablets

Immediate-release tablets are used to manage acute pain of moderate to severe nature that is not responding to other medications. The tablets are taken orally after every 4 to 6 hours for effective pain management.

Extended-Release (ER) tablets are indicated for the treatment of chronic pain. If you have ongoing pain that is quite severe and is not relieved by any other medicine as is the case in pain due to cancer, so your doctor will give you Extended-Release (ER) tablets of Opana that are sometimes combined with other analgesics, for instance, Ibuprofen, and Acetaminophen for maximum pain relief. Your doctor will start with the lowest dose of Opana. However, he may increase the dose as tolerance develops and the desired therapeutic effect is not maintained with the earlier prescribed dose. 

It is advised that all around the clock pain medication should be stopped while using Opana. 

Furthermore, Oxymorphon should not be taken with food. It should be taken 1 hour before or 2 hours after a meal. It is best to take the drug at the same time each day. You should swallow the tablet as a whole and avoid crushing, chewing, or dissolving it. It is strictly prohibited to break your Opana pill to inhale the powder or mix it with any liquid to inject it into your body as it can simply result in death.

Opana is an opioid agonist which means that it exerts its effect by interacting with the opioid receptors present in the central nervous system and other parts of your body such as the gastrointestinal tract and urinary bladder. Opana acts by impeding the neuronal firing and transmitter release at the synapses which are meant to carry pain signals.

A synapse is a junction between two neurons (nerve cells) that transfer the signals whatever it may be. In this case, pain signals are transmitted across the synapse. Opana and other opioids act by blocking the transfer of pain signals from one neuron to another thus producing an analgesic effect without the patient losing consciousness. Patients treated with Opana and other opioids are still aware of the presence of pain, but the sensation is not unpleasant. 

Furthermore, Oxymorphone along with other opioids produces a powerful sense of contentment and well-being. This euphoria is caused by the disinhibition of dopamine-containing neurons which means that the release of dopamine is unhindered. Normally, dopamine is taken up by the neurons after its release but this uptake is blocked by the action of Opana and other opioids making dopamine stay longer in the bloodstream, thus creating a rewarding effect for a prolonged duration. This attribute has led to the use of Opana as a drug of abuse to achieve ecstasy not realizing that its misuse can be fatal.

Similar to other opioids, Opana is highly addictive and is habit-forming if used for a long time even for medicinal purposes as in pain relief.

Owing to its analgesic and euphoric property, Opana is greatly abused and is used mostly by 18 to 25-year-old individuals for recreational purposes as mentioned earlier. According to the Center for Disease Control (CDC), in 2014, 14,000 Americans lost their lives due to the overuse of the prescription drug, Opana. 

Opana which comes in an octagon-shaped tablet is crushed, sniffed, and snorted for recreation. It is known in the streets with other popular names such as:

  • Stop signs
  • Mrs. O
  • Octagon
  • New blues
  • Pink lady
  • The O bomb
  • Pink heaven
  • Oranges 
  • OM

Opana addiction is widespread since oral Oxymorphone is three times more potent than oral Morphine due to the heightened dopamine release creating an intense feeling of happiness and reward. When you start taking Opana whether for medicinal or recreational purposes you develop tolerance and dependence on the drug. Developing tolerance means that you will require a higher dose of the drug to achieve a therapeutic effect for pain relief or recreational purposes and the previous dose will not be effective any longer. 

Moreover, abuse of Opana leads to physical and psychological dependence to such a height that a person is incapable of performing routine tasks without taking the drug. 

There are several reasons for Opana’s addiction. Firstly, its availability as a prescription medicine makes people presume that it is not illicit to use even when they are abusing it. In 2012, 1.2 million Oxymorphone prescriptions were given for the treatment of pain as reported by the Drug Enforcement Administration (DEA). Unfortunately, people develop a habit of using Opana more than the given dose and longer than the prescribed time as they develop tolerance to the drug and they remain unaware of the fact that they have become dependent on the drug. As soon as they stop taking Opana, they experience withdrawal effects which leads them to continue taking the drug long after their pain has resolved. 

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Secondly, Oxymorphone addiction is quite prevalent because of the feeling of reward and bliss that a person attains after using it. People who are facing unpleasant life scenarios such as going through huge financial crises, job loss, bad grades, failing school or college, or anything that makes them want to take a break from life are at a higher risk of drug abuse and that is when Opana comes to the rescue. Opana due to its action of releasing dopamine from the neurons creates a shortcut in the brain reward system, leading to a feeling of ecstasy and people tend to forget all their worries. This feeling of lightheadedness makes them want to use the drug repeatedly and it’s no surprise that they become addicted to Opana.

