Extended-Release Opioids: Dangers, Differences, Precautions

Extended-release or sustained-release opioids tend to contain higher doses. They’re formulated to gradually release into the patient’s body over an extended time, typically either a 12-hour or 24-hour period.

However, this time-release mechanism can be bypassed depending on the technology used. Crushing, snorting, and injecting extended-release tablets greatly increases the risk of life-threatening overdose.

The Current Opioid Overdose Crisis

As of 2015, an estimated 1 6 million people worldwide have been affected by opioid use disorders. A majority of heroin users begin taking opioids as legally prescribed pain-relieving tablets. In 2016, the United States recorded over 42,000 deaths due to opioid overdose.

This number grows every year. Many of the deaths are attributed to recreational use. The illegal manufacturing of the potent synthetic opioids like fentanyl are largely to blame. Fentanyl is 80 to 100 times more potent than morphine. It is commonly mixed in illegally pressed pills and sold as Xanax or various other street drugs.

However, many of the deaths are due to recreational users who take legally manufactured synthetic opioids in ways that are not recommended by physicians.

A Safer Extended-Release Oxycodone

Efforts are being made through the coordinated efforts of pharmaceutical companies and the FDA to reformulate extended-release tablets to reduce the likelihood of overdose. Collegium Pharmaceutical’s Xtampza ER is a sustained-release version of oxycodone. Xtampza ER is used to treat moderate to severe chronic pain in opioid-tolerant patients. It’s made in sustained-release capsules of 9 mg, 13.5 mg, 18 mg, 27 mg, and 36 mg. The pills are designed to release a percentage of the drug immediately upon ingestion, with the majority of the drug being released gradually over a 12-hour period.

The patient takes two pills a day for around-the-clock pain relief. Taking more than 36 mg in a single dose or exceeding 72 mg in a 24-hour period dramatically increases the risk of overdose.

According to a recent study presented at PAINWeek 2017 in Las Vegas, Nevada, Xtampza ER’s new formulation has a lower abuse potential than immediate-release oxycodone. Typically, extended-release opioids have a higher abuse potential due to their higher drug content. When crushed, the total drug content is released into the system all at once, increasing the risk of overdose.

The opposite proved to be the case with Xtampza ER. Researchers evaluated the pharmacokinetics of crushed and intact extended-release oxycodone compared to crushed immediate-release oxycodone.

Participants were asked to rank the euphoria of the high along with its pain-relieving effects. Researchers used various metrics, including pupil constriction to determine the strength of the drug’s effects. In general, the smaller the patient’s pupils, the higher the intensity of the effects. When all the numbers were crunched, immediate-release oxycodone had an overall higher risk of drug abuse and overdose.

This is a great accomplishment, considering that sustained-release opioids tend to have a significantly higher abuse potential, especially when crushed.

A Safer Version of Opana ER

In similar fashion, Endo Pharmaceuticals came out with a reformulation of their extended-release oxymorphone hydrochloride tablets in 2012. Opana is derived from morphine but is significantly more potent. Opana ER was first approved in 2006. Just like Xtampza ER, it’s intended for the management of moderate to severe chronic pain that requires 24-hour pain relief.

In 2012, Endo Pharmaceuticals changed the formulation of Opana ER to make it more difficult to manipulate for snorting or injecting. The new formulation met the FDA’s regulatory standards for approval. Following the drug’s release, the FDA determined that the new formulation did not meaningfully reduce Opana ER’s abuse potential.

Endo suggested adding additional warnings to the Opana ER’s label to highlight the potential of drug abuse. However, since the drug’s 2012 release, more evidence has surfaced indicating additional risk factors.

FDA Requests Removal of Opana ER

The 2012 reformulation of Opana ER is significantly more difficult to take via injection. However, taking it through this route is still possible, and severely opioid-dependent users continue to crush, dissolve, and inject the substance.

Common side effects of Opana ER include nausea, vomiting, heart palpitations, sedation, drowsiness, and respiratory depression. When Opana ER is taken intravenously, these adverse effects can become intensified.

Clinically significant respiratory depression is more likely to occur when Opana ER is injected. This can lead to carbon dioxide toxicity, oxygen-deprivation, coma, critical organ failure, irreversible paralysis, brain damage, and death.

In 2015, state officials in Indiana to emergency action following an epidemic of HIV in Austin, Indiana. The epidemic was spread primarily by drug users who were injecting oxymorphone intravenously. This event was one of the final strikes against extended-release oxymorphone tablets like Opana ER. Following this event, the FDA formally recommended the removal of Opana ER from the market.

