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Extended-Release Opioids: Dangers, Differences, Precautions

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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].

Handling Anxiety and a Drug Addiction

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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].

5 Tips For Boosting Self-Esteem While In Recovery

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Getting sober may come with many sudden realizations, such as the amount of time you lost while under the influence. It’s a reality that can be hard for many to grapple with. Low self-esteem is common among recovering individuals and coming to terms with this can be difficult. By pursuing new challenges, you can start to rebuild your sense of self-esteem in recovery. It’s easy to dwell on the past, but the rest of your life is ahead of you. At Stonewall Institute Treatment Center, not only do we offer superior treatment for alcohol and substance use issues, we also focus on getting yourself in the right headspace so that you can get out there and meet your recovery goals.

1. Meet New People

Stagnancy is a big part of addiction. It’s easy for anyone to get lulled into the same daily routines without growing and moving forward in life. When you use, you tend to spend a large amount of time with other people who are doing the same things as you. Meeting new people can introduce you to a new set of healthy habits.  Picking a group of people with healthy practices takes the guesswork out of making good lifestyle choices. A group of friends that are inspired to live life to the fullest. Following their lead is the simplest way to get inspired to live a fulfilling life.

 

2. Learn Something New

Proving that you can still learn new skills will reduce anxiety about the future. Though sometimes hard, it’s possible to quiet that voice of doubt that lives in the back of your head. You just have to prove that you still have what it takes to acquire new skills. Anxiety comes from concern about the future. Nothing is more anxiety inducing than not believing you can start from scratch with something new. If you have faith that you can learn new things, you’ll quickly start to feel better about the road ahead. This is easier said than done. The majority of people go through life with stretches of time spent in stagnancy. Shaking the cobwebs loose and going for it is even harder when you’re coming out of the mental haze of addiction. Push yourself in the early stages of recovery to let go of lost time and get aggressive about tackling fresh challenges. Anything you can do to prove that you still have what it takes to acquire new skills will calm the anxiety you have about the future and build self-confidence.

3. Start An Exercise Routine

Physical challenges are great for building self-esteem. First, physical accomplishments and health goals are straightforward to execute. You put in the work, and the results come. There isn’t a lot of room for judging yourself. This makes exercise habits one of the best ways to prove to yourself early on in recovery that you can stay consistent and get results. The key here is consistency. Any form of physical exercise is beneficial. If you get bored of the same workouts, try a yoga class or go on a long walk with a loved one. Whatever you choose doesn’t have to be strenuous, just as long as you’re moving your body and thus, reducing stress and anxiety.

Making small strides every day refreshes your memory about the benefits of hard work. The emotional satisfaction that comes with that feeling of accomplishment is its own reward. The joy that comes from hard work is easy to forget when you’ve been struggling with the complications of addiction. Exercise reminds you of that feeling of success, and you can use it to translate positive momentum into other, more complicated areas of your life.

 

4. Share Your Story

Addiction can bring with it a lot of feelings of guilt and shame. The harm that some addicted individuals cause directly or indirectly to their loved ones can be a heavy burden to bear. It can leave the lingering question of whether or not you’re worthy of the love and acceptance you once were. By taking the step to share your full story with the world, you can get confirmation that you are still, in fact, deserving of love. Being vulnerable is also the mark of a great leader, and people respond accordingly. When you take the first step to expose your true self, people react by doing the same, and they share with you the best possible version of themselves. This opens the door to making new connections with emotionally available people who resonate with your story. If you live in the Phoenix, AZ area, the Stonewall Institute Treatment Center’s 10-week alcohol and drug treatment program can be a safe place to share your story and get support from knowledgeable experts and like-minded individuals.

 

5. Make Space In Your Day For Quiet Reflection

Spending time alone is part of the journey towards self-acceptance in the face of recovery. Just as being vulnerable with others can make connections and build self-esteem, meditating can help you reconnect with yourself. The modern world is so fast-paced and over-stimulating that it can be hard to get quiet time alone. Much of the benefit that comes from meditation is the result of removing all the background noise. A traditional meditation practice is something you can work up to, but initially, blocking off technology-free time to yourself is a great first step.

When you’re ready to kick your reflection time into the next gear, try going on hikes. There’s quite a bit of research on the mental health benefits of what the Japanese call forest-bathing. According to scientific literature, the smells, sights, and sounds of a babbling creek and wind rushing through the trees reduces anxiety. The sounds of nature are the perfect contradiction to the hyperactive stimulus of heavy traffic, computers, and cell phones.

 

The brain fog of addiction and recovery can make life seem emotionally stifling and overwhelming. Individuals suffering from addiction can have low self-esteem from the regrets that come with wasted time. By putting in the extra effort to reconnect with yourself and the world, you can get in a better headspace for living a productive life. Pushing yourself to master new skills and staying consistent with hard work is the best way to build self-esteem in recovery. If you or someone you love is struggling with substance dependence, don’t hesitate to contact Stonewall Institute Treatment Center today. Call us today at 602-535-6468 or by email at [email protected].

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