Moreover, the Extended-Release (ER) formulation of Opana releases the drug over a delayed period in the bloodstream requiring administration once or twice a day. This feature of Oxymorphone suits people who use it for recreational purposes as they crush and sniff the pill. Some addicts even crush the Opana pill and mix it in a liquid to inject it into their vein and this route of administration of Oxymorphone is ten times more potent than morphine, thus the feeling of euphoria intensifies many folds. 

Oxymorphone abuse results in an altered personality. You can easily recognize such people in your circle who have become addicted to Opana as the sign and symptoms are quite clear.

Signs and symptoms of Oxymorphon abuse include physical, psychological, and behavioral alterations and they may be as follows:

  • Physical: They may feel drowsy, sleepy, and may have flushed skin. The most characteristic feature of Opana abuse is ‘pinpoint’ pupil because opioid abuse is the only case where the person may have pinpoint pupils whereas, in alcohol and other drug abuse the person will have ‘dilated’ pupil. 
  • Psychological: People who are abusing Oxymorphone tend to be more distracted, less focused during work or studies. They will experience anxiety and depression if they do not get the drug. They are often in an unexplained state of ecstasy and a false sense of well-being. People who abuse Opana are known to hallucinate and experience frequent mood swings.
  • Behavioral: They do not interact with family, friends, and co-workers. They will begin to isolate themselves and you will notice a loss of interest in the activities that earlier used to excite them. Most of their time would be spent in arranging the drug, using it, and after the effect of the drug wears off they will face the withdrawal effects which will push them to take more drugs. For seeking Oxymorphone, they go to many doctors to get themselves Opana prescription and even use illegal means to get hold of the drug. They start socializing with people who are also Opana addicts so that their supply of Oxymorphone remains uninterrupted and this leads to a vicious cycle of drug abuse.

There are a plethora of side effects linked with Opana addiction. Some of them are as follows:

  • Change in the threshold of pain
  • Anxiety, depression, or unease
  • Sedation
  • Nausea and vomiting
  • Hormonal imbalances
  • Hallucinations
  • Paranoia
  • Delusions 
  • Worsening of mental condition
  • Sexual dysfunction
  • Impotence
  • Impaired immune system
  • Loss of consciousness and coma
  • Many drug abusers who use injections are at the risk of getting HIV, Hepatitis C, and thrombotic microangiopathy.

Short term side effects of Oxymorphone Addiction

Being a narcotic drug with a potential for addiction, Oxymorphone has its fair share of side effects one of which is drug dependence, and the risk of overdose. Opana addiction affects not just the brain, but the overall health of an individual. 

However, these side effects depend on the amount of drug a person consumes regularly, his previous drug abuse history, his health status, and age among other factors. 

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Following are some of the short time side effects of Opana:

  • sudden unexplained weight loss 
  • decreased appetite
  • nausea and vomiting
  • dry mouth
  • increased sweating
  • increased heart rate
  • reddening of eyes
  • flushing
  • itching
  • headaches

Long-term side effects of Oxymorphone Abuse

When a person is abusing Oxymorphone for a long duration of time some deleterious consequences come into view. This happens when a person develops tolerance and dependence on Opana and continues taking increased doses of the drug over a prolonged period. As a result, such people face liver, kidney, heart, and respiratory problems along with other medical complications. 

Some of the long-term side effects of Oxymorphone addiction are listed below:

  • Disorders of the gastrointestinal system
  • Blood infection
  • Impaired immune system
  • Sexual dysfunction 
  • Impotence
  • Fertility problems
  • Liver damage
  • Kidney problems
  • Hormonal imbalances
  • Skin abscesses

The half-life of Opana ranges from 9 to 11 hours which means the time taken for the drug dose to reduce to half is 9 to 11 hours. Moreover, Oxymorphone requires at least 5 half-lives to be eliminated from your system that roughly equates to 45 to 55 hours. It is important to know the half-life of Oxymorphone to be aware of the several other drug interactions that are also central nervous system depressants and to avoid using them concomitantly with Opana. 

However, some points that you need to know is that the time needed for the elimination of Opana varies from individual to individual based on many factors, such as:

  • Age: Younger people eliminate the drug at a faster rate as compared to older adults.
  • Health: People who are healthy with maximum functioning of kidneys and liver, tend to eliminate the drug at a faster rate as compared to people who are combating with a diseased liver or kidney as these two are the principal organs of metabolism and elimination of a drug respectively. 
  • Metabolism: Those who have a faster metabolism quickly remove Opana from their system in comparison to those with a slower metabolism.
  • Hydration status: Like most drugs, Oxymorphone too is eliminated by the kidneys through urine, so a person who stays well hydrated removes the drug at a faster rate compared to the one who is not.
  • Duration of the drug usage: People who are consuming Opana for a long time, tend to hold the drug for a prolonged period in their bodies. While people who have been using the drug less frequently remove Oxymorphone at a quicker rate. 