In 2017, Endo Pharmaceuticals voluntarily removed Opana ER from the market due to the high rates of overdose and risk factors associated with recreational drug use.

How to Take Opioids Safely

All opioids carry with them a high potential for misuse, addiction, and overdose. Substances like oxycodone, oxymorphone, morphine, codeine, and fentanyl are classified as Schedule II controlled substances by the FDA. The manufacturing and distribution of these drugs are tightly regulated. Most have limits as to how much can be produced each year.

The North American opioid overdose epidemic began in the late-1990s and has been growing exponentially ever since. In response, hospitals and physicians have taken the initiative to reduce the rate at which opioids are prescribed.

Patients should only be prescribed opioids when milder, non-opioid pain-relievers are ineffective. The minimum effective dose of opioids should always be prescribed. Doses can be gradually increased every few days until the minimum effective dose is achieved. In general, only opioid-tolerant individuals should be prescribed extended-release versions of opioids.

When it’s time to stop taking opioids, doses should be reduced gradually to minimize symptoms of opioid withdrawal. Discontinuation of opioid use should always be conducted under medical supervision for the best possible outcome.


If you or someone you love is struggling with opioid dependency, Stonewall Institute Treatment Center is more than happy to answer any questions you may have. Call us today at 602-535 6468 or email us at [email protected].

Supplements to Reduce Anxiety in Recovery

Supplements to Reduce Anxiety in Recovery

Being clean and sober from alcohol and drugs doesn’t mean you can’t take natural, homeopathic supplements to improve your mood and reduce anxiety. A wide variety of natural anti-anxiety remedies are out there to try. They’re non-addictive and non-habit forming. Some impact the brain in ways similar to alcohol, but without the addictive effects. You won’t feel intoxicated, but you may feel relaxed and ready to take on the day.

Stonewall Institute supports holistic and natural recovery, but understands that every patient is different. Proper medication, supplements, and intensive therapy are important for a successful recovery.  Please consult with your doctor before taking any of the supplements mentioned below.

Theanine

Theanine is an amino acid that has anxiolytic (anti-anxiety) effects. ​It’s found in​ high quantities in green tea leaves. When you’re recovering from addiction to drugs or alcohol, the brain may need a little encouragement to return to normal neurotransmitter production. Theanine is an amino acid analog of two critical neurotransmitters: L-glutamate and gamma-Aminobutyric acid (GABA).

When glutamate activity in the brain is high, and GABA activity is low, anxiety can become worse. Taking theanine as an oral supplement can promote the expression of GABA in the brain by suppressing the expression of glutamate.

Theanine also increases levels of nerve growth factor (NGF) and brain-derived neurotrophic factor in the brain (BDNF). BDNF is critical for rebuilding damaged neurons, something that’s often desperately needed in the brain of someone seeking substance use recovery.

Theanine increases alpha waves in the brain. Alpha waves are one of several ranges of frequency that characterize the brain depending on whether you’re sleeping, feeling energized, or in a state of calm. Alpha waves are present during meditation and REM sleep.

5-HTP

Before there was serotonin, there was 5-hydroxytryptophan (5-HTP). 5-HTP is an amino acid that serves as a primary building block for the production of the neurotransmitter serotonin. Rave culture is familiar with 5-HTP as an ecstasy (MDMA) hangover cure. MDMA (3,4-Methylenedioxymethamphetamine) induces feel-good effects by triggering the brain to produce serotonin in large quantities.

Serotonin has many functions throughout the body and ​is closely involved in digestion​. The majority of the serotonin produced in the body is made by bacteria deep in the intestinal tract. In the brain, serotonin is responsible for producing a feeling of peace and general well-being.

Supplementing with 5-HTP can help you sleep better. Recovery from addiction can make it hard to sleep at times. Poor sleep can further throw off neurotransmitter and hormone levels as you try to recover. While you’re awake, the brain converts 5-HTP into serotonin. While you sleep, it converts it into melatonin. Without adequate melatonin, the brain doesn’t know to shut off and get some rest.

By promoting restful sleep and increasing serotonin expression during the day, 5-HTP can be an excellent addition to your recovery toolkit.

GABA

GABA, full name gamma-Aminobutyric acid, is a non-essential amino acid that functions as a neurotransmitter in the brain. GABA’s job is to calm overactive brain activity and ​reduce anxiety​. When you drink alcohol, you can thank increased GABA production for the relaxation component of the alcohol buzz.

