Opana (oxymorphone), a powerful prescription pain reliever, has been marketed in both an immediate-release and an extended-release (Opana ER) formulation. The immediate-release formulation is intended to treat moderate-to-severe pain while Opana ER is designed to control pain continuously around the clock.
In June 2017, the U.S. Food and Drug Administration (FDA) recommended that Opana ER be removed from the market because of its high potential for abuse. In 2012, the makers of Opana ER, Endo Pharmaceuticals, reformulated the medication to make it more abuse-deterrent after people were crushing the tablets to snort them.
When an extended-release drug is crushed and then taken in a way other than swallowing as it was intended, the entire dose of the drug enters the bloodstream at once. This drastically raises the odds for a life-threatening overdose. The U.S. Centers for Disease Control and Prevention (CDC) reports that about 115 people die from an opioid overdose every day in the United States.
Opana is also a highly addictive drug, and regular use can cause drug dependence. Snorting and smoking Opana are extremely risky methods of abuse that increase the odds for overdose, raise levels of drug dependence, and elevate the chances of struggling with an addiction.
When Opana is snorted, it enters the bloodstream rapidly. Snorting sends the drug quickly across the barrier between the blood and the brain, which can overwhelm the system.
Opioid overdose is a public health epidemic in the United States, as the National Institute on Drug Abuse (NIDA) publishes that more than 30,000 Americans lost their lives to an opioid overdose in 2015. Crushing and snorting Opana is extremely dangerous and elevates the overdose risk exponentially. This is especially true if Opana ER is snorted, as it is meant to be released slowly in a controlled manner over an entire day and not sent directly into the bloodstream all at once. It can be impossible to control the dosage when snorted, and it is extremely easy to take in too much.
Opana overdose is indicated by respiratory distress, and a person may stop breathing completely. Pinpoint pupils, tremors, cold skin, bluish coloring to lips and nails, extreme drowsiness, possible loss of consciousness, limp and weak muscles, breathing issues, and confusion are all possible signs of an Opana overdose.
Other potential issues from snorting Opana regularly include:
Snorting Opana also causes a physical dependence to build up faster and in fewer doses, which can mean it will be harder to stop taking the drug. Difficult withdrawal symptoms can kick in when Opana processes out of the body.
The U.S. Drug Enforcement Administration (DEA) warns that oxymorphone use can lead to drug tolerance, physical dependence, the onset of withdrawal symptoms, and addiction. Snorting Opana increases these risks.
Tolerance means that it takes more of the drug to feel the same effects, and a person is more likely to escalate the dosage to keep feeling it in the desired manner. This can then lead to continued use and higher amounts of Opana taken each time, which serves to compound physical dependence and the odds for painful withdrawal symptoms and addiction. Snorting Opana increases the chances of struggling with addiction.
The National Survey on Drug Use and Health (NSDUH) publishes that close to 7 million people in the United States misused an opioid painkiller in 2016. Opioids like Opana block pain sensations, and they also cause levels of dopamine in the brain to rise. Dopamine is involved in helping to regulate emotions, and high levels of the neurotransmitter can cause a person to feel happy, mellow, and relaxed. This surge of pleasure, or “high,” can be extremely desirable, making opioids and Opana hot targets of abuse.
When under the influence of Opana, a person is liable to be sluggish, sleepy, uncoordinated, mellow, and unable to think clearly or make rational and sound decisions. The risk of engaging in activities that can be potentially hazardous goes up, as inhibitions are lowered. A person can’t think through the consequences of their actions while under the influence of Opana and therefore more apt to act in ways that are out of character.
Opana is also habit-forming, which means the more often it is taken, the more physically dependent on it a person will become. With dependence comes difficult withdrawal symptoms. Physically, they often feel like a bad case of the flu, and emotionally, they may present as anxiety, depression, and drug cravings.
Opioid addiction is a real cause for concern with repeated Opana misuse. In 2015, the American Society of Addiction Medicine (ASAM) reports that close to 2.5 million Americans struggled with opioid addiction.
Swallowing Opana and taking the drug as directed should not produce euphoria. Those seeking to abuse the drug may alter its formulation to experience the effects more quickly and intensely.
Opana tablets are regularly crushed and then injected, smoked, or snorted to intensify the high. Endo Pharmaceuticals attempted to deter this by adding a protective coating on Opana ER capsules to make them harder to crush and snort. The FDA determined that the reformulation of Opana ER did not deter abuse but rather shifted the method from snorting the drug to injecting it instead. The reward of the new formulation of the medication did not, therefore, outweigh the risks, and Endo Pharmaceuticals removed the drug from the market.
Opana is still marketed as an immediate-release, pain-relieving medication, and it is still widely abused.
Smoking Opana carries many of the same risks as snorting it, as it also bypasses the intended method of metabolism. Instead of being ingested and broken down by the gastrointestinal system, it is sent directly across the blood-brain barrier and into the system. The same risks for overdose, drug dependence, more extreme withdrawal symptoms, and addiction are amplified when Opana is smoked.
Additional risks specific to smoking Opana include:
When Opana is misused with other drugs or alcohol, the risks go up, and the odds for an adverse reaction are amplified. Smoking and snorting Opana are both extremely hazardous methods of abuse that come with many potential life-threatening consequences.
(June 2017). FDA Requests Removal of Opana ER for Risks Related to Abuse. U.S. Food and Drug Administration. from https://www.fda.gov/newsevents/newsroom/pressannouncements/ucm562401.htm
(August 2017). Understanding the Epidemic. Centers for Disease Control and Prevention. from https://www.cdc.gov/drugoverdose/epidemic/index.html
(September 2017). Key Substance Use and Mental Health Indicators in the United States: Results from the 2016 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration. from https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2016/NSDUH-FFR1-2016.htm
Opioid Addiction 2016 Facts & Figures. American Society of Addiction Medicine. from https://www.asam.org/docs/default-source/advocacy/opioid-addiction-disease-facts-figures.pdf
(March 2018). Opioid Overdose Crisis. National Institute on Drug Abuse. from https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis
(April 2013). Oxymorphone. Drug Enforcement Administration. from https://www.deadiversion.usdoj.gov/drug_chem_info/oxymorphone.pdf