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Northpoint Seattle’s outpatient treatment program is located in beautiful Seattle, Washington, and we work to help the surrounding communities.
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Seattle, WA 98133, United States
Oxymorphone Abuse and Addiction in Washington State: The Risks and Treatment Options
Oxymorphone addiction and abuse have only contributed to the ongoing opioid crisis in Washington State. Because this is a prescribed medication, people are typically surprised to learn they need detox and rehab to stop taking it safely. Without getting professional treatment, people have a very high risk of relapsing if they attempt to stop using it on their own.
The opioid epidemic has plagued Washington State – as well as the rest of the United States – for several years. The estimated costs of it are $1 trillion and increasing by the day. Oxymorphone has played a major role in this problem, despite the fact that it was removed from the market in 2017. While it might not be as common as it once was, because of its euphoric effects, people still seek it out. It is usually purchased online from other countries that still manufacture it.
Oxymorphone is not a safe drug at all, even though it has that reputation because of the fact that it is prescribed. We want people to be aware of the risks of misusing it as well as how addictive it can be. We also want to make them aware of their treatment options right here in the Seattle area.
Do You Have Questions About Addiction? Call Our Recovery Experts Now.
What Is Oxymorphone Anyway?
Before getting into what an oxymorphone addiction entails, let’s first take a look at what oxymorphone really is.
Oxymorphone belongs to a family of drugs known as opioids. You’ve probably heard of some these kinds of drugs: heroin, OxyContin, codeine, and the incredibly potent and dangerous Fentanyl.
These drugs (except for heroin) are generally used in the medical community for their pain-relieving properties. But opioids aren’t just used for any type of pain. In most cases, physicians reserve prescribing them for more severe conditions.
Alleviating the suffering of certain types of advanced cancer, treating chronic pain following surgery, and even easing non-cancer pain (e.g. from severe back injuries) are some of the most common medical applications.
Like all opioid drugs, oxymorphone affects the brain by interacting directly with the mind’s opioid receptors, namely the “mu” opioid receptors. These receptors are partly responsible for sedation, pain response, and mood regulation.
Opioids in general can be broken down into three types: full agonists, partial agonists, and antagonists.
Full agonists bind with the opioid receptors and activate them, causing pain relief, sedation, etc. Most opioids you’ve heard of are probably full agonists including OxyContin, heroin, and oxymorphone itself.
Partial agonists also bind with these receptors, but they don’t stimulate them quite as much as full agonists. Some examples of partial agonists are buprenorphine (used during opioid detox and rehab) and tramadol, also known as Ultram.
Antagonists, on the other hand, bind with these same receptors but instead of activating them, they simply block them off. When using an antagonist like naltrexone or naloxone, your opioid receptors generally won’t be able to be activated as a result, making these drugs incredibly useful during rehab.
As you can probably guess, the full agonists are often the most dangerous when it comes to addiction. And as a full agonist, oxymorphone is no exception.
Numorphan is used solely via injection while Opana comes in tablet form and is often the more highly-abused of the two types.
Opana also comes in two versions: Opana and Opana ER (extended release).
Opana and Opana ER both are formulated with oxymorphone being the active ingredient. However, Opana ER is designed to release the opioid over a much longer period of time compared to Opana.
As such, Opana ER usually contains more oxymorphone than its immediate-release counterpart. This characteristic led to it becoming highly abused and subsequently resulted in the drug’s removal from the market at the request of the U.S. Food and Drug Administration.
It Could Happen in WA State: A Doctor is Arrested for Mass-Prescribing Opioid Drugs
When Oxymorphone was still on the market, it was being prescribed at very high rates. One of the doctors who mass-prescribed it was Dr. Joel Smithers. It was reported that he was responsible for patients accessing about half a million doses of opioids within two years’ time.
Dr. Smithers’ patients came from five different states to see him at his small practice. Some of them spent as much as 16 hours driving just to get their prescriptions. Drug enforcement agents finally stopped this practice in 2017. DEA supervisory special agent Christopher Dziedzic stated, “He’s done great damage and contributed to the overall problem in the heartland of the opioid epidemic.”