GABA is an inhibitory neurotransmitter of the excitatory neurotransmitter glutamate. Gaba reduces anxiety by decreasing glutamate activity.

GABA supplements don’t work for a large percentage of the population. For some, it can be very useful at inducing feelings of calm without being sedative. Individuals with anxiety tend to be low on GABA.

B-Complex Vitamin

If you’re deficient in GABA, it can be helpful to stock your body up on B-vitamins. The vitamin-B family includes all the essential water-soluble vitamins besides vitamin C. You have to get them through diet because the body can’t make them on its own. B-vitamins include thiamine, riboflavin, niacin, pantothenic acid, pyridoxine, biotin, folic acid, and the cobalamins. Pyridoxine, also known as B6, and the cobalamins, also known as B12, are especially helpful for treating anxiety and depression.

B6 and B12 are cofactors in many of the body’s metabolic processes. Being deficient in these essential nutrients can cause a host of cognitive problems, ​including anxiety and brain fog​. It’s important that your body’s vitamin B profile is balanced. Taking a B-complex multivitamin is a safe way to restore optimal brain activity following addiction. B-vitamins help balance hormone production, increase energy, support the adrenal gland, and maintain the health of nerve cells.

Valerian Root

Valerian root is one of several herbs that achieve their anxiolytic effects by increasing GABA production. This is another good one to take if you’ve been having a hard time sleeping at night. Valerian is a common ingredient in many herbal sleep tinctures along with kava, lemon balm, passionflower, and chamomile. Many of these share valerian’s GABA-promoting effects.

Xanax reduces anxiety by dramatically increasing the expression of GABA. If you’re recovering from addiction to Xanax, supplements like valerian that boost GABA may be especially helpful. Because valerian can be so sedative, it’s best to avoid taking it during the day.

Studies indicate that ​valerian root may slow the reuptake of GABA​ in the brain, thereby increasing its effects. This is the same way the selective serotonin reuptake inhibitors (SSRI’s) treat depression by slowing the reuptake of serotonin.

Magnesium

Several recent research studies have linked magnesium deficiency to increased rates of anxiety. In animal studies, ​test subjects display reduced anxious behavior​ when administered magnesium. Researchers believe that magnesium achieves its effects by modulating the HPA-axis, the body’s stress response system.

Being deficient in magnesium can have widespread negative effects on overall health. It’s involved in over 600 different processes in the body and brain. In addition to increasing anxiety, magnesium deficiency can contribute to low energy, brain fog, and depression.

Magnesium is used by the mitochondria in your cells to turn food into energy. It also helps repair damaged strands of DNA and RNA.


Although supplements can be helpful in your recovery, seeking proper treatment for substance use is also essential.  Stonewall Institute’s 10-week Intensive Outpatient Program allows for holistic recovery in a comfortable and flexible environment.

As a recovering addict, your brain has most likely been through a lot of stress. As you progress in recovery, your brain chemistry will stabilize and mood will improve. Along the way, the supplements covered in this article can help manage symptoms of anxiety. If you or someone you know is struggling with drug or alcohol abuse, Stonewall Institute Treatment Center is more than happy to answer any questions you may have. Call us today at 602-535 6468 or email us at [email protected].

Handling Anxiety and a Drug Addiction

 

We’ve talked much about mental disorders and their relation to drug addiction through this blog. However, just like any of these disorders, anxiety is an illness that can be looked into at great length for its effects on treatment are just as strong as the addictions it may cause.

Many anxious people require substances of some sort that allow them to feel at ease.  Medications that cause their central nervous system to slow down and relieve them of constricting thoughts are most common, however alcohol is also very common due to its wide availability.

Benzodiazepines are a class of drugs typically prescribed to alleviate symptoms of anxiety within a patient.  Commonly prescribed benzodiazepines include Xanax, Ativan, Klonopin, and Valium.

These medications, while highly effective, are also highly addictive and are cause for concern when taken regularly.  The most commonly abused benzodiazepine is Xanax due to it’s effectiveness and sedating effects.  The risk for dependence is high, even with a legitimate prescription from a doctor.

When considered, one of the biggest problems with addiction is the cycle of constantly looking for a quick fix.  Seeking out something to alter our moods in order to ease those unwanted emotions.  This is why dual diagnosis has been taken much more seriously in the last couple decades rather than before.  For those unaware, a dual diagnosis is when an addiction is diagnosed alongside a mental disorder.  It’s becoming apparent to many professionals that without treating the two together, further complications will inevitably follow after treatment.