How long does Opana stay in your urine?

Since the drug Opana is eliminated from the kidneys through urine so it’s not surprising that a urine test is the most frequently used method for drug screening. Oxymorphone stays in the urine for 2 to 4 days since the last dose and it takes almost 5 days for the metabolites to be completely excreted by the body, and to not show up in the urine test.

Fact: Did you know that Opana can be detected in a hair test, for about 90 days after its last dose?

When someone using Opana over a long period such that he developed dependence and tolerance to it, stops using it, is referred to as Opana withdrawal. It is said that you should not go cold turkey when you want to withdraw from Oxymorphone as withdrawal effects can be quite serious and it is suggested that you slowly taper off the drug dose before stopping completely.

Symptoms of Oxymorphone Withdrawal

Oxymorphone withdrawal symptoms can begin as soon as few hours after taking the drug but mostly it takes 14 to 18 hours after the last dose and peaks after two days.

The early features of Oxymorphone withdrawal present as common flu, with generalized body aches, feeling lethargic, anxious, and agitated. Cravings for drugs set in along with nausea, vomiting, and chills.

Following are the symptoms of Oxymorphone withdrawal that results when the brain is adapting to regulate the body without the drug:

  • extreme cravings
  • sweating
  • watering eyes
  • runny nose
  • chills
  • joint pain
  • diarrhea, nausea, and vomiting
  • disturbed sleep 
  • high blood pressure
  • changes in heart rate
  • changes in breathing rate
  • restless and agitated behavior
  • intention of suicide

Tell your doctor right away if you experience any of the above-mentioned withdrawal symptoms for better management of your condition.

Opana withdrawal timeline

Opana withdrawal timeline refers to the period over which the symptoms of withdrawal are stretched. It progresses through two distinct phases that are as follows:

  • Early withdrawal phase: This begins a few hours after the last dose and peaks in 2 days. A person going through this stage might feel agitated, restless and will mimic symptoms of common flu with chills, runny nose, and lethargy. He will face extreme cravings for the drug that may make him nauseated. These withdrawal effects may wear off in a week.
  • Late withdrawal phase: This stage is mostly linked to psychological alterations such as staying anxious and feeling depressed and a person can stay in this state as long as months after the withdrawal. 

One of the greatest risks with the abuse of Opana apart from physical and psychological dependence and addiction is Opana overdose. When a person takes Oxymorphone too frequently or in doses greater than tolerated by the body, this results in an overdose of the drug. The reason why overdosing on Opana is considered dangerous is because it straightaway leads to death.

According to the Center for Disease Control and Prevention (CDC), more than three out of the five drug overdose deaths involve opioids. Statistics reveal that 42,000 people died of an opioid overdose in 2016 out of which 40% had consumed the prescribed drug, Oxymorphone. Moreover, it’s devastating to know that the deaths from overdose of opioids such as Opana have increased by five-folds since 1999. All these figures proved that the Opioid epidemic was at a crucial stage and needed prompt action after which FDA asked the company, Endo Pharmaceuticals to take Opana ER (Oxymorphone hydrochloride) down from the market in 2017. 

Opana overdose results in depression of the respiratory system and it is the most common cause of death in acute opioid overdose. When the respiratory system is depressed, less oxygen diffuses in the blood and consequently disrupts the oxygen supply to the brain and other vital organs such as the heart. As a result brain damage ensues that further results in coma or death. Likewise, the heart receives suboptimal oxygen resulting in hypotension and bradycardia which means a decrease in blood pressure and heart rate respectively. 

Oxymorphone Overdose Signs

  • Difficulty breathing due to the depressed respiratory system
  • Cold clammy skin due to decreased blood pressure
  • Bluish discoloration of lips, fingernails due to decrease in oxygen supply
  • Decrease in the pupil size- pinpoint pupil
  • Slowed or stopped heartbeat due to decreased activity of the heart
  • Weak muscles 
  • Extreme drowsiness due to depression of the brain
  • Unusual snoring sound due to sedation

Fortunately, Oxymorphone overdose is reversible and this condition can be treated with an over-the-counter medicine called Naloxone (Narcan) which the first responders carry with them. You can administer Naloxone as many times as needed until professional help arrives, based on the directions given by the pharmacy or as suggested by the doctor. 

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