Ask the Expert on . . . Oxycontin and Narcotic Withdrawal

Virna Ignacio Almuete, RPh

Disclosures

June 16, 2005

Question

Is there any rationale for using oxycontin as a "weaning" medication for narcotic addiction? Are there any studies indicating success rates or failure rates for this approach?

Response from Virna Ignacio Almuete, RPh

First we should review some terminology.

Narcotic dependence develops when the body adapts to repeated drug exposure and leads to tolerance or the need for increasing doses to maintain the defined effect of the drug. When the drug is withdrawn, physiologic reactions occur. This is known as the withdrawal syndrome. The withdrawal syndrome is characterized by restlessness, lacrimation, rhinorrhea, yawning, perspiration, chills, myalgia, and mydriasis.

Narcotic addiction is a state in which an organism engages in a compulsive behavior, even when faced with negative consequences. This behavior is reinforcing, or rewarding. A major feature of addiction is the loss of control in limiting the intake of the addictive substance.

Detoxification is a process whereby individuals are systematically withdrawn from addicting drugs in an inpatient or outpatient setting, typically under the care of a physician.

The term "weaning" is typically used to describe the gradual tapering of a narcotic in a physically dependent person, leading to the cessation of therapy.

The controlled-release nature of the formulation allows oxycontin to be effectively administered every 12 hours. The advantage of a slow-release form is that it has a slow onset, which avoids the peaks and valleys of immediate-release forms. The gradual onset of the slow-release form may avoid the euphoric effect and perhaps the abuse potential. However, the oxycontin delivery system has been developed with a biphasic release pattern. The product has a quick initial delivery, which mimics the quick peak of an immediate-release formulation, followed by a more prolonged slow release. To my knowledge, there are no published trials using oxycontin in detoxification or maintenance for opioid addiction.

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