For in the end, the goal of addiction is beyond getting one into a sober life.  Rather, it’s about changing one’s perspective on what life can be.  Changing their perspective into a drug-free and productively optimistic future.

 

Understanding Anxiety and its Effects on the Mind

The American Psychological Association distinguishes anxiety as an emotion of pure tension.  A rigidity of worried thoughts that even come with some physical changes – such as increased blood pressure.  Everyone has anxiety to some regard, as it’s a natural way of reacting to stress.

However, what will be discussed throughout this blog is that of an anxiety disorder – a condition where anxiety is prominent to a person’s overall emotional stability and controls them on a day-to-day basis.  With that, those with this condition generally seek out some kind of coping method, whether it be prescription medication from a doctor, cognitive behavioral therapy, or different self-medication methods such as alcohol or drug use.

To a person with anxiety, using substances is a means of self-medicating. It’s a way these individuals go about coping with their symptoms. In comparison to the general population, substance abuse is much more common in people with anxiety. In fact, the National Institute of Drug Abuse estimates that people with the disorder are twice as likely to seek out something that will sufficiently alter their mood.

This is important in regards to treatment because it also gives anxious individuals more problems within rehab. For one, it’s been scientifically proven that people of the disorder experience more severe addiction withdrawal symptoms. To top it off, they all have more of a chance at relapse. The situation after addiction rehabilitation where someone goes back to abusing a substance.

If only anxious individuals were aware that drugs do anything but medicate their emotions. Rather, they actually make anxiety worse. It’s a ruthless cycle when really considered. People of the disorder seek out something to calm their tension.

Though the tension might be calmed for a moment of time, it always returns as the drug wears off. This leads them to feeling the necessity for more. And as a tolerance is built to certain chemicals, there will be the need to intake more in order to feel the calming effects. With the need for a drug constantly growing and building, so one’s anxiety.

For us to continue on the subject, it’s vital we differentiate the difference between anxiety and an anxiety disorder. As mentioned above, everyone experiences anxiety from one time to another. An anxiety disorder is when these tense feelings become so prominent, it leaves a large impact on one’s life.

 

What to Look Out For

There are some things to look out for if you’re skeptical that a loved one has an anxiety disorder. People who suffer generally tend to avoid certain day-to-day activities that the general population finds no problem with. They do this as a means of avoiding anxiety.

Sometimes, people of the disorder also experience uncomfortable physical sensations. This inevitably could lead to physical health problems.

The following are symptoms of an anxiety disorder. If you’re skepticality matches some of these conditions, you might want to think about talking to your loved one. Anxiety disorders are treatable and should be done so through a professional manner. For without that, one may end up seeking self-medication.

  • Dizziness/fainting
  • Nervousness/restlessness/and a consistent feeling of tension
  • Rapid heart rate
  • Increased of heavy sweating
  • Weakness or lethargy
  • Loss of concentration or focus
  • Fear of large amounts of people
  • Insomnia and/or poor rest
  • Chest pain
  • Nausea/vomiting
  • Feelings of constant danger/dread/or panic
  • Rapid breathing/hyperventilation
  • Muscle trembles/twitching
  • An overwhelming sensation of fear/panic/uneasiness/nervousness/worry
  • Inability to relax or get comfortable
  • Excessive sweating
  • Muscle tension/soreness

There are three different anxiety disorders to be aware of. Each are of their own context, but there are instances where individuals will experience more than one of these at once.

Generalized Anxiety Disorder (GAD)

To sum it up, GAD is when a person feels – what seems to be – unexplainable anxiety on a day-to-day basis.

Studies have found that a little more than 3% of the U.S. population suffers from GAD. Less than half of those people are receiving treatment.

Panic Disorder

If an individual feels a consistent stream of panic attacks, they could be suffering from a panic disorder. Often, these co-occur with depression.

Social Anxiety Disorder

To put it simple, individuals with SAD generally only feel anxious in social situations. Which is much more frequently than some understand. Whether it’s work, school, a family/friendly event, we find ourselves in social situations on a day-to-day basis.

People with SAD find it hard to handle these day-to-day situations. It makes them feel tense. And their comfortable preference is in alone corders.

 

Seeking Treatment

As mentioned above, anxiety disorder is something that can be treated. Parallel to this, drug addiction can, likewise, be treated. With a dual diagnosis, you’re given the ability to not only enter sobriety, but to take away the problems that have led to substance abuse.

When seeking alcohol and/or drug treatment, an important aspect to remember is that you find a facility that can properly handle treating an anxiety disorder. If you’re preparing yourself to undergo such a huge life change, you’re going to want to receive only the most professional help available.

