The U.S. Food and Drug Administration (FDA) initially approved the use of the opioid drug oxymorphone under the brand name Opana for the treatment of postsurgical and chronic pain. Oxymorphone is a drug that is in the same class as morphine, heroin, codeine, and other opiate drugs, as it is listed as a Schedule II controlled substance. Since the original approval of the drug by the FDA, there have been some generic manufacturers of oxymorphone.
Oxymorphone use produces effects that are similar to other opiate drugs in its class. The immediate effects of the drug will often include:
Substances classified in the Schedule II category are considered to have significant medical uses, but they are also potentially dangerous drugs of abuse. Drugs in this category have a significant potential to produce psychological or physical dependence in individuals who use them for more than a few weeks. These medications are at the highest level of control for substances that can be obtained by individuals with a prescription from a physician.
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According to an article in the journal Neuropsychopharmacology, the development of physical dependence on an opioid drug will typically follow a similar course for the majority of opiate medications. The process will typically begin with an increased level of tolerance to the drug and then eventually the development of physical dependence (withdrawal symptoms).
Individuals who use Opana under the supervision of a physician but use it for an extended period will develop some level of physical dependence on the drug; however, this situation does not mean they have an addiction or an opiate use disorder (the clinical term for the abuse of or addiction to an opiate drug). Individuals with substance use disorders do not use drugs under a doctor’s supervision and/or according to the prescription instructions provided on the label of their medication. Instead, they typically take the drug in larger amounts, more frequently, and in combinations with other drugs, such that they are using it for its psychoactive purposes. The level of physical dependence that occurs with individuals who abuse Opana is often much more severe than the level of physical dependence that may occur in some individuals who use the drug medicinally for lengthy periods.
Tolerance to Opana is a relatively common occurrence for any person who uses the drug for more than a few weeks. The person’s system will adjust itself to the presence of the drug over time. Alterations will occur in the production of neurotransmitters and hormones to account for the presence of the drug. This means that the person will need more of the drug to achieve the same effect if they use it for an extended time.
As the individual continues to use the drug, the person’s system adjusts itself. If levels of the drug drop below a certain point, the system is unbalanced, and the person begins to experience the negative physical and emotional ramifications of this state of imbalance (withdrawal symptoms).
Although the actual withdrawal effects associated with physical dependence on opiate drugs like Opana are not considered to be potentially life-threatening for most individuals, issues like decreased judgment, severe emotional distress, confusion, or dehydration can result in serious ramifications.
Some individuals undergoing severe withdrawal from Opana may be more prone to overdose when they relapse, become involved in accidents, suffer serious dehydration, or even engage in self-harm. Therefore, the best course of action for anyone who is suspected of undergoing withdrawal symptoms from Opana or any other opiate drug should be placed under the supervision of a physician and given medical treatment.
According to the chapter titled Opioid Overdose and Withdrawal from the book Pain Management and Palliative Care, the timeline associated with withdrawal from Opana (oxymorphone) is similar to the timeline that occurs in withdrawal from other opiate drugs.
An initial or acute period may begin within a few hours of stopping the drug or within 24 to 48 hours. Individuals with more severe physical dependence will develop symptoms more quickly. Symptoms in this period will typically include:
For most individuals, the symptoms that occur in the acute phase will be intense. They will usually last between three and four days, and then their intensity will slowly begin to decrease.
Following the peak of the acute phase symptoms, there will be a phase of several days to several weeks where there will still be some symptoms present, but they will be far less severe than they were in the early stage.
For most people, the withdrawal syndrome will run its course within one to four weeks after they stop using Opana. However, many individuals will still experience residual symptoms for months and even years after discontinuing the drug. These may include periodic cravings for the drug, periodic heightened sensitivity to stress, problems with motivation, and depression.
People who have some other co-occurring psychological disorders, such as major depressive disorder, anxiety disorder, eating disorder, or bipolar disorder, will often have extensive emotional problems along with the physical symptoms of withdrawal. They may continue to experience severe emotional issues well after the normal time frame associated with opiate withdrawal.
As mentioned above, the preferred way to confront the withdrawal symptoms associated with discontinuing Opana, according to organizations like the American Society of Addiction Medicine (ASAM), would be to become involved in a medical detox program. Individuals in the early stages of recovery should consider only facilities that offer physician-assisted medical detox as part of the overall rehab program. In some cases, rehab facilities work with standalone detox programs, and clients transition from one program into the other.
In medical detox, professionals will monitor the recovery of the individual and administer medications to alleviate withdrawal symptoms. Very often, the medications are opiate replacement medications, such as drugs that contain buprenorphine (e.g., Suboxone). Recently, the FDA approved a non-opiate medication that can be used to treat withdrawal symptoms associated with opiate use disorders.
Admission to a formal medical detox program will decrease the risk of relapse in the early stages of recovery. It will also allow the individual to concentrate on the skills needed to begin the long road to recovery.
Medical detox typically begins with a physician administering a dose of a replacement medication that is sufficient to alleviate any withdrawal symptoms. Then, over time, they will slowly decrease the amount of the drug (using a tapering schedule) to wean the person off the medication. Eventually, the person will not need to take any medication to address their withdrawal symptoms. Depending on the situation, the medical detox program can be administered on an inpatient or outpatient basis.
There are some steps a person can take while in medical detox to help them get through the withdrawal process more comfortably, according to Addict in the House: A No-Nonsense Family Guide Through Addiction and Recovery.
Finally, withdrawal only represents the very first stage of recovery from the abuse of an opiate drug like Opana. Simply getting through the withdrawal phase of recovery and not continuing with therapy will almost certainly guarantee relapse. It is extremely important for individuals to maintain their involvement in therapy, support group participation, and other supportive activities following the completion of medical detox.
(February 2018). Oxymorphone (marketed as Opana ER) Information. Food and Drug Administration. from https://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm562339.htm
(February 2009). Oxymorphone. Drug Enforcement Administration. from https://www.deadiversion.usdoj.gov/drug_chem_info/oxymorphone.pdf
(January 2010). Neurocircuitry of Addiction. Neuropsychopharmacology. from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2805560/
(May 2018). FDA Approves the First Non-Opioid treatment for Management of Opioid Withdrawal Symptoms in Adults. Food and Drug Administration. from https://www.fda.gov/newsevents/newsroom/pressannouncements/ucm607884.htm