Q. I started taking oxycodone for chronic back pain, but now I'm addicted to it. I've heard there may be medications that can help me quit.
A. Oxycodone, like morphine, codeine and hydrocodone, is an opioid drug. Opioids are among the most powerful painkillers available. They can also produce a feeling of well-being and euphoria.
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Opioids affect the brain by attaching themselves to structures on brain cells called receptors. The opioid is like a key and the receptor is like a lock. When the key fits into the lock, the brain cell is affected.
However, opioids are notorious for producing withdrawal symptoms that make it difficult to quit. Such symptoms include restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with goose bumps and involuntary leg movements.j
Medications for opioid addiction can help prevent or ease withdrawal symptoms and reduce cravings. There are two different types: agonists and antagonists.
Agonists attach to the same receptors that opioids attach to, but produce different effects on brain cells. Methadone and buprenorphine are the two agonist medicines used in the United States:
• Methadone is the most used medication for treating opioid dependence. When taken as directed, methadone does not produce a high.
A single dose of methadone can ease or prevent opioid withdrawal symptoms and alleviate cravings for 24 to 36 hours. It also eliminates the "rush," the feel-good sensations of opioids. Some people continue methadone indefinitely as a way to help them remain abstinent. This is known as methadone maintenance therapy.
In the U.S., methadone is available only through specialized clinics. You must report to the clinic daily to get your treatment.
• Buprenorphine is similar to methadone. It has not been around nearly as long, and there are not a lot of studies comparing it to methadone. Nevertheless, it appears to be safer and its withdrawal symptoms briefer. You do not need to attend a clinic to use the drug; doctors in private practice can prescribe it. Buprenorphine is most appropriate for people who are extremely motivated to abstain or who have mild dependence.
Antagonist medicines block the attachment of opioids to their receptors. When they are first used in someone addicted to opiates, they can produce withdrawal symptoms, so they need to be given only in a closely monitored setting.
• Naltrexone is FDA-approved to treat opioid addiction, but it does not have a good track record of helping people stay opioid-free. It is best used in people who are highly motivated to get off opioids.
• Naloxone is sometimes used by doctors for rapid and ultra-rapid detoxification. These controversial techniques shorten the duration of withdrawal. During ultra-rapid detox, people are anesthetized for 24 hours, sparing them the worst of withdrawal. Rapid detox can be dangerous and may not be effective for treating addiction.
Ask the doctor who prescribed oxycodone for you if one of the drugs discussed above would help to overcome your addiction. There may also be another drug less addictive than oxycodone to relieve your back pain.
• Dr. Komaroff is a physician and professor at Harvard Medical School. Submit questions or get additional information at AskDoctorK.com.