This is due to the fact that a dual diagnosis is much more difficult to treat in comparison to just drug addiction. When considered, the professionals at hand are in charge of guiding you out of two illnesses.

Typically, individuals who receive a dual diagnosis enter an inpatient program or an intensive outpatient program. Since a dual diagnosis is such a big (and often complicated) problem in an individual’s life, there’s lots to be done in terms of treatment. So much so that it’s vital the individual takes the time and effort to completely focus on these problems and finding a solution. An inpatient or outpatient program offers just this along with the safety of being under professional guidance.

When talking about anxiety, it’s fairly common for people going through substance abuse detox to experience attacks – usually due to the lack of “self-medication”. When the body undergoes a drainage of chemicals that have always made it feel good, the mind has the tendency to not know how to handle the situation. Therefore, it doesn’t come to much of a surprise that anxiety attacks can occur.

If an individual were to do this on their own terms, it may be all too difficult to handle. To top it off, there’s also more of a risk they’ll seek out means of self-medication. However, within an inpatient program or an intensive outpatient program, individuals are assured their under proper professional guidance. Inevitably, making the possible anxiety attacks more of an ease to experience.

It must be considered that under this professional help, you will have the ability to let yourself open up emotionally. And when undergoing such a life changing process, this is very important to the better of yourself as an individual.


If you or anyone you love has anxiety and/or a substance addiction or you’re looking for more information on the subject, Stonewall Institute Treatment Center is more than happy to help. Please, give us a call at (602) 535 6468 or email us at [email protected].

What Causes Drug Abuse?

Everyone grows up in this world differently. Therefore, not everyone’s drug abuse is triggered by the same causes. In fact, the causes for drug abuse can be so versatile, it’d be impossible to pinpoint every single source. Yet, there are common cases we have noticed amongst a good sum of addicted individuals. Likewise, these individuals also hold common aspects that sustain and fuel their addiction.

 

Genetic Susceptibility

It’s been scientifically stated that a person’s genetic makeup is accountable for half of their exposure to addiction. If your mother or father has suffered from addiction, there’s the tendency for the children to, likewise, experience similar sufferings.

This explains the commonality of families facing addiction together. Though it’s usually not the only probable cause for drug abuse, it remains a key factor in an individual’s decisions and behavior.

 

Personality Traits

Going off genetic susceptibility, there are certain personality traits people are born with that makes them more vulnerable to drug addiction. For example, if an individual feels experimental in terms of socializing, they may end up experimenting with drugs in a social regard.

It should be noted that though these personality traits come from one’s DNA, it’s not to say that the DNA held the trait of addiction. Rather, the DNA held traits that can lead to addiction if not disciplined properly.

 

Mental Health

In recent years, one of the biggest contributors to drug addiction has been mental health disorders. There are two reasons for this:

1. People suffering from mental health issues usually end up receiving prescription they become dependent on.

2. People suffering from mental health may seek out substances as a way of relief.

Another probability we’ve been noticing is there are occasions where non-mental health individuals develop mental health problems after addiction.

 

The Age When You Begin

Due to the fact that a teenager’s brain is still developing, if they take drugs at a young age, they are more likely to be dependent on them.

When an adult intakes drugs for the first time, after their brain has developed, they are less likely to be addicted. Reason being they didn’t allow their brains to grow while under the influence.

 

Environment

If you find yourself surrounded by other addicts on a daily basis, it’s going to be hard to avoid addiction within yourself. As the saying goes, we are a product of our environments. These surroundings are that of the following:

● Poor relations with family

● Lack of parent supervision

● Easily accessible drugs within community

● Being close with other addictions

 

Conclusion

Stonewall Institute Treatment Center is here to answer any questions you have on drug abuse. If you or a loved one is abusing drugs and are seeking out treatment, give us a call for more information on our facility at 602 535 6468 or email us at [email protected].

Substance Abuse Treatment Arizona

 Stonewall Institute offers professional substance abuse treatment in Arizona.  Our Intensive Outpatient Program is facilitated by a licensed psychologist with training and experience in treating addiction and co-occurring disorders.  It is common for substance abuse and co-occurring disorders to partner, and it is important that both be treated for the benefit of long-term sobriety.  Our program focuses on the individual and issues that trigger alcohol and drug use.  The IOP accepts insurance and also offers payment plans.   If you are concerned about your drug or alcohol use, contact us today at 602-535-6468 or visit us on the web at www.stonewallinstitute.com