As the investigation continued, it was determined that Smithers was not operating a legitimate medical practice at all. He was actually heading up an interstate drug distribution ring. His medical practice did not have the basic supplies that would be necessary to operate. His receptionist lived in a back room, and many of his patients slept outside, waiting to see him. Some would wait as long as 12 hours.
The minimum sentence for Smithers would be 20 years in prison. But because of the scope of his actions and how many lives were impacted, it is expected to be much more.
We like to think that something like this could never happen in Washington State, but that is simply not true. It can and it has.
In 2019, the Drug Enforcement Administration began alerting the public about dangerous counterfeit pills in Washington State. The pills were being manufactured by Mexican drug cartels, and they contained fentanyl, which is a potentially lethal synthesized opioid drug. This drug has been found in illicit Oxycodone and Oxymorphone pills, among others.
Between January and March of 2019, 27% of counterfeit prescription pills were found to contain fentanyl in fatal doses. Just one pill could kill an adult. The DEA reported having seized more than 16 kilograms of the drug within the last year. That breaks down to more than 8 million doses.
Signs of Oxymorphone Abuse
Abusing oxymorphone can have some pretty dire consequences. Not only is doing so associated with a host of dangerous health effects, it can also put you at a greater risk of developing a crippling addiction to this potent medication – one that’s incredibly difficult to overcome.
But before getting into the addiction side, let’s first take a look at what Opana abuse is, what it can do to your body, and how to spot the signs of abuse in others.
Simply put, the Mayo Clinic defines prescription drug abuse as “the use of a prescription medication in a way not intended by the prescribing doctor.” And while this definition is both succinct and seemingly simple, there’s more to abusing prescription meds than most people may know.
For example, while crushing and snorting Opana is obviously one form of oxymorphone abuse, so is a relatively harmless act like accidently missing a dose and taking one later, even though your prescription explicitly says to wait for your next one.
It’s clear, then, that there is a wide range of abusive behaviors, some of which are more dangerous than others.
Some more abusive behaviors include:
- Using a prescription drug that isn’t yours
- Seeking prescriptions from more than one doctor
- Lying to your doctor for a prescription or other drug-seeking behaviors
- Taking prescription drugs with other substances like alcohol when prohibited
- Taking more of the drug than your physician prescribed
- Using a prescription medication (both yours or someone else’s) to treat a condition that the drug is not prescribed for
Of course, using prescription drugs like Opana for non-medical purposes (most notably to get high), is largely the most dangerous reason for abusing oxymorphone. It’s also particularly widespread.
In fact, the National Institute on Drug Abuse (NIDA) estimates that an astounding 54 million people (or 1 in 5 Americans) have used prescription drugs for non-medical reasons in their lifetime.
And while doing so is surprisingly common, it is also especially deadly. According to NIDA, over half of all drug-related emergency room visits can be attributed to prescription drug misuse. What’s more, almost 40% of those visits were caused by prescription opioid pain relievers like oxymorphone.
The most commonly abused form of oxymorphone is Opana. As opposed to its solution-based counterpart Numorphan, Opana comes in the form of a tablet. As such, Opana is much easier to administer, transport, hide, and manipulate, making it the ideal form for abuse.
However, there are two types of Opana products: Opana IR (immediate release) and Opana ER (extended release). And while they both are formulated from the same oxymorphone base, Opana ER is far more dangerous than it’s short-acting alternative.
That’s because Opana ER simply has higher amounts of oxymorphone in it. For example, Opana IR comes in only two dosages: 5 mg and 10 mg.
Opana ER, on the other hand, comes in much higher dosages including:
- 5 mg
- 5 mg
- 10 mg
- 15 mg
- 20 mg
- 30 mg
- 40 mg
As you can see, a single Opana ER pill may contain up to 8x as much oxymorphone as an immediate release Opana. And the reasoning here makes sense – extended release medications are meant to last far longer than their immediate release counterparts.
