Treating an Opana addiction can be a complicated and time-consuming process, but one that is necessary for rehabilitation and overall health. Withdrawal from Opana (or, in its generic form, oxymorphone) puts a person through a physically, psychologically, and emotionally distressing procedure, so understanding how the drug works, and what getting off the drug entails, is an important part of securing a full recovery.
How Opana Is So Addictive
Since Opana is an opioid, the oxymorphone in the tablets quickly binds to the opioid receptors in the person’s central nervous system when the drug is consumed. The process not only clamps down on the pain signals being sent to the brain, but also releases a burst of neurochemical activity, which the person feels as a pleasantly warm, comfortable sensation. This sensation, however, is far stronger and more powerful than any natural experience, and it creates such a lasting impact on the brain’s chemistry (in particular, the reward system) that the person is compelled to feel it again.
For a person who is in significant physical distress because of pain, the feeling of a hit of Opana can be irresistible. This is partly because of the relief and partly because the mechanism of action of the oxymorphone opioid creates the sensation of pleasure and reward, like the person has done something good and is basking in the contented afterglow. Recreational users might not have physical pain to worry about, but they may have mental health issues that melt away after an Opana dose, or they may simply be seeking the euphoric bliss that comes from their opioid receptors being flooded by the oxymorphone.
Opana and Schedule II
But those sensations come with a price. The Drug Enforcement Administration places oxymorphone (and Opana) on its Schedule II list of controlled substances, subjecting it to stringent regulations and controls. It is only the drug’s effectiveness in treating pain where other painkillers have failed that saves it from the DEA’s Schedule I list, which is reserved for controlled substances that have no acceptable medical value, such as heroin, ecstasy, and LSD.
As a Schedule II drug, Opana has been put on notice for its “high abuse and dependence potential,” and because its use increases tolerance (that is, a user will have to take more and more Opana to feel the same effects, eventually becoming hooked on the drug as the only source of relief, pleasure, and finally normalcy).
Another reason the DEA put Opana on its second-highest schedule is because of the statistics related to its abuse. In 2011, there were 12,122 emergency department visits as a result of oxymorphone abuse, an increase of 7,523 from just the previous year. Figures from the American Association of Poison Control Centers report 1,041 dangerous exposures to oxymorphone in 2011, up from only 169 in 2010.
The twofold effect of physical and psychological dependence (which qualifies Opana for Schedule II) leads to withdrawal symptoms caused by the detox process having a similar toll. According to the Practical Pain Management journal, oxymorphone has a half-life between seven and nine hours. Withdrawal takes place within 14-18 hours after the last dose; the drug exits the bloodstream, signaling the end of the narcotic effects and the beginning of the body’s struggle to cope in the absence of Opana.
Typical withdrawal symptoms include:
- Uncontrollable tearing up and runny nose
- Muscle and joint pain
- Pupil dilation
- Abdominal pain, nausea, and diarrhea
The Detox Timeline
The first two days of Opana detox tend to be the most physically arduous days of the process and the time period in which the temptation to relapse are at their highest, since this would mark the first time that the person has gone without Opana for a notable period of time. Similarly, without the opioid to dampen any physical pain, muscle cramping and joint pain will also develop at the start of the process. Individuals may feel the onset of a mild flu and may have trouble sleeping the first few days.
Withdrawal tends to get worse by the third day when the psychological symptoms start to kick in. In their own way, this can be the hardest stage for those in recovery; their brains are constantly begging for the narcotic high to quell the discomfort, which is itself one of the symptoms of withdrawal. However, given Opana’s potency, any oxymorphone consumed during detox, when the withdrawal symptoms render the person especially vulnerable and weak, could easily make the addiction infinitely worse than it was. Individuals are left with little choice but to endure intense craving for more Opana, although doctors and medical professionals can provide medications to assist in this part of the detoxification process.
Withdrawal usually stabilizes around the fourth or fifth day of the process. Individuals might still not have an appetite, but it is imperative that they start eating light, nutritious meals by this point.
By the end of the seventh day since the last dose of Opana, most of the withdrawal symptoms should have subsided. Meals can be more substantive, light exercise can help build up basic stamina, and the person’s mental health would have improved enough for therapy and counseling to begin.
Factors Influencing the Timeline
The timeline of Opana detox and withdrawal will not be the same for everyone; there are a number of factors and conditions that affect a particular person’s extent of dependence on Opana, which in turn influences the length and severity of the withdrawal symptoms. Short-term and moderate abuse tends to result in generally smoother and shorter withdrawal, maybe concluding in just a few days; long-term and more severe dependence on oxymorphone can exact a greater physical, psychological, and emotional toll, lengthening the process to up to two weeks.
Other factors that might influence the length of withdrawal include having a family history of substance abuse or mental health disorders, individual psychological makeup, environmental conditions (e.g., living arrangements, job satisfaction, etc.), and even the method of abuse (e.g., crushing and snorting crushed pills or dissolving the powder in water and injecting it).
Oral consumption of Opana preserves the drug’s intended extended-release format; crushing it, and then snorting or injecting it, bypasses the chemical restrictions on the drug, transferring the contents of the medication into the bloodstream at once. This means that the narcotic high is experienced immediately and powerfully, and it increases the risk for a potentially fatal overdose. It also increases the likelihood that the person will become more physically and psychologically dependent on the unleashed oxymorphone.
Medically Assisted Detox
For obvious reasons, attempting to detox from Opana without medical help and supervision is incredibly dangerous. Most people will not resist the temptation to relapse when they are in the throes of withdrawal, especially in the case of severe Opana dependence where withdrawal can last over a week. Going to a hospital or treatment facility for help detoxing from Opana assures the best chances of kicking the habit as comprehensively, safely, and comfortably as possible.
One of the biggest advantages of withdrawing from Opana under medical supervision is that doctors and medical staff can administer medications to provide some ease during the most taxing parts of the detox process. Such medications fall into two groups: substitution and adjunctive. Substitution medications are opioids (like the oxymorphone in Opana, but long-acting; that is, they are not as instantly powerful and habit-forming as oxymorphone. Even as the person’s body is processing Opana out of it, substitution medications (such as certain forms of methadone or buprenorphine) can still activate the opioid receptors in the central nervous system, keeping withdrawal symptoms in check but without creating the same overpowering narcotic effect that Opana did.
Since both methadone and buprenorphine are long-acting, clients require fewer doses to keep their opioid receptors activated. Neither drug is chemically capable of causing the same kind of high as Opana. However, they are still opioids, and there is a possibility of the person developing a dependence on substitution medications administered during the withdrawal process. Careful monitoring by doctors and other medical staff members should ensure that the client doesn’t abuse the medications being used to wean off the initial opioid.
Adjunct Medication and Long-Term Care
While substitution medications target general withdrawal symptoms, adjunct medications focus on specific symptoms of withdrawal caused by the discontinuation of Opana. For diarrhea and nausea, for example, doctors may administer anti-nausea medication; as the client experiences insomnia and agitation, a doctor could offer a sleep aid. Since psychological symptoms can be the hardest to bear, antidepressants and anti-anxiety drugs can be particularly helpful in how they restore the balance of neurotransmitters in the brain – a balance initially thrown off by Opana abuse and then thrown off again by the cessation of Opana. Doctors can use other drugs for their off-label purposes, such as blood pressure medicine to reduce the sensitivity and pain caused by the high blood pressure that sometimes occurs during withdrawal.