So, rather than taking six doses of regular old Opana, you can instead take two Opana ERs.
The problem, however, comes from the fact that it’s possible to bypass the extended release mechanism and inject, snort, or even smoke Opana, letting abusers get the full dosage all at once.
And given that oxymorphone is about twice as potent as OxyContin and three times as potent as morphine, bringing in that much of such a powerful drug can be incredibly dangerous.
Getting your friend or loved one help for their oxymorphone abuse is absolutely critical for overcoming their Opana abuse problem. But before you can do that, you need to be able to spot the signs of a problem in the first place.
And the clearest, most recognizable sign of abuse is if they are currently high on Opana. While taking opioids according to a prescription can bring at least some degree of the following symptoms, when they’re abused in order to achieve a high, these symptoms will likely be far more severe.
As a powerful opioid itself, oxymorphone intoxication has a number of side effects that are similar to those experienced under the influence of other opioids. These include:
- Lack of energy – Though opioids are generally grouped in their own separate category, they’re also considered to be a type of sedative. As such, oxymorphone intoxication may bring with it a dulled, drowsy state marked by a lack of energy, droopy eyes, or sleeping.
- Slowed breathing – As a central nervous system (CNS) depressant, opioids tend to slow down the body’s autonomic processes such as respiration. Shallow and slowed breathing, then, just may be a sign of being high on oxymorphone.
- Confusion – Someone high on Opana will also likely be much more psychologically impaired. They may have trouble communicating with you, putting together coherent thoughts, or even remembering what they were just doing.
- Euphoria – When greatly stimulated, opioid receptors also produce a type of euphoria. In fact, this effect is one of the main reasons these drugs are so commonly abused. Be on the lookout for this sign if you’re trying to determine if they’re high on oxymorphone or not.
- Poor coordination – Taking oxymorphone and other opioids can limit an individual’s physical coordination skills. In fact, opioids have actually been shown to directly affect an individual’s risk of falls and fractures. If you notice particularly sloppy coordination then, your friend or loved one may be high on oxymorphone.
- Constipation – Opioid receptors aren’t just in your brain – they’re also located in your gastrointestinal tract, among other places. When someone abuses Opana then, the GI tract also tends to slow down, making it far less effective than usual.
Oxymorphone is incredibly powerful and particularly addictive. As such, if your friend or loved one is coping with an Opana abuse problem, there are a number of other signs to watch out for other than just whether or not they are intoxicated.
Let’s take a quick look at the top six most noticeable signs that someone close to you is abusing this dangerous drug.
- You have a gut feeling they might be abusing a drug – While it’s most certainly not right 100% of the time, our mind takes in more information than we can process consciously. It picks up on things we may have missed. And if you’ve got a gut feeling that something’s wrong, it just might be because your brain is trying to tell you something…
- They tend to go missing frequently or may have a lot of time that’s unaccounted for – Whether they lie about where they’ve been or simply aren’t around a lot more often than usual, this time away may have been spent on feeding their oxymorphone abuse problem.
- They’ve missed a significant amount of work or school – Absenteeism and drug abuse tend to go hand in hand. It could be that they’re oversleeping due to a particularly intoxicating time last night or that they’re actually ditching their obligations in favor of getting high. Either way, it points to a problem.
- Their personal hygiene has noticeably declined – A drug problem is typically all-consuming. Your mind is fundamentally altered to favor drug-seeking behaviors. As a result, other activities tend to take a back seat – showering, oral hygiene, and even laundry are just some of the most common ones.
- You notice that money or personal items have gone missing – Paying for a drug habit can be expensive. And given that the typical street price for oxymorphone is $1.47/mg, abusing this drug be financially taxing. As a result, many abusers may start pawning off items, stealing money, or even opening up lines of credit in your name.
- They’re exhibiting unusual or erratic behavior – Last but not least, if you find that someone you care about has been acting particularly reckless lately or maybe has been going through some severe mood swings, it might be a sign that something is amiss.
Overdoses on opioids like oxymorphone are both incredibly deadly and increasingly common.
In fact, drug overdoses as a whole rose a whopping 21% in 2016. What’s more, the rate of drug overdose deaths involving natural and semisynthetic opioids like oxymorphone increase on average by 13% annually from 1999 to 2009 and by 3% annually from 2009 to 2016.
The problem, it seems, is getting worse – and it’s getting worse fast.
That’s why it’s so important to recognize the signs of overdose – getting professional help as soon as possible may just end up saving the life of someone you love.
According to MedlinePlus, some of the signs of oxymorphone overdose include:
- Difficulty breathing or slowed or stopped breathing
- Bluish-tinged skin, lips, or fingernails
- Cold, clammy skin
- Increase or decrease in pupil size
- Limp or weak muscles
- Extreme sleepiness
- Unusual snoring
- Slowed heartbeat
- Loss of consciousness
If you think your friend or family member is overdosing on Opana and they’re exhibiting these signs, get help immediately. If they have collapsed or aren’t breathing, call 911. If they are still conscious and are breathing, you can call your local poison control center at 1-800-222-1222.
One of the most promising defenses against death via opioid overdose is a lifesaving drug called naloxone. It can help reverse the deadly respiratory depression by essentially displacing the opioid molecules attached to the patient’s receptors and jumpstarting their respiration back to normal levels.
Without professional emergency treatment though, an overdose can be easily end in death.
That’s why it’s absolutely critical that you seek help. Do not wait. Do not assume it will all be okay. And do not under any circumstances hesitate because you’re worried about their legal repercussions.
This is, after all, a life we’re talking about.
Oxymorphone Addiction
As with many other types of drugs and medications, abusing oxymorphone too much and on a continuous basis can lead to a dangerous addiction that can have life-changing consequences both in the short-term and in the long-term.
That’s why it’s so important to know how to identify the signs of an addiction to oxymorphone in yourself. That way, you can get the professional help you need to overcome this destructive addiction.
Before jumping into what Opana addiction is composed of, let’s take a quick look at what addiction in general really is.
Contrary to the beliefs of many, addiction is more than just a physical dependency. After all, people taking medications according to their physician’s prescription can still become physically dependent and may build tolerance and go through withdrawals when that drug is removed.
Addiction, on the other hand, is characterized by a set of compulsive and detrimental drug-seeking behaviors as well as physical dependency.
As a result, an addict may have little to no control over their drug use and despite acknowledging the physical and psychological harmful effects that this abuse is clearly having, they may still be driven to continue using.
But don’t be confused – addiction is in fact a disease. NIDA is quick to point out that while the initial choice to abuse a substance is often voluntary, substance abuse quickly impairs a person’s ability to exert self-control. What’s more, it also causes physical changes in the brain that seriously alter judgment, decision making, learning and memory, and behavior control.
Addiction, then, clearly isn’t an unwillingness to stop using – it’s a disease caused by very real physical changes in the brain. With this information in mind, it should be given the same attention and care as any other chronic disease.
In the short-term, using and abusing oxymorphone has been associated with a number of side effects. Many of these are possible, even when taking oxymorphone according to your prescription. However, abusing it in large quantities can make these side effects even more severe and possibly life-threatening.
According to MedlinePlus, the most common short-term side effects of Opana include:
- Stomach pain or swelling
- Vomiting
- Excessive sweating
- Fast heartbeat
- Headache
- Itching
- Dizziness
- Sexual changes
- Irregular heartbeat
- Extreme drowsiness
- Fainting
- Agitation
- Depression
- Confusion
- Flushing
- Gas
- Nausea
- Dry mouth
- Seizures
An addiction to oxymorphone also carries an increased chance of a fatal overdose, engaging in risky behaviors, and putting oneself in physically dangerous situations that might have otherwise been avoided.
In the long-term, habitually abusing oxymorphone can be incredibly damaging both to your physical health as well as to the course of your life in general.
In the first place, becoming addicted to Opana is associated with a higher chance of getting involved with intravenous drug use. This of course includes abusing oxymorphone itself intravenously, but studies have also shown that abusing prescription opioids may in fact lead to using heroin.
One study actually found that nearly half of young heroin users started abusing prescription opioids before making the leap to heroin. Some even claimed that it was easier to obtain and cheaper than prescription drugs.
And when you consider just how deadly of a drug heroin is, this risk alone makes oxymorphone a substance worth avoiding.
What’s more, researchers are currently looking into the long-term effects of the decreased respiration that is so common when taking prescription opioids like oxymorphone. When less oxygen reaches the brain than normal (a condition called hypoxia), it may lead to permanent brain damage and cell death.
Studies have shown that abusing opioids like heroin can cause a deterioration of the brain’s white matter which, in turn, could affect decision-making abilities, the ability to regulate behavior, and responses to stressful situations.
The Dangers of Snorting Opana
Up until recently, one of the most common methods of abusing oxymorphone was using it intranasally (i.e. by snorting it). Abusers would often crush up the Opana pills into a fine powder and then snort the resulting powder.
Getting high on oxymorphone this way is attractive to addicts for a number of reasons:
- It doesn’t carry the same health risks as intravenous injection
- It can be easily stored, transported, and hidden in pill form
- It bypasses many of the body’s natural filtration systems (a.k.a. “first pass metabolism”)
- It has a much faster onset compared to simply swallowing the pills whole
However, there are a number of dangers specific to snorting oxymorphone, many of which can be particularly devastating.
In the first place, both snorting and injecting any substance carries a higher risk of overdose which, as with any opioid, may end up being fatal.
That’s because snorting and injecting a drug circumvents natural bodily processes that help to break down the drug, making them less dangerous along the way. Without these defense measures, a much more potent version of the drug enters your bloodstream than if it were taken orally.
What’s more, snorting oxymorphone introduces an abrasive chemical into an especially sensitive area – your sinus cavity. After abusing Opana intranasally over a long period of time, this area can become extremely damaged, resulting in chronic nosebleeds, infections, and even the development of a hole in your septum.
Intranasal users of oxymorphone, then, should be particularly aware of these consequences since they could lead to permanent damage.
Given the especially high potency of Opana and Opana ER, it isn’t any wonder that this drug has come under an unusual amount of scrutiny over the years.
Since its introduction onto the pharmaceutical market in 2006 by Endo Pharmaceuticals, Opana ER has been rife with abuse potential. Soon after its release, communities all across the country were reporting rampant abuse, overdoses, and deaths from addicts who were snorting gargantuan amounts of this powerful drug.
In an effort to curb this abuse potential (and to fend off generic competitors), Endo reformulated Opana ER to include a crush-resistant coating and released it onto the market in 2012 after FDA approval. Endo then began replacing the old models with the purportedly safer ones.
The company then filed a petition with the FDA to withdraw its approval of other non-crush-resistant versions of oxymorphone sold by generic competitors “for reasons of safety or effectiveness.” Essentially, Endo sought to cut out the competition and increase their market share by claiming other products simply weren’t as safe as their reformulated Opana ER.
However, it was uncovered during the FDA’s investigation that while the new formulation did prevent abusing Opana intranasally, it dramatically increased the likelihood of intravenous abuse via injection.
To make matters worse, it seems Endo knew about this increased potential for abuse the whole time.
One study, actually co-authored by an Endo medical director, found that before the reformulation, about 36% of abusers were injecting the non-crush-resistant Opana. Afterwards though, that number grew to an astounding 64% of users.
Unsurprisingly, the FDA determined that the reformulated Opana ER was actually not safer as a result. In fact, after a particularly terrifying health epidemic in Indiana caused by Opana ER, the FDA (for the first time ever) requested the complete removal of Opana ER from the market.
Endo complied a month later and removed Opana ER permanently in July of 2017.
While snorting crushed Opana is undoubtedly dangerous and especially lethal, injection still reigns supreme as the deadliest way to abuse Opana.
Similar to snorting a substance in that doing so bypasses the body’s natural defense systems and delivers a more potent high, intravenous drug use also carries with it a set of unique hazards that make it a much more dangerous form of abuse.
For example, the risk of developing an actual addiction to a drug may depend largely on how quickly it reaches the brain. Snorting, for example, can take several minutes to fully take effect. Injection, on the other hand, allows the drug’s effects to be felt almost immediately, making it more likely to cause eventual addiction.
But there are more dangers associated with injecting oxymorphone too. The potency and rapid transmission of this drug into the blood stream can put added pressure on the liver, heart, and kidneys, eventually causing permanent damage to these essential organs. And just like with injecting other synthetic opioids, collapsed veins, abscesses, and deadly infections are also par for the course.
And while this physical damage is startling and reason enough not to start intravenous oxymorphone abuse, one of the biggest dangers is the threat of contracting serious blood-borne diseases.
HIV, Hepatitis B and C, syphilis, and more are all transmissible via blood-to-blood contact. And if you are sharing needles when abusing drugs (an incredibly common practice), then you are dramatically increasing the risk of contracting such diseases.
And as the case of Austin, Indiana shows, the transmission of these diseases can be both rapid and devastating.
Few cases show how quick and distressing the spread of blood-borne diseases can be when it comes to needle sharing quite like that of Austin, IN. This small, rural community faced one of the worst HIV and Hepatitis C outbreaks in the country’s history, all thanks to needle sharing among Opana abusers.
It began in late 2014 when 11 new cases of HIV were identified between November to January 2015. On average, this southeastern Indiana county saw less than five infections annually, making this dramatic uptick a case for concern. By April 2015, that number jumped to 135 confirmed cases.
A Center for Disease Control and Prevention report showed that among the interviewed people who were infected, an astounding 96% admitted to dissolving and injecting Opana ER. An alarming 84% of those infected also tested positive for Hepatitis C.
In less than one year, this 4,100-person county saw a less than 0.1% HIV infection rate jump by almost 3,300%.
Then-governor Mike Pence actually doubled back on his personal beliefs and gave the county the freedom to open up needle exchange programs, one of the only measures that’s been proven to curb the spread of infectious diseases among intravenous drug users.
While this wildfire spread has since been controlled by dedicated medical officials, the number of confirmed HIV cases in April 2017 reached 215, making the infection rate for this small community an unheard of 5%.
Dr. Tom Frieden, former director of the CDC, called the spread of HIV in Austin “the largest concentrated outbreak ever documented in the United States.”
Injecting oxymorphone has life-changing consequences. And Austin, Indiana proves it.
Risk Factors for Oxymorphone Addiction
Despite the enormous amount of study that’s already been done on this dangerous and life-changing condition, a lot about addiction is still relatively unknown. For example, researchers still aren’t 100% sure why some people get addicted to drugs while others from the same background are seemingly able to move on without them.
That being said, studies have shown that there are a number of risk factors for developing an addiction to oxymorphone and other drugs. And although it’s still impossible to say with absolute certainty whether a single individual will fall into the thralls of addiction, the factors below (pointed out by SAMHSA) can give a pretty good indication of the risk.
- Mental disorder (depression, PTSD, anxiety, etc.)
- Acute and chronic pain
- Physical health problems like headaches or fatigue
- Heightened physiological reactions to certain types of drugs
- A history of substance abuse or misuse
What’s more, SAMHSA also lists a number of protective factors which make abuse less likely down the line. These include:
- A commitment to doing well in school
- An awareness of the dangers of misusing prescription drugs
- A healthy perception of “doctor’s orders”
Beyond these factors, there are a number of other defining characteristics that can make Opana abuse even more likely. These include:
- Being young
- Being male
- Are dealing with a mental illness
- Are currently taking psychotropic medications
- Are taking more than one opioid drug
- A tendency to mix drugs and alcohol
Again, it’s impossible to say for sure whether anyone is going to develop an addiction to oxymorphone. But knowing these factors beforehand can help you identify whether you are more at risk than others and can help you plan accordingly.